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Sample records for acute abdomen due

  1. Acute abdomen

    Acute abdomen may be connected with the injury of one of the internal organs, injury of large blood vessels, with the spreading of pains from some other area. It may also be a manifestation of systemic disease or poisoning. The main purposes of radiodiagnosis are: determination of the cause of clinical syndrome; determination of the localization and spreading of pathological changes in abdominal organs; finding out the character of complications. If the data of the ordinary roentgenological investiagtion and isn't complete, the computer tomography of abdominal and pelvic cavities is needed

  2. Acute abdomen

    The book first presents the anatomy and physiology of the abdomen and continues with chapters discussing clinical and laboratory aspects and a suitable order of diagnostic examinations with reference to the acute processes, explaining the diagnostic tools: ultrasonography, radiography including angiography and CT, tapping techniques and endoscopy together with their basic principles, examination techniques, and diagnosis. One chapter presents a complete survey of the processes involving the entire abdomen - as e.g. peritonitis, ileus, abdominal trauma, intraperitoneal hemorrage. This chapter profoundly discusses the diagnostics and therapies including emergency measures and surgery. Problems requiring consultation among varous specialists, in internal medicine, gynecology, urology, or pediatrics, are discussed in great detail. Information for the anesthetist is given for cases of emergency. More than one third of the book is devoted to organ-specific information, dicussing the pathogenesis, diagnostics, and therapy of the oesophagus, stomach, large and small intestine, bile ducts, pankreas, liver, spleen, and the abdominal vessels and the abdominal wall. (orig.) With 153 figs., 90 tabs

  3. Small Bowel Perforation due to Gossypiboma Caused Acute Abdomen.

    Colak, Tahsin; Olmez, Tolga; Turkmenoglu, Ozgur; Dag, Ahmet

    2013-01-01

    Gossypiboma, an infrequent surgical complication, is a mass lesion due to a retained surgical sponge surrounded by foreign body reaction. In this case report, we describe gossypiboma in the abdominal cavity which was detected 14 months after the hysterectomy due to acute abdominal pain. Gossypiboma was diagnosed by computed tomography (CT). The CT findings were a rounded mass with a dense central part and an enhancing wall. In explorative laparotomy, small bowel loops were seen to be perforated due to inflammation of long standing gossypiboma. Jejunal resection with end-to-end anastomosis was performed. The patient was discharged whithout complication. This case was presented to point to retained foreign body (RFB) complications and we believed that the possibility of a retained foreign body should be considered in the differential diagnosis of who had previous surgery and complained of pain, infection, or palpable mass. PMID:24288645

  4. Spontaneous Uterine Perforation due to Pyometra Presenting as Acute Abdomen

    Loabat Geranpayeh

    2006-01-01

    Full Text Available Spontaneous perforation of the uterus is rare, its incidence being about 0.01%–0.05%. We report a rare case of diffuse peritonitis caused by spontaneously perforated pyometra. A 63-year-old woman with severe abdominal pain was admitted to our hospital. Laparotomy was performed because of the suspicion of gastrointestinal perforation with generalized peritonitis. At laparotomy, about 900 mL of pus was found in the peritoneal cavity. There were no abnormal findings in the alimentary tract, liver, or gallbladder. A total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Pathological investigation of the surgical specimen revealed endometritis and myometritis of the uterus; but there was no evidence of malignancy, and the cervical canal was patent. Although spontaneously perforated pyometra is rare, a perforated pyometra should therefore also be considered when elderly women present with acute abdominal pain.

  5. A Rare Cause of Acute Abdomen: Urinary Bladder Rupture due to Foley Catheter

    Ömer Engin

    2013-07-01

    Full Text Available Urinary bladder rupture is usually found due to blunt or penetrating traumas and iatrogenic injuries, and spontaneous intraperitoneal perforation is very rare. 57 years old male patient was consulted to general surgery department due to abdominal pain, nausia-vomiting and fever. He had Diabetes Mellitus, Multiple Sclerosis, Leriche Syndrome and operation for benign prostatic hypertrophy 5 years ago on his medical history which the case catheterised him urinary bladder himself frequently in nonsterile conditions. He did not care about sterility. On physical examination, suprapubic defence and rebound was noted more prominently on right lower quadrant. He was taken to operating room with the diagnosis of acute abdomen. On exploration, infection was seen on all layers of the whole urinary bladder, abscess formation and necrosis causing a microperforation which is detected by methylene blue was also present. Intraabdominal abscess drainage, cystostomy and primary suturing of the urinary bladder was performed. Patient died due to sepsis at the 9.th post operative day.

  6. Radiological aspects of acute abdomen

    This work demonstrates the main roentgen signs of the most common causes of acute abdomen, through some cases chosen from H.N.M.D. Roentgen Department-Learning Register. First, we will show the normal roentgen anatomy of the abdomen. Then, we will discuss about the basic roentgen routine of acute abdomen and some technical changes depending on the suspected illness, the clinical conditions of the patient and certain roentgen findings. Finally, we will show the most important roentgen signs of the most familiar effects accurate abdomen, putting emphasis on the next things: intestinal obstructions, peritonitis, acute cholecustitis, acute pancreatitis, acute appendicitis, subphrenic abscesses, toxic megacolon of ulcerative retocolitis, gastric or duodenal ulcer perforation and renal colic. (author)

  7. [Acute abdomen in gynecology].

    von Hugo, R; Meyer, B; Loos, W; Dirmeier, H

    1988-09-01

    The aim of the present study is, to describe the morbidity and mortality of 196 patients with an acute abdominal condition who underwent surgery at the Department of Gynecology and Obstetrics of the TU Munich between 1982 and 1986. This is a percentage of 2.7 of all 7,167 operations carried out during this period. 118 of these patients had an extrauterine pregnancy and were therefore excluded from the study. The second group of 79 patients, mostly with inflammatory diseases, were analyzed. In most of these cases the acute abdominal condition was caused by a tuboovarian abscess (48.1%), followed by peritonitis because of a bowel-disease (11.4%). 6 patients suffered from an abscessing endometritis due to a caesarean section with sepsis in 5 cases. A generalized peritonitis occurred in 5 cases and was treated with a planned relaparatomy with lavage. 63% of the patients had no complications within 28 days after operation, 13% developed a subileus; in 7% a relaparatomy was necessary. 6% of the patients had problems of wound-healing. One patient with stomach-cancer died 3 weeks after the operation because of a fulminant lung-embolism. Thus the mortality rate was 1.5%. A further 27% were treated at the intensive care-unit and 18% needed artificial respiration. The average postoperative period of hospitalisation was 15 days. In comparison, patients with elective operations remained 13 days. The morbidity and mortality of patients due to surgery of an acute abdominal condition was relatively small; postoperative complications could be well treated in all cases and is probably the result of a positive and early indication for surgical intervention. PMID:3181709

  8. Obstructive acute abdomen: reviewing important points

    The obstructive acute abdomen is a common presentation, for which safe and effective management depends on a fast and accurate diagnosis. Conventional radiograph remains the first choice among the imaging exams because of its availability, low cost and the possibility to be done serially to follow the patient's clinical progression. The ultrasonography does not require ionizing radiation. It is a dynamic and in realtime exam. Computed tomography is used increasingly due to the provision of essential diagnostic information not apparent from radiographs, such as the confirmation of the obstruction, degree and place of the occlusion, presence of ischemia as well as the causes of the obstruction. Magnetic resonance imaging has presented great technological advances and it may play a role in the future of obstructive acute abdomen diagnosis. The objective of this pictorial essay is to review the different imaging techniques used on diagnosing obstructive acute abdomen. (author)

  9. Radiological aspects of acute abdomen; Aspectos radiologicos do abdomen agudo

    Toledo, Renato Muller de; Lacerda, Jose Carlos Teixeira; Georg, Bruno Rigueira; Ramos, Alexandre Ferreira [Hospital Naval Marcilio Dias, Rio de Janeiro, RJ (Brazil). Servico de Radiodiagnostico

    1994-12-31

    This work demonstrates the main roentgen signs of the most common causes of acute abdomen, through some cases chosen from H.N.M.D. Roentgen Department-Learning Register. First, we will show the normal roentgen anatomy of the abdomen. Then, we will discuss about the basic roentgen routine of acute abdomen and some technical changes depending on the suspected illness, the clinical conditions of the patient and certain roentgen findings. Finally, we will show the most important roentgen signs of the most familiar effects accurate abdomen, putting emphasis on the next things: intestinal obstructions, peritonitis, acute cholecustitis, acute pancreatitis, acute appendicitis, subphrenic abscesses, toxic megacolon of ulcerative retocolitis, gastric or duodenal ulcer perforation and renal colic. (author) 4 refs., 13 figs.

  10. Intestinal tuberculosis presenting as acute abdomen

    Objectives: To study the outcome of intestinal tuberculosis presenting as acute abdomen. Study design: Descriptive Study. Place and Duration: Bolan Medical Complex Hospital (BMC) Quetta and Combined Military Hospital (CMH) Quetta from Nov 2003 to Nov 2005 from Bolan Medical Complex and from Nov 2005 to Nov 2006 in CMH Quetta. Material and Method: Thirty seven patients of acute abdomen presenting with intestinal obstruction were admitted; 28 from emergency department and 9 from out patient department. Twenty seven patients were from BMC and 10 from CMH Quetta. Patients were diagnosed as having abdominal tuberculosis on the basis of operative findings and histopathological reports. Results: Out of 37 patients presenting with acute abdomen due to intestinal obstruction, 54% were male and 46% were female with M: F ratio of 1: 1.2. Age of the patient ranged from 20 to 50 years, with maximum frequency between 30 to 40 years. Abdominal pain was the commonest presenting feature in all patients followed by constipation in 81.1% patients. Peritonism was seen in 27% patients. Different operative procedures performed were adhesionolysis 65.8%, segmental resection 7.9%, right hemicolectomy 10.5%, stricturoplasty 7.9% and ileostomy 1.3%. Mesenteric lymph node biopsy 40.8%. Conclusion: Intestinal tuberculosis is still a very important surgical problem in our country presenting as acute abdomen. A suspicion must always be kept during laparotomy and adequate tissue histopathology should supplement the diagnosis. (author)

  11. The acute abdomen in childhood

    The acute abdomen in childhood demands early diagnosis for the sake of appropriate and early therapy. A high number of differential diagnosis in the assessment of acute abdominal pain and problems, as well as different causes of diseases in different age of the children, make a partition with respect to the age of the children considerable. A partition in diseases, which are leading to acute abdominal pain in neonates, in toddlers and small infants and in schoolchildren makes sense. In older schoolchildren and adolescents also diseases of the grown up generation are possible as a cause of acute abdominal pain. The lack of compliance (cooperation and communication) in small children obstructs clinical and radiological assessment and elucidates the necessity of knowledge of causes of acute abdominal pain as much as possible. A lot of patience and experience are mandatory in the evaluation of small children and therefore make a dedicated, trained and experienced stuff necessary. A dedicated paediatric radiologist will find a safe and proper technique, and in cooperation with the referring clinician the necessary decision for therapy will be made. (orig.)

  12. A Rare Cause of Acute Abdomen: Intrauterine Device (IUD

    Yavuz Koca

    2014-06-01

    Full Text Available Uterus perforation due to intrauterine device (IUD can occur for several reasons. IUD migration into the abdominal cavity is a complication that can cause acute abdomen conditions such as pelvic and intra-abdominal abscess, intra-abdominal organ perforation and fistula. In such cases, the laparoscopic approach is recommended as the first choice. Thirty-six-year-old female patient with clinical acute abdomen caused by the IUD, was presented with the literature.

  13. A Rare Cause of Acute Abdomen: Intrauterine Device (IUD)

    Yavuz Koca

    2014-01-01

    Uterus perforation due to intrauterine device (IUD) can occur for several reasons. IUD migration into the abdominal cavity is a complication that can cause acute abdomen conditions such as pelvic and intra-abdominal abscess, intra-abdominal organ perforation and fistula. In such cases, the laparoscopic approach is recommended as the first choice. Thirty-six-year-old female patient with clinical acute abdomen caused by the IUD, was presented with the literature.

  14. Scrub typhus presenting as an acute abdomen

    PP Abhilash Kundavaram; Sohini Das; M Varghese George

    2014-01-01

    Scrub typhus is a mite-borne infectious disease caused by Orientia tsutsugamushi, which presents as an acute febrile illness with headache, myalgia, breathlessness, and an eschar, a pathognomonic sign, in a varying proportion of patients. However, this illness can present unusually with fever and severe abdominal pain mimicking acute abdomen. A careful search for an eschar in all patients with an acute febrile illness would provide a valuable diagnostic clue and avoid unnecessary investigatio...

  15. Scrub typhus presenting as an acute abdomen

    PP Abhilash Kundavaram

    2014-01-01

    Full Text Available Scrub typhus is a mite-borne infectious disease caused by Orientia tsutsugamushi, which presents as an acute febrile illness with headache, myalgia, breathlessness, and an eschar, a pathognomonic sign, in a varying proportion of patients. However, this illness can present unusually with fever and severe abdominal pain mimicking acute abdomen. A careful search for an eschar in all patients with an acute febrile illness would provide a valuable diagnostic clue and avoid unnecessary investigations and surgical exploration.

  16. Dengue Haemorrhagic Fever presenting as Acute Abdomen

    Al-Araimi, Hanaa; Al-Jabri, Amal; Mehmoud, Arshad; Al-Abri, Seif

    2011-01-01

    We describe a case of a 38 year-old Sri Lankan female who was referred to the surgeon on call with a picture of acute abdomen. She presented with a three-day history of fever, headache, abdominal pain and diarrhoea; however, the physical examination was not consistent with acute abdomen. Her platelet count was 22 ×109/L. A diagnosis of dengue haemorrhagic fever (DHF) was made and dengue serology was positive. Dengue epidemics have been associated with a variety of gastrointestinal symptoms an...

  17. Acute abdomen due to group A streptococcus bacteremia caused by an isolate with a mutation in the csrS gene.

    Kaneko, Masahiko; Maruta, Masaki; Shikata, Hisaharu; Hanayama, Masakazu; Ikebe, Tadayoshi

    2015-11-01

    Streptococcus pyogenes (group A streptococcus) is an aerobic gram-positive coccus that causes infections ranging from non-invasive pharyngitis to severely invasive necrotizing fasciitis. Mutations in csrS/csrR and rgg, negative regulator genes of group A streptococcus, are crucial factors in the pathogenesis of streptococcal toxic shock syndrome, which is a severe, invasive infection characterized by sudden onset of shock and multiorgan failure, resulting in a high mortality rate. Here we present a case of group A streptococcal bacteremia in a 28-year-old Japanese woman with no relevant previous medical history. The patient developed progressive abdominal symptoms that may have been due to spontaneous bacterial peritonitis, followed by a state of shock, which did not fulfill the proposed criteria for streptococcal toxic shock. The isolate was found to harbor a mutation in the negative regulator csrS gene, whereas the csrR and rgg genes were intact. It was noteworthy that this strain carrying a csrS mutation had caused group A streptococcal bacteremia characterized by acute abdomen as the presenting symptom in a young individual who had been previously healthy. This case indicates that group A streptococcus with csrS mutations has potential virulence factors that are associated with the onset of group A streptococcal bacteremia that does not meet the diagnostic criteria for streptococcal toxic shock syndrome. PMID:26231317

  18. Recurring Acute Abdomen, Ovarian Cyst and Hypothyroidism

    T Rohatgi, N Rohatgi and K Buckshee

    2007-01-01

    Spontaneous ovarian hyperstimulation, large ovarian cyst and multicystic ovaries associated with primaryhypothyroidism is infrequently reported and not widely recognized in gynaecologic literature. We reporta case of a 15 year old girl who had an acute abdomen and emergency laparotomy revealed bilaterallyenlarged ovaries, a large ovarian cyst with torsion in the right ovary and ascites. Thus right adnexa wasremoved. At that time thyroid dysfunction was neither suspected nor investigated. Five...

  19. Surgical acute abdomen in elderly patients.

    Itengré Ouédraogo

    2004-08-01

    Full Text Available Fundaments : The surgical acute abdomen usually is the most frequent cause of abdominal surgery of urgency in t he old one, with the high mortality in spite of the modern surgical technologies. Objective: To evaluate the surgery of the surgical acute abdomen in the old one. Method: Appears a prospectivo descriptive study that includes 102 patients of 60 years or more who underwent surgery at the ¨Dr Gustavo Aldereguía Lima¨ University Hospital of Cienfuegos with this diagnostic. The primary data were obtained from clinical cards of the patients and the daily clinical observation until the debit. Results: The patients presented an average age of 74 years, being the most frequent causes of the syndrome intestinal obstruction (32,4%, the biliary tract affections (22,5%, and acute appendicitis (21,6%. The most frequent symptom was abdominal pain (96,08%, and we noticed tachycardia in 80,4%. Postoperating complications in 47,06% of the patients appeared and was observed a mortality of 26,5% with statistically significant relation with the age, ASA classification, surgical risk, time of evolution and the surgical time. The peritonitis heads the direct causes of death.

  20. Abdome agudo perfurativo por corpo estranho em paciente com situs inversus totalis Perfurative acute abdomen due to foreign body in patient with situs inversus totalis

    André Vitorio Câmara Oliveira

    2008-12-01

    dyspnea, dehydration (++/4++, blood pressure= 70X40mmHg, anicteric, tense abdomen, diffusely painful, distended and hypertympanic, hydroaerial sounds absent. The thorax X-ray evidenced cardiac dextroversion, pneumoperitoneum bilaterally with gastric bubble on the right. Due to the general serious condition and confirmed diagnosis of acute abdomen perforation, a hydroelectrolytic vein replacement was held and the patient was submitted to an exploratory celiotomy, observing fecaloid diffuse peritonitis and perforation of sigmoid colon for foreign body taken away followed by mechanical cleaning, washing peritoneal cavity, Hartmann retossigmoidectomy, and bilateral drainage. CONCLUSION: Although a rare entity, the diagnosis of situs inversus totalis must be suspected in a physical examination and confirmed through image examinations, since the anatomic variations can disrupt the performance of clinical surgery.

  1. Surgical acute abdomen in elderly patients. Abdomen agudo quirúrgico en el anciano.

    Lidia Torres Ajá; Angel Delfín Rodríguez Sarria; Julio Pablo Miñoso Andina; Itengré Ouédraogo

    2004-01-01

    Fundaments : The surgical acute abdomen usually is the most frequent cause of abdominal surgery of urgency in t he old one, with the high mortality in spite of the modern surgical technologies. Objective: To evaluate the surgery of the surgical acute abdomen in the old one. Method: Appears a prospectivo descriptive study that includes 102 patients of 60 years or more who underwent surgery at the ¨Dr Gustavo...

  2. Acute Abdomen; Pre and Post-Laparotomy Diagnosis

    Marjan Laal

    2009-07-01

    Full Text Available Background: Abdominal pain is a common presentation that requires almost immediate management. It is sometimes crucial to diagnose at the earliest and make a decision as to operate. Therefore it is necessary for the physician to be familiar both with the presentations of common causes of abdominal pain and the validity of diagnostic tests.  Diagnosis of acute abdomen before laparotomy is essential in reducing the morbidity and mortality while preventing from unnecessary operations especially where the diagnostic facilities are limited and clinical awareness plays an important role in the diagnosis and management. Objectives: This study attempted to compare pre and post-operative diagnosis in acute abdomen.Materials & Methods: This was an observational study, conducted from February to December 2005. The study included 139 consecutive patients referred to Sina hospital (Tehran, Iran presented with symptoms of acute abdomen, operated to see the negative laparotomy rate, the diagnostic accuracy and predictive values of different investigations in acute abdomen. Statistical analysis was performed using SPSS software version 11.5. P value of Results: All 139 patients with diagnosis of acute abdomen underwent emergency laparotomy. Acute abdomen was most common in the age group 20-29 years with male predominance. Acute appendicitis (57.6% was the most common cause of surgical condition, and then the most common causes of acute abdomen were peritonitis (14.4% and bowel obstruction (7.9% in male and ovarian cyst torsion (24.5% in female patients. The negative laparotomy rate was 12.2% (P value Conclusion: The decision to operate is based on the results of a good history and thorough physical examination(s with the guidance of investigative tools. Diagnostic modalities could guide the physician in confirming the diagnosis. An accurate diagnosis of acute abdomen can avoid from unnecessary operations so reduces the rate of negative laparotomies.

  3. Role of Ultrasonography in Acute Abdomen

    An, Ji Hyun; Lee, Yeon Hee; Kim, Tae Hoon; Yu, Pil Mun; Choi, Young Hi; Kim, Sang Joon; Kim, Seung Cheul; Cho, Jeong Hee [Dankook University College of Medicine, Cheonan (Korea, Republic of); Jung, Jae Un [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    1996-12-15

    Authors analyzed the distribution of diseases and compared ultrasonographic conclusions with confirmed diagnoses of emergency abdominal ultrasonographies in acute abdominal conditions. We evaluated the role of emergency abdominal ultrasonography especially in the decision of emergency operation. In one hundred and forty five patients, emergent abdominal ultrasonography was performed within on admission. We compared the sonographic conclusion with postoperative pathology and analyzed the diagnoses of medically treated diseases. Twenty-eight patients underwent surgery and 117 patients were treated conservatively. Among the surgically treated patients, 19 patients (70.4%) were correctly diagnosed by preoperative ultrasonography.These included acute appendicitis (N = 8), acute cholecystitis (n = 7), ovarian cyst torsion (n = 2), and liver abscess (n = 1). Correct preoperative diagnosis was not made in 9 patients, including acute appendicitis (n = 4), peritonitis due to bowel perforation (n = 2), ectopic pregnancy (n = 1), colonic diverticulitis (n = 1) and pelvic inflammatory disease (n = 1). Clinical follow up was possible in 50 patients among the non-operative patient group, and the clinical diagnoses were chronic liver disease (n = 14), acute pyelonephritis (n = 10), and biliary stone (n = 10). Emergent ultrasonography plays an important role in acute abdominal conditions by supporting the differential diagnosis of medical and surgical disease

  4. Examination of the Acute Abdomen in Children.

    Nakayama, Don K

    2016-01-01

    The history and physical examination (H&P) on a child with an acute abdomen is an opportunity to build a solid relationship with the child and parents. Building confidence and trust under fraught circumstances requires a genuine affection for children, and sympathy for the anxiety of the parents. Arrival of a surgeon is a signal that the illness is serious and not likely to respond to the usual remedies. The surgeon therefore must have a gentle, unhurried approach. Obtaining the history should be non-directive and allow both parent and child to describe the entire timeline of the illness without interruption. The physical examination should be done without hurting the child, first observing how the child moves about in bed and undresses, then having the child control palpation by holding the examiner's hand and pulling it away should undue pain be elicited. Even though a diagnosis and a plan for surgery may already have been made, exiting the exam room after the H&P to review lab and radiological images gives the family time to regroup information. The diagnosis and decision for operation require simple and direct explanations that communicate patience, have a tone of reassurance, and affirm repeatedly that parents understand what is being said. The message is that surgery is a shared decision, and safety and the child's wellbeing always foremost. To the child three points have to be paramount: They won't feel pain during or after the procedure; after the operation they will feel better; and they won't be alone. The goal is to build a trusting relationship so that the child has some calm in departing to the operating room and the parents willingly see them leave. PMID:26966084

  5. Desmoid tumor in Gardner's Syndrome presented as acute abdomen

    Hatzimarkou, Andreas; Filippou, Dimitrios; Papadopoulos, Vasilios; Filippou, Georgios; Rizos, Spiros; Skandalakis, Panagiotis

    2006-01-01

    Background Gardner's syndrome can occasionally be complicated with intra-abdominal desmoid tumor. These tumors usually remain asymptomatic but can exhibit symptoms due to intestinal, vascular and ureteral compression and obstruction. Case presentation A rare case of a 41-year-old male patient with Gardner's syndrome complicated with intra-abdominal desmoid tumor, which first presented as acute abdomen, is presented. Conclusion Extra-abdominal manifestations of Gardner's syndrome along with a palpable abdominal mass would raise suspicion for the presence of a desmoid tumor in the majority of cases. In life-threatening cases, surgical treatment should be considered as a palliative approach, though the extent of excision remains debatable PMID:16569244

  6. Desmoid tumor in Gardner's Syndrome presented as acute abdomen

    Rizos Spiros

    2006-03-01

    Full Text Available Abstract Background Gardner's syndrome can occasionally be complicated with intra-abdominal desmoid tumor. These tumors usually remain asymptomatic but can exhibit symptoms due to intestinal, vascular and ureteral compression and obstruction. Case presentation A rare case of a 41-year-old male patient with Gardner's syndrome complicated with intra-abdominal desmoid tumor, which first presented as acute abdomen, is presented. Conclusion Extra-abdominal manifestations of Gardner's syndrome along with a palpable abdominal mass would raise suspicion for the presence of a desmoid tumor in the majority of cases. In life-threatening cases, surgical treatment should be considered as a palliative approach, though the extent of excision remains debatable

  7. Evaluating the Acute Abdomen in the Pregnant Patient.

    Masselli, Gabriele; Derme, Martina; Laghi, Francesca; Framarino-dei-Malatesta, Marialuisa; Gualdi, Gianfranco

    2015-11-01

    Acute abdominal pain in pregnancy presents diagnostic and therapeutic challenges. Ultrasound remains the primary imaging investigation of the pregnant abdomen because of its availability, portability, and lack of ionizing radiation. MR imaging has been shown to be useful in the diagnosis of gynecologic and obstetric problems and in the setting of acute abdomen during pregnancy. MR imaging is often used when ultrasound is inconclusive. Computed tomography is the investigation of choice when there is a life-threatening situation and in case of traumatic injuries, when a rapid diagnosis is required. PMID:26526440

  8. Analysis of the computed tomography in the acute abdomen

    Introduction: This study tends to test the capacity of the computed tomography in assist in the diagnosis and the approach of the acute abdomen. Material and method: This is a longitudinal and prospective study, in which were analyzed the patients with the diagnosis of acute abdomen. There were obtained 105 cases of acute abdomen and after the application of the exclusions criteria were included 28 patients in the study. Results: Computed tomography changed the diagnostic hypothesis of the physicians in 50% of the cases (p 0.05), where 78.57% of the patients had surgical indication before computed tomography and 67.86% after computed tomography (p = 0.0546). The index of accurate diagnosis of computed tomography, when compared to the anatomopathologic examination and the final diagnosis, was observed in 82.14% of the cases (p = 0.013). When the analysis was done dividing the patients in surgical and nonsurgical group, were obtained an accuracy of 89.28% (p 0.0001). The difference of 7.2 days of hospitalization (p = 0.003) was obtained compared with the mean of the acute abdomen without use the computed tomography. Conclusion: The computed tomography is correlative with the anatomopathology and has great accuracy in the surgical indication, associated with the capacity of increase the confident index of the physicians, reduces the hospitalization time, reduces the number of surgeries and is cost-effective. (author)

  9. Solitary mesenteric vascular anomaly presenting as acute abdomen

    Thambidorai C

    2008-01-01

    Full Text Available A 4-year-old girl with a solitary vascular anomaly of the mesentery presented with acute lower abdominal pain. Despite the use of ultrasound, computed tomography scan and image-guided core biopsies, the lesion was initially mistaken for an inflammatory intra-abdominal mass. The correct diagnosis was made at laparotomy. Solitary vascular anomaly of the mesentery is rare and its presentation as an acute abdomen has not been reported before.

  10. Acute abdomen due to ovarian congestion caused by coiling of the fallopian tube accompanied by paratubal cyst around the utero-ovarian ligament

    Kim, Juyoung; Park, Daehyun; Han, Won Bo; Jeong, Hyangjin; Park, Youngse

    2014-01-01

    Torsion of uterine adnexa is an important cause of acute abdominal pain in females. The main organ which can cause torsion is the ovaries, but torsions of the fallopian tube, subserosal myoma, paratubal cyst, and even the uterine body have been reported. The incidence of isolated fallopian tubal torsion is very rare. Even more rarely, it can coil around nearby organs such as the utero-ovarian ligament, showing similar clinical manifestations with those of adnexal torsion. We experienced an ex...

  11. Obstructive acute abdomen: reviewing important points; Abdome agudo obstrutivo: revisando pontos fundamentais

    Francisco, Marina Celli; Abud, Thiago Giansante; Reibscheid, Samuel; Szejnfeld, Jacob; Lederman, Henrique Manoel [Universidade Federal de Sao Paulo (UNIFESP-EPM), Sao Paulo, SP (Brazil). Dept. de Diagnostico por Imagem]. E-mail: nana_celli@hotmail.com; Neves, Felipe Trentin [Hospital Ipiranga, Sao Paulo, SP (Brazil); Colleone Neto, Ramiro [Universidade Federal de Sao Paulo (UNIFESP-EPM), Sao Paulo, SP (Brazil)

    2008-07-01

    The obstructive acute abdomen is a common presentation, for which safe and effective management depends on a fast and accurate diagnosis. Conventional radiograph remains the first choice among the imaging exams because of its availability, low cost and the possibility to be done serially to follow the patient's clinical progression. The ultrasonography does not require ionizing radiation. It is a dynamic and in realtime exam. Computed tomography is used increasingly due to the provision of essential diagnostic information not apparent from radiographs, such as the confirmation of the obstruction, degree and place of the occlusion, presence of ischemia as well as the causes of the obstruction. Magnetic resonance imaging has presented great technological advances and it may play a role in the future of obstructive acute abdomen diagnosis. The objective of this pictorial essay is to review the different imaging techniques used on diagnosing obstructive acute abdomen. (author)

  12. Guillain-Barre Syndrome Presenting as Acute Abdomen

    Faruk incecik

    2015-09-01

    Full Text Available Guillain-Barr and eacute; syndrome (GBS is the most common cause of acute flaccid paralysis in childhood. Symmetric weakness, headache, respiratory symptom, neuropathic pain, muscle pain, paresthesia, and facial palsy were the most common clinical presentations. We report 13-year-old boy with GBS who presented with acute abdominal pain. This is the first report, to our knowledge, first presented of acute abdomen of a pediatric patient with GBS. [Cukurova Med J 2015; 40(3.000: 601-603

  13. IDIOPATHIC OMENTAL INFARCTION : A RARE CAUSE OF ACUTE PAIN ABDOMEN

    Narendra Nath

    2015-02-01

    Full Text Available Omental torsion leading on to omental infarction is an unusual cause of acute abdominal pain in adults. Often the condition mimics common causes of acute abdomen like acute cholecystitis, acute appendicitis or acute pancreatitis. A review of literature reveals that this enigmatic condition has been managed both non - operatively and by surgery in the past. We report the case of a 46 - year - old man who presented with a 4 - day history of severe right - sided abdominal pain mimicking acute cholecystitis. Abdominal CT scan revealed a right upper quadrant mass with a whirl - like appearance, suspicious for omental infarction. He was started on conservative management with analgesics and antibiotics. He improved symptomatically and was discharged

  14. Infarction of a polyp within a mesenteric cyst: An unusual presentation as an acute abdomen

    Gon Sonia

    2010-01-01

    Full Text Available A case of mesenteric cyst in a five-year-old male child who presented with acute abdomen due to an infarcted polyp present within the cyst is reported. To the best of our knowledge, such an event has never been reported in the literature previously.

  15. Marfan syndrome with acute abdomen: a case report

    Beyazit Zencirci

    2010-01-01

    Beyazit ZencirciKahramanmaras Sutcu Imam University Medical Faculty, Department of Anesthesiology and Reanimation Kahramanmaras, TurkeyIntroduction: Marfan syndrome is an autosomal dominant connective tissue disorder characterized by a combination of clinical manifestations in different organ systems. Patients with Marfan syndrome (MFS) whose lifetimes are extended may be encountered as acute abdomen (appendicitis) cases apart from the obligatory reasons and emergencies arising naturally out ...

  16. Lassa fever presenting as acute abdomen: a case series

    Andrew E. Dongo; Kesieme, Emeka B.; Iyamu, Christopher E; Okokhere, Peter O; Akhuemokhan, Odigie C.; Akpede, George O.

    2013-01-01

    Lassa fever, an endemic zoonotic viral infection in West Africa, presents with varied symptoms including fever, vomiting, retrosternal pain, abdominal pain, sore-throat, mucosal bleeding, seizures and coma. When fever and abdominal pain are the main presenting symptoms, and a diagnosis of acute abdomen is entertained, Lassa fever is rarely considered in the differential diagnosis, even in endemic areas. Rather the diagnosis of Lassa fever is suspected only after surgical intervention. Therefo...

  17. Lassa fever presenting as acute abdomen: a case series.

    Dongo, Andrew E; Kesieme, Emeka B; Iyamu, Christopher E; Okokhere, Peter O; Akhuemokhan, Odigie C; Akpede, George O

    2013-01-01

    Lassa fever, an endemic zoonotic viral infection in West Africa, presents with varied symptoms including fever, vomiting, retrosternal pain, abdominal pain, sore-throat, mucosal bleeding, seizures and coma. When fever and abdominal pain are the main presenting symptoms, and a diagnosis of acute abdomen is entertained, Lassa fever is rarely considered in the differential diagnosis, even in endemic areas. Rather the diagnosis of Lassa fever is suspected only after surgical intervention. Therefore, such patients often undergo unnecessary surgery with resultant delay in the commencement of ribavirin therapy. This increases morbidity and mortality and the risk of nosocomial transmission to hospital staff. We report 7 patients aged between 17 months and 40 years who had operative intervention for suspected appendicitis, perforated typhoid ileitis, intussuception and ruptured ectopic pregnancy after routine investigations. All seven were post-operatively confirmed as Lassa fever cases. Four patients died postoperatively, most before commencement of ribavirin, while the other three patients eventually recovered with appropriate antibiotic treatment including intravenous ribavirin. Surgeons working in West Africa should include Lassa fever in the differential diagnosis of acute abdomen, especially appendicitis. The presence of high grade fever, proteinuria and thrombocytopenia in patients with acute abdomen should heighten the suspicion of Lassa fever. Prolonged intra-operative bleeding should not only raise suspicion of the disease but also serve to initiate precautions to prevent nosocomial transmission. PMID:23597024

  18. Lassa fever presenting as acute abdomen: a case series

    2013-01-01

    Lassa fever, an endemic zoonotic viral infection in West Africa, presents with varied symptoms including fever, vomiting, retrosternal pain, abdominal pain, sore-throat, mucosal bleeding, seizures and coma. When fever and abdominal pain are the main presenting symptoms, and a diagnosis of acute abdomen is entertained, Lassa fever is rarely considered in the differential diagnosis, even in endemic areas. Rather the diagnosis of Lassa fever is suspected only after surgical intervention. Therefore, such patients often undergo unnecessary surgery with resultant delay in the commencement of ribavirin therapy. This increases morbidity and mortality and the risk of nosocomial transmission to hospital staff. We report 7 patients aged between 17 months and 40 years who had operative intervention for suspected appendicitis, perforated typhoid ileitis, intussuception and ruptured ectopic pregnancy after routine investigations. All seven were post-operatively confirmed as Lassa fever cases. Four patients died postoperatively, most before commencement of ribavirin, while the other three patients eventually recovered with appropriate antibiotic treatment including intravenous ribavirin. Surgeons working in West Africa should include Lassa fever in the differential diagnosis of acute abdomen, especially appendicitis. The presence of high grade fever, proteinuria and thrombocytopenia in patients with acute abdomen should heighten the suspicion of Lassa fever. Prolonged intra-operative bleeding should not only raise suspicion of the disease but also serve to initiate precautions to prevent nosocomial transmission. PMID:23597024

  19. ACUTE ABDOMEN SECONDARY TO NEOPLASM IN A HIV/SIDA PATIENT (IN SPANISH

    Herrera-Lomónaco Sandra

    2014-06-01

    Full Text Available Introduction: patients with HIV/SIDA might present as complications, symptoms of acute abdomen that could be of infectious, neoplasic or idiopathic etiology. The frequency of epithelial, mesenchymal and hemato-lymphoid neoplasm, tend to be increased in the HIV/SIDA patients. Case report: a 23-year-old male with diagnosis of HIV since three years ago and without regular antiretroviral treatment due to voluntary suspension. He presented symptoms of two days of evolution consistent in diarrhea, pain in right iliac region, vomiting and clinical signs of peritoneal irritation. Then, with diagnosis of acute abdomen secondary to acute appendicitis, he was carried to laparotomy. During the surgery procedure, intestinal perforation in the ileocecal region was found. Debridement, enterorrhaphy and appendicectomy were done, with adequate postoperative improvement. The histopathological diagnosis was Diffuse Large-B-cell Non-hodgkin Lymphoma of the ileocecal region. He was discharged for the oncological and integral management of the HIV/SIDA. Conclusion: the Diffuse Large-B-cell Non-Hodgkin Lymphoma is the type of lymphoma most frequently reported in association with the HIV/SIDA. The presented case is unusual, where the intestinal perforation caused acute abdomen imitating appendicular event. The lack of use of antiretroviral treatment probably contributed to the development and evolution of the Diffuse Large-B-cell Non-Hodgkin Lymphoma. Rev. cienc.biomed.2014;5(2:351-356. KEYWORDS Acute abdomen, Neoplasm, Non-Hodgkin lymphoma, HIV.

  20. Surgical acute abdomen in elderly patients. Abdomen agudo quirúrgico en el anciano.

    Lidia Torres Ajá

    Full Text Available Fundaments : The surgical acute abdomen usually is the most frequent cause of abdominal surgery of urgency in t he old one, with the high mortality in spite of the modern surgical technologies. Objective: To evaluate the surgery of the surgical acute abdomen in the old one. Method: Appears a prospectivo descriptive study that includes 102 patients of 60 years or more who underwent surgery at the ¨Dr Gustavo Aldereguía Lima¨ University Hospital of Cienfuegos with this diagnostic. The primary data were obtained from clinical cards of the patients and the daily clinical observation until the debit. Results: The patients presented an average age of 74 years, being the most frequent causes of the syndrome intestinal obstruction (32,4%, the biliary tract affections (22,5%, and acute appendicitis (21,6%. The most frequent symptom was abdominal pain (96,08%, and we noticed tachycardia in 80,4%. Postoperating complications in 47,06% of the patients appeared and was observed a mortality of 26,5% with statistically significant relation with the age, ASA classification, surgical risk, time of evolution and the surgical time. The peritonitis heads the direct causes of death.

    Fundamento : El abdomen agudo quirúrgico suele ser la causa más frecuente de cirugía abdominal de urgencia en el anciano, se asocia con una alta mortalidad a pesar de las tecnologías quirúrgicas modernas. Objetivo : Evaluar la cirugía del abdomen agudo quirúrgico en el anciano. Método : Estudio descriptivo prospectivo que incluye a 102 pacientes de 60 años o más operados en el Hospital Universitario ¨Dr. Gustavo Aldereguía Lima¨ de Cienfuegos entre agosto y diciembre del 2002 con el diagnóstico de abdomen agudo quirúrgico. Los datos primarios se obtuvieron de las fichas clínicas de los pacientes y de la observación clínica diaria hasta el egreso

  1. Acute abdomen as atypical presentation of brucellosis: report of two cases and review of literature.

    al Faraj, S

    1995-01-01

    Abdominal involvement in brucellosis is seen in the acute, subacute and chronic disease. It is not typical, however, that acute abdomen is the presenting feature of brucellosis. In this paper, two cases of serologically diagnosed brucellosis are reported, both presenting initially with acute abdomen and fever. In brucella-endemic regions of the world, brucellosis has to be considered in the differential diagnosis of acute abdomen and fever. With definitive diagnosis, unnecessary laparotomy ca...

  2. Spontaneous Spleen Rupture in a Teenager: An Uncommon Cause of Acute Abdomen

    Verroiotou Maria

    2013-01-01

    Full Text Available Spontaneous spleen rupture is a rare complication of infectious diseases and it can become a potentially life-threatening condition if not diagnosed in time. A 17-year-old Greek female presented to the ER due to acute abdominal pain, mainly of the left upper quadrant. She had no recent report of trauma. The patient was pale, her blood pressure was 90/70 mmHg, and her pulse was 120 b/min. Clinical examination of the abdomen revealed muscle contraction and resistance. The patient was submitted to an ultrasound of the upper abdomen and to a CT scanning of the abdomen that revealed an extended intraperitoneal hemorrhage due to spleen rupture. Due to the patient’s hemodynamic instability, she was taken to the operation room and splenectomy was performed. Following a series of laboratory examinations, the patient was diagnosed to be positive for current cytomegalovirus infection. The postoperative course was uneventful, and in a two year follow-up the patient is symptom-free. Spontaneous spleen rupture due to Cytomegalovirus infection is a rare clinical entity, described in few case reports in the world literature and should always be taken into consideration in differential diagnosis of acute abdomen, especially in adolescents with no recent report of trauma.

  3. Roentogenologic diagnosis of an acute abdomen in children

    Oka, Makio; Chiba, Nobuyuki; Miyagi, Tetsuo (Kanagawa Children' s Medical Center, Yokohama (Japan))

    1983-05-01

    An acute abdomen is one of the main topics among emergency practice for children. We have experienced about 300 acute abdomen cases per year at our Children's Hospital since 1970. Radiological technologists provide a 24-hour emergency service using special knowledge and techniques in our radiological investigation. In the noenatal period esophageal atresia should be diagnosed by plain up-right film with a coiled-up rubber tube, and a contrast examination is contraindicated to prevent severe aspiration pneumonia. In the cases with intestinal atresia, the contrast examination is not necessary again, because the findings of plain film such as the distribution of air-filled intestinal loops, dilated bowel with air-fluid level gives us enough information for the diagnosis of these congenital anomalies. On the contrary, barium enema is useful and harmless for the neonatal age group. It is practical for diagnosing Hirschsprung's disease, midgut malrotation with volvulus, ileal and colonic atresia and necrotizing enterocolitis. An imperforate anus should be classified into the high and low type in the neonatal period to define the treatment. Invertogram is an only way for the differentiation of a baby without external fistula, and we have established the technique for this. The level is diagnosed by the relationship between the gas-filled rectal pouch and ischiac bone. In the infant group intussusception is the most common and urgent acute abdomen. We use a special device to fix the bady, dilute the barium with warm saline (to avoid water intoxication), limit the water pressure to within one meter, and avoid abdominal manipulation and longtime exposure. The successful reduction rate that our team has obtained is almost 85%.

  4. Rare Hernias Presenting as Acute Abdomen- A Case Series

    Ulahannan, Sansho Elavumkal; Kurien, John S; Joseph, Aneesh; Kurien, Annie Sandhya; Varghese, Sandeep Abraham; Thomas, Bindhya; Varghese, Fobin

    2016-01-01

    Hernia is an abnormal protrusion of an organ or tissue through a defect in its surrounding walls. It can be divided into internal, external and diaphragmatic hernias. Most of them can be asymptomatic. If they become symptomatic they can present with features of intestinal obstruction, incarceration or strangulation. In this case series we compare the incidence of these rare presentations of hernias with world literature and to warn surgeons not to cut the obstructing band in cases of internal hernias. In this case series, we review the clinical details of 7 rare presentations of hernia, who presented with various types of hernias to a tertiary care centre in Kerala over a period of one year. Of these 7 cases 6 cases were internal hernias (3 left paraduodenal hernias, 2 transmesentric hernias, and 1 pericaecal hernia) and a case of spigelian hernia above the level of umbilicus. All of them presented as acute abdomen in the emergency department. Among these 7 cases, only one case was diagnosed preoperatively. Three patients had bowel gangrene and had to undergo resection- anastomosis of the bowel. The survival rate among these cases was 100% as compared to 50% in the world literature if they had been left untreated. Even though internal hernias are a rare entity, we need to have it as a differential diagnosis in case of intestinal obstruction, in a previously non-operated abdomen.

  5. The role of US examination in the management of acute abdomen.

    Mazzei, Maria Antonietta; Guerrini, Susanna; Cioffi Squitieri, Nevada; Cagini, Lucio; Macarini, Luca; Coppolino, Francesco; Giganti, Melchiore; Volterrani, Luca

    2013-07-15

    Acute abdomen is a medical emergency, in which there is sudden and severe pain in abdomen of recent onset with accompanying signs and symptoms that focus on an abdominal involvement. It can represent a wide spectrum of conditions, ranging from a benign and self-limiting disease to a surgical emergency. Nevertheless, only one quarter of patients who have previously been classified with an acute abdomen actually receive surgical treatment, so the clinical dilemma is if the patients need surgical treatment or not and, furthermore, in which cases the surgical option needs to be urgently adopted. Due to this reason a thorough and logical approach to the diagnosis of abdominal pain is necessary. Some Authors assert that the location of pain is a useful starting point and will guide a further evaluation. However some causes are more frequent in the paediatric population (like appendicitis or adenomesenteritis) or are strictly related to the gender (i.e. gynaechologic causes). It is also important to consider special populations such as the elderly or oncologic patients, who may present with atypical symptoms of a disease. These considerations also reflect a different diagnostic approach. Today, surely the integrated imaging, and in particular the use of multidetector Computed Tomography (MDCT) has revolutionised the clinical approach to this condition, simplyfing the diagnosis but burdening the radiologists with the problems related to the clinical management. However although CT emerging as a modality of choice for evaluation of the acute abdomen, ultrasonography (US) remains the primary imaging technique in the majority of cases, especially in young and female patients, when the limitation of the radiation exposure should be mandatory, limiting the use of CT in cases of nondiagnostic US and in all cases where there is a discrepancy between the clinical symptoms and negative imaging at US. PMID:23902801

  6. Varicella Zoster Infection: A Rare Cause of Abdominal Pain Mimicking Acute Abdomen

    Olmez, Deniz; Boz, Alper; Erkan, Nazif

    2009-01-01

    Varicella zoster is an acute viral infection that results from reactivation of a latent varicella zoster virus. It usually occurs in adult population and immune compromised patients. It rarely occurs in healthy children. Here we present a 14 years old male with varicella zoster that had abdominal pain mimicking acute abdomen to alert others who are consulted for the differentiation of acute abdomen and others who may be consulted for pain management. Keywords Varicella zoster; Abdominal pain PMID:22461879

  7. Varicella Zoster Infection: A Rare Cause of Abdominal Pain Mimicking Acute Abdomen

    Olmez, Deniz; Boz, Alper; Erkan, Nazif

    2009-01-01

    Varicella zoster is an acute viral infection that results from reactivation of a latent varicella zoster virus. It usually occurs in adult population and immune compromised patients. It rarely occurs in healthy children. Here we present a 14 years old male with varicella zoster that had abdominal pain mimicking acute abdomen to alert others who are consulted for the differentiation of acute abdomen and others who may be consulted for pain management. Keywords Varicella zoster; Abdominal pain

  8. An unusual cause of the acute abdomen: computed tomography angiography findings of the intestinal intramural hematoma

    Full text: Introduction: The intestinal intramural hematoma is a rare abdominal emergency condition resulting from submucosal or subserosal hemorrhage. The various causes of this condition are anticoagulant therapy, trauma, surgery, biopsy and spontaneous. The most common cause of this condition is blunt abdominal trauma. Objectives and tasks: In this report we aimed to present computed tomography (CT) angiography findings of the intestinal wall hematoma which is an unusual cause of acute abdomen. Materials and methods: A 67-year-old man presented to our emergency department complaining of severe abdominal pain, nausea and vomiting. The physical examination revealed right upper quadrant and epigastric abdominal tenderness. Sonographic examination revealed free fluid in the right paracolic area and minor pelvis. Due to these findings, the patient underwent CT angiography examination with suspicion of acute intestinal ischemia. Results: Diffuse atherosclerotic calcified plaques in the abdominal aorta and moderate degree stenosis proximal celiac truncus were determined on CT angiography images. Mesenteric arterial system was patent. On CT images most remarkable finding was diffuse wall thickening reaching up to 1.5 cm at the widest part in small intestinal segments. These findings were seen in the right half of abdomen and pelvis, approximately 12 cm and 20 cm small intestinal segment, respectively. The patient was using warfarin and acetylsalicylic acid medication due to heart valve replacement surgery. This history and CT angiography findings were consistent with intestinal mural hematoma. Conclusion: In the differential diagnosis of the acute abdomen, intestinal intramural hematoma must be kept in mind, especially in patients using anticoagulant drugs. In such cases, CT angiographic examination is rapid, effective and reliable method in both determination of the vascular abnormality and evaluation of the intestinal wall pathologies

  9. Perforated Duodenal Ulcer –A Rare Cause of Acute Abdomen in Pregnancy

    Goel, Bharti; Rani, Jyotsna; Huria, Anju; Gupta, Pratiksha; Dalal, Usha

    2014-01-01

    Acute abdomen during pregnancy is a medico-surgical emergency demanding concerted, synchronized specialties approach of obstetrician, surgeon and gastroenterologist. Duodenal perforation is one of the rarer causes of acute abdomen in pregnancy. Here, we report a case of duodenal perforation with peritonitis in third trimester of pregnancy requiring surgical management. Our aim of reporting this case is to stress the physicians to keep the differential of duodenal perforation also in mind whil...

  10. COMPARISON OF CLINICAL JUDGMENT AND RADIOLOGICAL CORRELATION IN EVALUATION OF ACUTE ABDOMEN

    Karunya Lakshmi; Abubacker Sulaiman; Ashwin Kumar; Shriranjani

    2015-01-01

    BACKGROUND: The aim of the study is to assess the accuracy of clinical examination in acute abdomen with radiological imaging. DESIGN: Retrospective trail . INTRODUCTION: Acute abdominal pain may be caused by a variety of conditions ranging from benign self - limiting disease to surgical emergencies. Accurate diagnoses of acute abdominal pain require detailed patient history, thorough physical examination, laboratory tests and diagnostic ima ging. Tak...

  11. Diseases of the hepatobiliary system as a cause of acute abdomen; Erkrankungen des hepatobiliaeren Systems als Ursache des akuten Abdomens

    Schima, W.; Eisenhuber-Stadler, E. [Krankenhaus Goettlicher Heiland, Abteilung fuer Radiologie und bildgebende Diagnostik, Wien (Austria); Koelblinger, C.; Kulinna-Cosentini, C.; Ba-Ssalamah, A. [Medizinische Universitaet Wien, Universitaetsklinik fuer Radiodiagnostik, Wien (Austria)

    2010-03-15

    Diseases of the liver and biliary system are common causes of acute abdominal pain and gallstone disease predisposes to cholecystitis and cholangiolithiasis. Sonography is the method of choice for the assessment of cholecystitis, whereas magnetic resonance cholangiopancreaticography (MRCP) is the standard technique to detect stones in the common bile duct. Multi-detector computed tomography (MDCT) is ideal for detection of associated complications, including abscess formation and gall stone ileus. Pyogenic, amebic and fungal liver abscesses are reliably diagnosed with MDCT which can also be used for interventional radiologic therapy of liver abscesses by percutaneous aspiration or drainage procedures. The second most common cause of liver rupture after blunt trauma is spontaneous rupture of hypervascular liver tumors (i.e., HCC, adenoma, angiosarcoma) and due to medical procedures. Multi-phase contrast-enhanced MDCT can reliably detect active bleeding to guide further therapy in these cases. (orig.) [German] Die Cholezystitis ist eine der haeufigsten Ursachen fuer ein akutes Abdomen. Waehrend die Sonographie die Methode der Wahl zum Nachweis einer Cholezystolithiasis und Cholezystitis ist, steht bei der Entwicklung von Komplikationen die Multidetektorcomputertomographie (MDCT) diagnostisch im Vordergrund. Die Magnetresonanzcholangiopankreatikographie (MRCP) hat einen hohen Stellenwert bei der Abklaerung der Cholangiolithiasis, v. a. bei der Differenzialdiagnose zu anderen Ursachen einer Cholestase. Die Diagnose bakterieller, Amoeben- oder fungaler Leberabszesse kann mittels Sonographie oder MDCT rasch gestellt werden, wobei diese Methoden auch fuer die interventionelle radiologische Therapie von Leberabszessen (Punktion oder Drainage) gut geeignet sind. Die mehrphasige, kontrastmittelverstaerkte MDCT ist die Methode der Wahl fuer den Nachweis von Leberinfarkten oder -rupturen, da bei diesen Erkrankungen bzw. Verletzungsfolgen die Darstellung der

  12. Radiological interventional procedures for the acute abdomen; Radiologisch-interventionelle Massnahmen beim akuten Abdomen

    Trumm, C.; Hoffmann, R.T.; Reiser, M.F. [Klinikum der Ludwig-Maximilians-Universitaet Muenchen, Campus Grosshadern, Institut fuer Klinische Radiologie, Muenchen (Germany)

    2010-03-15

    In patients with acute thrombo-embolic occlusion of the superior mesenteric artery, catheter-assisted thrombolytic therapy represents a procedure of increasing importance in addition to surgery and intensive care treatment. The thrombolytic drugs utilized for this purpose are urokinase, streptokinase and recombinant tissue plasminogen activator (rtPA). Therapeutic embolization is predominantly used in the treatment of arterial bleeding from the gastro-intestinal tract, the liver, the intestines (due to an aneurysm or vascular malformation) and in bleeding from intestinal anastomoses. Polyvinyl alcohol particles, embospheres, gelfoam and microcoils can be utilized as embolic agents. Percutaneous transhepatic cholangiodrainage and stent implantation are applied in patients with biliary obstructions caused by inoperable tumors of the gall bladder or bile ducts, of the pancreatic head or duodenum and by metastases located in the liver parenchyma or hepatic hilum. Image-guided percutaneous drainage is a valuable option in the management of abscesses in the peritoneal cavity; less common indications are lymphoceles, biliomas, urinomas, hematomas, necrosis and pseudocysts. (orig.) [German] Die kathetergestuetzte thrombolytische Therapie stellt im Kontext einer chirurgischen und intensivmedizinischen Versorgung von Patienten mit thrombembolisch bedingter mesenterialer Ischaemie ein unterstuetzendes Behandlungsverfahren von zunehmender Bedeutung dar. Als thrombolytische Agenzien werden Urokinase, Streptokinase und der rekombinante Gewebeplasminogenaktivator (rtPA) verwendet. Die therapeutische Embolisation kommt neben der endoskopischen und chirurgischen Blutungsstillung bei arteriellen Blutungen im Gastrointestinaltrakt, aus der Leber, im Darm (als Folge eines Aneurysmas oder einer vaskulaeren Malformation) sowie bei blutenden intestinalen Anastomosen zum Einsatz. Zur Embolisation koennen Polyvinylalkoholpartikel, Embosphaeren, Gelfoam oder Mikrocoils verwendet werden. Die

  13. Non Obstetric Acute Abdomen in Pregnancy – An Experience from Kashmir

    Ajaz Ahmad Rather

    2013-11-01

    Full Text Available Objectives: The objective of this study was to study the profile of pregnant patients who were managed by general surgical unit of a referral hospital in Kashmir valley for non obstetric causes of acute abdomen over a period of seven years. Methods: The study was done retrospectively after acquiring data from databank related to pregnant patients managed for acute abdomen over a period of seven years (from January 2006 to December 2012 in the general surgical department of the medical college of SK Institute of Medical Sciences, Srinagar, Kashmir. Results: 49 non obstetric acute abdomen were managed in pregnant females over a period of seven years. 23 (46.9% patients reported with a delay of more than 12 hours and 34 (69.4% cases underwent surgical interventions. Appendicitis was the commonest cause of acute abdomen and Ultrasonography was the only imaging modality utilized. Only 3 cases had preterm labor. Conclusions: Acute abdomen in pregnant females should be assessed with high level of suspicion .Delay in presentation and intervention leads to adverse outcomes.

  14. Laparoscopic Excision of a Pedunculated Uterine Leiomyoma in Torsion as a Cause of Acute Abdomen at 10 Weeks of Pregnancy

    Kosmidis, Christophoros; Pantos, George; Efthimiadis, Christopher; Gkoutziomitrou, Ioanna; Georgakoudi, Eleni; Anthimidis, George

    2015-01-01

    Patient: Female, 31 Final Diagnosis: Acute abdomen due to pedunculated uterine leiomyoma in torsion Symptoms: Abdominal pain • vomiting Medication: Cefoxitin 2gr Clinical Procedure: Laparoscopic excision of the pendunculated uterine leiomyoma – laparoscopic appedicectomy Specialty: Surgery Objective: Unusual clinical course Background: Pregnancy outcomes after laparoscopic myomectomy are generally favorable, with a pregnancy rate that is comparable to or even higher than the rate associated w...

  15. A Rare Cause of Acute Abdomen: Idiopathic Isolated Cecal Necrosis

    Ender Özer

    2015-03-01

    Full Text Available Idiopathic isolated cecal necrosis is a clinical problem characterized by right-sided inferior abdominal pain. It is rarely seen, develops due to decreased blood flow to the colon and, imitates acute appendicitis. Its clinical signs are similar to many illnesses causing sensitivity in the right inferior quadrant and, the diagnosis is generally determined during surgery. An 86-year-old male patient presented with the complaints of abdominal pain, trichiniasis, nausea and vomiting. Surgical intervention was decided when physical examination and laboratory results were taken into consideration. After diagnostic laparoscopy, right hemicolectomy was performed because of cecal necrosis. While the mortality and morbidity rates for ischemic bowel disease are high, prognosis for early diagnosed patients with isolated cecal necrosis is better, provided that timely surgical treatment is decided.

  16. Diagnostic difficulty in mesenteroaxial gastric volvulus— A rare cause of acute abdomen in a child

    Saifullah Khalid; Samreen Zaheer; Mohd Khalid,; Ekram Ullah; Sarfaraz A. Khan

    2014-01-01

    Gastric volvulus as a cause of acute abdomen is uncommon, especially in children. This increases the likelihood of missed or delayed diagnosis leading to increased morbidity and mortality. Acute gastric volvulus is a potentially life- threatening condition and timely diagnosis and management significantly reduces the chances of complications. We report a case of an adolescent male child, who presented to the casualty with acute abdominal pain in the epigastric region, associated w...

  17. When and why use unenhanced computed tomography in patients with acute abdomen

    The use of unenhanced computed tomography has been frequently recommended for the initial assessment of patients with clinical suspicion of acute abdomen instead of other diagnostic methods. The authors present a review of the literature on the main aspects, advantages, limitations and efficacy of unenhanced computed tomography for the diagnosis of acute appendicitis, renal colic, diverticulitis, acute pancreatitis, primary epiploic appendicitis, pneumoperitoneum and small bowel obstruction. The advantages and limitations of this technique are also discussed. (author)

  18. Acute abdomen: An uncommon presentation of a common intestinal nematode.

    Rizvi, Ghazala; Rawat, Vinita; Pandey, Hari Shankar; Kumar, Mukesh

    2015-01-01

    Enterobius vermicularis is a common parasitic infection of the intestine which is rarely symptomatic. It is unusual to find it in the wall or outside the gastrointestinal tract. We encountered five such cases where we observed the worm outside the lumen of the intestine. The pathological findings and the clinical features are discussed. This case series highlight that E. vermicularis can be the cause of pathology within the abdomen and should be considered in the differential diagnosis of some commonly encountered abdominal conditions. PMID:26629456

  19. Detection of Hyperechoic Inflammatory Fatty Tissue during Transabdominal Ultrasonography: Diagnostic Role in Acute Abdomen

    Park, Seong Jin; Lee, Hae Kyung; Yi, Bum Ha [Soonchunhyang University Bucheon Hospital, Bucheon (Korea, Republic of); Kim, Hyun Cheol [Soonchunhyang University Cheonan Hospital, Cheonan (Korea, Republic of)

    2005-12-15

    To assess the incidence and diagnostic role of hyperechoic inflammatory fatty tissue (HIFT) in transabdominal ultrasonography (TAUS) for acute abdomen. With TAUS, we examined 98 consecutive patients (68 women, 30 men: mean age, 32 years: age range, 4-84 years) having acute abdominal pain. We examined the abdomen and pelvis by TAUS to determine the cause of acute abdomen, to check for the presence of HIFT, and to investigate whether it was easier and earlier to find the main cause and HIFT presence. We also prospectively evaluated the shape, distribution, and diagnostic role of HIFT. Final diagnoses consisted of 47 cases of acute appendicitis, 14 of enterocolitis, 13 of PID, 7 of gynecological hemoperitoneum, 5 of colonic diverticulitis, 3 of ovarian torsion, 2 of colon perforation, 2 of only presence of non-specific HIFT, 1 of mesenteric lymphadenitis, and 4 of normal. HIFT were seen in 67 patients (68.4%), including 44/47(93.6%) of acute appendicitis, 2/14(14.3%) of enterocolitis, 11/13(84.6%) of PID, 0/7 of hemoperitoneum, 5/5 of colonic diverticulitis, 0/3 of ovarian torsion, 2/2 of colon perforation, and 1/1 mesenteric lymphadenitis. HIFT were detected earlier than the main cause in 17/44 of acute appendicitis, 6/11 of PID, and 4/5 of colonic diverticulitis. In acute appendicitis, the shape of HIFT appeared as fat thickening along the mesoappendix in 12/44, fat thickening along the mesoappendix and the opposite side in 13/44, fat encircled appendix in 6/44, fatty mass wrapping abscess in 10/44, and diffuse intraperitoneal fat thickening in 3/44. In PID, HIFT appeared as a single fatty mass in the pelvis and lower abdomen in 6/11, wrapping pelvic abscess in 2/11, and multiple fatty masses scattered in abdomen and pelvis in 3/11. In colonic diverticulitis, all 5 cases appeared as hyperechoic hemispheric mass covering the inflamed diverticulum. HIFT are a usual US finding in patients with acute abdomen, particularly on abdominal and pelvic inflammatory conditions

  20. Spontaneous rupture of pyometra manifesting as an acute abdomen: a case report.

    Singh, Alpana; Mundhra, Rajlaxmi; Agarwal, Tannavi; Radhakrishnan, Gita

    2015-07-01

    Spontaneous perforation of pyometra is a rare entity with a reported incidence in the range of 0.01-0.05%. The clinical picture is similar to peritonitis arising from intestinal perforation and commonly the correct diagnosis is only made perioperatively. We report a case in an elderly postmenopausal woman presenting with an acute abdomen. PMID:25999354

  1. Hereditary angioderma: an uncommon cause of acute abdomen. Abdominal computed tomography and ultrasound findings

    We present an uncommon case of acute abdomen in a patient with hereditary angioderma. The ultrasound and CT findings described may suggest this diagnosis, thus avoiding useless surgical interventions in patients in whom the disease has not been previously diagnosed. (Author) 19 refs

  2. Ultrasound of the acute abdomen performed by surgeons in training

    Eiberg, J.P.; Grantcharov, T.P.; Eriksen, J.R.;

    2008-01-01

    perform valid abdominal ultrasound examinations of patients referred with acute abdominal pain. METHODS: Patients referred with acute abdominal pain had an ultrasound examination by a surgeon in training as well as by an experienced consultant radiologist whose results served as the gold standard. All...... participating surgeons were without any pre-existing ultrasound experience and received one hour of introduction to abdominal ultrasound. RESULTS: Thirty patients underwent 40 surgeon performed and 30 radiologist performed ultrasound examinations. Regarding gallstone and cholecholecystitis the sensitivity...

  3. Two Cases of Acute Abdomen after an Intravitreal Injection of Bevacizumab

    Onoda, Yasutaka; Shiba, Tomoaki; Hori, Yuichi; Maeno, Takatoshi; Takahashi, Mao

    2015-01-01

    We report on a patient with ischemic colitis and another with paralytic ileus, both of whom experienced an acute abdomen after intravitreal injection of bevacizumab (IVB). Case 1 was a 78-year-old woman. Her medical history included surgery for colon carcinoma 10 years earlier. The patient developed acute severe abdominal pain and nausea the day after IVB for retinal vein occlusion with macular edema, and massive lower gastrointestinal bleeding occurred. Ischemic colitis was diagnosed. Case 2...

  4. Bilateral ovarian teratoma presenting with a clinical picture of acute abdomen

    Massimiliano Rocchietti March

    2012-12-01

    Full Text Available We describe the case of a 30-year-old patient with bilateral mature cystic teratoma (MCT of the ovaries. The patient had been complaining of mild abdominal pain for several months that had suddenly become severe. Early diagnosis at the emergency room was acute appendicitis, but definitive diagnosis was bilateral ovarian teratoma. We therefore recommend considering ovarian teratomas in the differential diagnosis of acute abdomen in young women in an emergency care setting.

  5. Acute chylous peritonitis due to acute pancreatitis

    2012-01-01

    We report a case of acute chylous ascites formation presenting as peritonitis (acute chylous peritonitis) in a patient suffering from acute pancreatitis due to hypertriglyceridemia and alcohol abuse. The development of chylous ascites is usually a chronic process mostly involving malignancy, trauma or surgery, and symptoms arise as a result of progressive abdominal distention. However, when accumulation of “chyle” occurs rapidly, the patient may present with signs of peritonitis. Preoperative...

  6. Non Obstetric Causes and Presentation of Acute Abdomen among the Pregnant Women.

    Monoarul Haque

    2014-09-01

    Full Text Available To identify the non-obstetric causes and presentation of acute abdomen among pregnant women.This was a cross sectional hospital-based study among 128 pregnant women by face to face interview using a semi-structured questionnaire. This study was conducted at the Gynecology & Obstetric Ward of 250 Bed General Hospital, Noakhali, Bangladesh, from January to August 2013. Data were analyzed by a software package used for statistical analysis (SPSS version 11.5 (SPSS, Inc., Chicago, IL, USA.Mean age of participants was 25±4 years. Our findings showed that 81% were Muslim, 67% were lower middle income group, as well as 47% completed primary level of education. The results revealed that 28% had biliary ascariasis, 24% had peptic ulcer disease and 10% had lower urinary tract infection. We also found that 6% had acute pyelonephritis, 6% had acute gastroenteritis, 6% had acute cholecystitis, 6% had acute appendicitis, 2% had acute pancreatitis, 3% had choledocolithiasis, 2% had ovarian solid mass, 2% had twisted ovarian cyst, 4% had renal colic, and 1% had renal calculus. In non-obstetrical presentation of acute abdomen, the study found that 84% of respondents complained their pain lasting more than 24 hours. Besides, half of respondents felt pain in epigastrium and right hypochondrium. Cramping, prickling and aching type of pain were more, while 66% suffered from continuous pain. Our results also showed that 73% did not explain any aggravating factor and relieving factor, and the rest said food, fasting state and position change aggravated pain as well as relieved pain.The study concludes that precise diagnosis of the acute abdomen in pregnant women by continual updating of abdominal assessment knowledge, and clinical skills is necessary in the management of abdominal pain in obstetric settings.

  7. Acute Abdomen in Interstitial Ectopic Pregnancy, An Emergency Laparoscopic Treatment

    E. Picardo

    2014-01-01

    Full Text Available The present case report demonstrates a laparoscopic approach to treat interstitial cornual pregnancy in emergency. Interstitial ectopic pregnancy develops in the uterine portion of the fallopian tube which accounts for 2–4% of all ectopic pregnancies and has the potential to cause life-threatening hemorrhage at rupture. The mortality rate for a woman diagnosed with such a pregnancy is 2–2.5%. Diagnosis of interstitial pregnancy is made by ultrasound. In this case a 32 year-old woman, Gravida 0 Parity 0 Living 0 Ectopic 1, presented to the emergency obstetrical room complaining acute abdominal pain. There was a history of 10 weeks of pregnancy but no pelvic ultrasound scan was performed before the access. A transvaginal ultrasound scan immediately performed demonstrated a gestational sac with viable fetus in the right interstitial region. Moreover there was an ultrasound evidence of hemoperitoneum. She was transferred to the operating room and an emergency laparoscopy surgery was performed. The postoperative course was uneventful and the patient was discharged two days after the surgery. Interstitial pregnancies present a difficult management problem with no absolute standard of care in literature. Laparoscopic technique is under study with favorable results. For our personal point of view a treatment via laparoscopy could be performed both in elective and in emergency cases.

  8. Spontaneous perforation of pyometra presenting as acute abdomen: a rare condition with considerable mortality.

    Yin, Wan-Bin; Wei, Yan-Hua; Liu, Guang-Wei; Zhao, Xiao-Tang; Zhang, Mao-Shen; Hu, Ji-Lin; Zhang, Nan-Yang; Lu, Yun

    2016-04-01

    Pyometra is an uncommon and potentially lethal disease that occurs mainly in postmenopausal women. Spontaneous perforation of pyometra presenting as acute abdomen is an extremely rare complication of pyometra, and the patients are always admitted to the emergency department. An additional case is reported herein. In addition, a literature review was performed between 1949 and 2015. A correct preoperative diagnosis was made in 21.05% of all the cases. Of all cases, 25.71% were associated with malignant disease. The mortality rate of spontaneous perforation of pyometra is 31.88%. Thus, it should be considered in the differential diagnosis of acute abdomen in elderly women. Total hysterectomy along with bilateral salpingo-oophorectomy is the preferred treatment. Administration of broad-spectrum antibiotics and postoperative intensive care support are essential to reduce the high mortality. PMID:26365324

  9. Delayed diagnosis of a heterotopic pregnancy as a cause of acute abdomen: A case report

    Ayan, Fatma Türkan; Çakmak, Bülent

    2013-01-01

    Introduction: Heterotopic pregnancy is a life threating condition of intrauterine and extrauterine gestations which occur at the same time. We report a delayed diagnosed case of heterotopic pregnancy. Case: A 31 year-old primigravida was referred to our Emergency Gynaecology Service complicated by acute abdomen. She had been treated with clomiphene citrate and on admission intrauterine a missed abortus of about 8 weeks complicated by a large subchorionic hematoma was detected. Emergency lap...

  10. Predictive value of POSSUM score in surgery of acute abdomen in cirrhotic patients

    Banu, P; Popa, F; Constantin, VD; Balalau, C

    2013-01-01

    Abstract Introduction: As liver cirrhosis has an increasing incidence in the general population and the life expectancy for these patients has increased, surgery procedures practiced for acute abdomen in such category of patients are more frequent. Aim: To evaluate the predictive value of POSSUM score in cirrhotic patients undergoing abdominal surgery in emergency cases. Material and method: A prospective study based on 115 consecutive patients with liver cirrhosis hospitalized and operated i...

  11. Huge bilateral polycystic kidneys with suspicion of malignancy, recurrent bleeding in cysts, and acute abdomen

    Bhatty, TAN; Moazin, MS; Haque, R.

    2012-01-01

    We present a case of huge bilateral polycystic kidneys, with suspicion of malignancy and repeated admissions with acute abdomen, secondary to bleeding in cysts, and anaemia, requiring affected side nephrectomy. Key message Autosomal dominant polycystic kidney disease (ADPKD) mostly ends up with end stage renal disease (ESRD), requiring haemodialysis, with increased risk of malignancy and enlargement of kidneys with its associated complications, mostly dealt with conservatively, except maligna...

  12. Spontaneous Perforation of Pyometra Presenting as Acute Abdomen and Pneumoperitoneum Mimicking Those of Gastrointestinal Origin

    Takahiro Yamada; Nanako Ando; Naoshi Shibata; Motomu Suitou; Hiroshi Takagi; Kazutoshi Matsunami; Satoshi Ichigo; Atsushi Imai

    2015-01-01

    Gastrointestinal (GI) perforation accounts for over 90% of acute abdomen and pneumoperitoneum. The presence of pneumoperitoneum secondary to spontaneously perforated pyometra is an interesting yet confusing finding given the absence of gastrointestinal (GI) perforation, because pyometra is more common in postmenopausal women. We report an instructive case of diffuse peritonitis caused by spontaneous perforation of pyometra. A 70-year-old postmenopausal female was admitted to surgical emergenc...

  13. Analysis of the computed tomography in the acute abdomen; Analise da tomografia computadorizada no abdome agudo

    Hochhegger, Bruno [Complexo Hospitalar Santa Casa de Porto Alegre, RS (Brazil); Moraes, Everton [Universidade Federal de Santa Maria (UFSM), RS (Brazil); Haygert, Carlos Jesus Pereira; Antunes, Paulo Sergio Pase [Hospital Universitario de Santa Maria, RS (Brazil); Gazzoni, Fernando [Pontificia Universidade Catolica de Porto Alegre (PUC-RS), Porto Alegre, RS (Brazil). Hospital Sao Lucas; Andrade, Rubens Gabriel Feijo [Fundacao Universitaria de Cardiologia de Porto Alegre, RS (Brazil). Inst. de Cardiologia; Bueno, Leticia Rossi [Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS (Brazil); Lopes, Luis Felipe Dias [Universidade Federal de Santa Maria (UFSM), RS (Brazil). Dept. de Estatistica]. E-mail: brunorgs@pop.com.br

    2007-07-01

    Introduction: This study tends to test the capacity of the computed tomography in assist in the diagnosis and the approach of the acute abdomen. Material and method: This is a longitudinal and prospective study, in which were analyzed the patients with the diagnosis of acute abdomen. There were obtained 105 cases of acute abdomen and after the application of the exclusions criteria were included 28 patients in the study. Results: Computed tomography changed the diagnostic hypothesis of the physicians in 50% of the cases (p < 0.05), and the confidence index in 85.71% of the cases (p 0.014). Computed tomography also altered the management in 46.43% of the cases (p > 0.05), where 78.57% of the patients had surgical indication before computed tomography and 67.86% after computed tomography (p = 0.0546). The index of accurate diagnosis of computed tomography, when compared to the anatomopathologic examination and the final diagnosis, was observed in 82.14% of the cases (p = 0.013). When the analysis was done dividing the patients in surgical and nonsurgical group, were obtained an accuracy of 89.28% (p 0.0001). The difference of 7.2 days of hospitalization (p = 0.003) was obtained compared with the mean of the acute abdomen without use the computed tomography. Conclusion: The computed tomography is correlative with the anatomopathology and has great accuracy in the surgical indication, associated with the capacity of increase the confident index of the physicians, reduces the hospitalization time, reduces the number of surgeries and is cost-effective. (author)

  14. [Acute abdomen caused by spontaneous perforation of the colon].

    Balotta, F; Ghidotti, G; Pecchia, G; Santoro, A

    The literature on simple ulcer of the colon is reviewed. Three successfully treated cases of spontaneous perforation of the colon due to ulcer of the sigmoid, and single and multiple ulceration of the caecum are described, with particular reference to their aetiopathogenesis. The view that simple ulcer is caused by mechanical and circulatory factors, with or without inflammation, is expressed. Surgical management of this lesion must take the patient's age and local and general condition into account. These parameters will determine the type of operation employed, ranging from simple colorrhaphy to variously extensive resection of the perforated segment. PMID:7019756

  15. Melioidosis as a cause of acute abdomen in immuno-competent male from eastern India.

    Karuna, Tadepalli; Khadanga, Sagar; Dugar, Dharmendra; Sau, Biyanka; Bhoi, Priyadarshini

    2015-01-01

    Though melioidosis is rare in India, it has gained importance as one of the most potent emerging infections. In India, the cases have been under-reported because of the lack of awareness. The majority of cases present with multifocal pyogenic infections with septicemia. We present an unusual case of melioidosis presenting as acute intestinal perforation. The organism was ceftazidime resistant, and we successfully treated the case with imipenem and doxycyclin. This case highlights ruling out the possibility of melioidosis in acute abdomen and existence of ceftazidime resistant cases in India. PMID:25949062

  16. OHVIRA syndrome presenting with acute abdomen: a case report and review of the literature.

    Gungor Ugurlucan, Funda; Bastu, Ercan; Gulsen, Gokce; Kurek Eken, Meryem; Akhan, Suleyman Engin

    2014-01-01

    Uterus didelphys with obstructed hemivagina and ipsilateral renal agenesis (OHVIRA) or Herlyn-Werner-Wunderlich (HWW) syndrome is a rare congenital urogenital anomaly. A 13-year-old female presented with acute abdominal pain and dysmenorrhea. Ultrasonography and magnetic resonance imaging showed uterus didelphys, hematometrocolpos, obstructed hemivagina, and right renal agenesis. Hemivaginal septal resection and anastomosis between the obstructed hemivagina and the normal vagina was tried, but it was not possible. Unilateral hysterectomy was performed. HWW syndrome may present with acute abdomen and is usually treated with vaginal septum resection and drainage of the hematometrocolpos. PMID:24461469

  17. An unusual case of intraabdominal abscess and acute abdomen caused by axial torsion of a Meckel's diverticulum

    İhsan Yıldız

    2016-03-01

    Conclusion: Although MD is known as a pediatric disease, it is likely to occur in adults as well. Axial torsion of Meckel's diverticulum should be kept in mind the adults presenting with symptoms of acute abdomen.

  18. Spontaneous Uterine Perforation due to Pyometra Presenting as Acute Abdomen

    Loabat Geranpayeh; Mohsen Fadaei-Araghi; Behnam Shakiba

    2006-01-01

    Spontaneous perforation of the uterus is rare, its incidence being about 0.01% − 0.05%. We report a rare case of diffuse peritonitis caused by spontaneously perforated pyometra. A 63-year-old woman with severe abdominal pain was admitted to our hospital. Laparotomy was performed because of the suspicion of gastrointestinal perforation with generalized peritonitis. At laparotomy, about 900 mL of pus was found in the peritoneal cavity. There were no abnormal findings in the alimentary tract, li...

  19. Spontaneous Uterine Perforation Due to Pyometra Presenting as Acute Abdomen

    Sahoo, Sarada Prasanna; Dora, Arun Kumar; Harika, M.; Kumar, K. Ramesh

    2011-01-01

    Spontaneous perforation of uterus is rare, its incidence being about 0.01%-0.5%. We report a rare case of diffuse peritonitis and pneumoperitoneum caused by spontaneously perforated pyometra. A 50-year postmenopausal lady with abdominal pain was admitted to our hospital. Laparotomy was performed because of the suspicion of gastrointestinal perforation with generalized peritonitis. At laparotomy about 1,500 ml of pus present in peritoneal cavity and whole of alimentary tract and gallbladder we...

  20. Acute chylous peritonitis due to acute pancreatitis.

    Georgiou, Georgios K; Harissis, Haralampos; Mitsis, Michalis; Batsis, Haralampos; Fatouros, Michalis

    2012-04-28

    We report a case of acute chylous ascites formation presenting as peritonitis (acute chylous peritonitis) in a patient suffering from acute pancreatitis due to hypertriglyceridemia and alcohol abuse. The development of chylous ascites is usually a chronic process mostly involving malignancy, trauma or surgery, and symptoms arise as a result of progressive abdominal distention. However, when accumulation of "chyle" occurs rapidly, the patient may present with signs of peritonitis. Preoperative diagnosis is difficult since the clinical picture usually suggests hollow organ perforation, appendicitis or visceral ischemia. Less than 100 cases of acute chylous peritonitis have been reported. Pancreatitis is a rare cause of chyloperitoneum and in almost all of the cases chylous ascites is discovered some days (or even weeks) after the onset of symptoms of pancreatitis. This is the second case in the literature where the patient presented with acute chylous peritonitis due to acute pancreatitis, and the presence of chyle within the abdominal cavity was discovered simultaneously with the establishment of the diagnosis of pancreatitis. The patient underwent an exploratory laparotomy for suspected perforated duodenal ulcer, since, due to hypertriglyceridemia, serum amylase values appeared within the normal range. Moreover, abdominal computed tomography imaging was not diagnostic for pancreatitis. Following abdominal lavage and drainage, the patient was successfully treated with total parenteral nutrition and octreotide. PMID:22563182

  1. Acute chylous peritonitis due to acute pancreatitis

    Georgios K Georgiou; Haralampos Harissis; Michalis Mitsis; Haralampos Batsis; Michalis Fatouros

    2012-01-01

    We report a case of acute chylous ascites formation presenting as peritonitis (acute chylous peritonitis) in a patient suffering from acute pancreatitis due to hypertriglyceridemia and alcohol abuse.The development of chylous ascites is usually a chronic process mostly involving malignancy,trauma or surgery,and symptoms arise as a result of progressive abdominal distention.However,when accumulation of "chyle" occurs rapidly,the patient may present with signs of peritonitis.Preoperative diagnosis is difficult since the clinical picture usually suggests hollow organ perforation,appendicitis or visceral ischemia.Less than 100 cases of acute chylous peritonitis have been reported.Pancreatitis is a rare cause of chyloperitoneum and in almost all of the cases chylous ascites is discovered some days (or even weeks) after the onset of symptoms of pancreatitis.This is the second case in the literature where the patient presented with acute chylous peritonitis due to acute pancreatitis,and the presence of chyle within the abdominal cavity was discovered simultaneously with the establishment of the diagnosis of pancreatitis.The patient underwent an exploratory laparotomy for suspected perforated duodenal ulcer,since,due to hypertriglyceridemia,serum amylase values appeared within the normal range.Moreover,abdominal computed tomography imaging was not diagnostic for pancreatitis.Following abdominal lavage and drainage,the patient was successfully treated with total parenteral nutrition and octreotide.

  2. Rare cause of acute surgical abdomen with free intraperitoneal air: Spontaneous perforated pyometra. A report of 2 cases

    Lim, Siew Fung; Lee, Song Liang; Chiow, Adrian Kah Heng; Foo, Chek Siang; Wong, Andrew Siang Yih; Tan, Su-Ming

    2012-01-01

    Summary Background: The acute abdomen accounts for up to 40% of all emergency surgical hospital admissions and a large proportion are secondary to gastrointestinal perforation. Studies have shown the superiority of the abdominal CT over upright chest radiographs in demonstrating free intraperitoneal air. Spontaneous perforated pyometra is a rare cause of the surgical acute abdomen with free intraperitoneal air. Only 38 cases have been reported worldwide. Case Report: We report 2 cases of spon...

  3. Diagnostic difficulty in mesenteroaxial gastric volvulus— A rare cause of acute abdomen in a child

    Saifullah Khalid

    2014-05-01

    Full Text Available Gastric volvulus as a cause of acute abdomen is uncommon, especially in children. This increases the likelihood of missed or delayed diagnosis leading to increased morbidity and mortality. Acute gastric volvulus is a potentially life- threatening condition and timely diagnosis and management significantly reduces the chances of complications. We report a case of an adolescent male child, who presented to the casualty with acute abdominal pain in the epigastric region, associated with vomiting and epigastric belching and was being managed with a clinical diagnosis of acute pancreatitis. Eventration of left hemi-diaphragm was missed and gastric volvulus was not suspected in the initial differential diagnosis leading to delay in the diagnosis and management. The child was diagnosed using upper gastrointestinal barium study and was immediately operated upon with favourable outcome.

  4. Evaluation of the usefulness of computed tomography on diagnosis and management of acute abdomen

    We evaluated the usefulness of computed tomography (CT) in diagnosing and managing acute abdomen. Subjects were 91 patients admitted complaining of acute abdominal pain and divided into two groups-those undergoing CT within 24 hours of admission (emergency CT group, n=70), those without CT (Non-CT group, n=21). The emergency CT group was subdivided into those with bowel obstruction (bowel obstruction group, n=29), those with acute appendicitis and other diseases necessitating differential diagnosis (appendicitis group, n=36), those with perforation of the digestive tract (perforation group, n=4), and other disease (n=1). We evaluated the accuracy of admission diagnosis retrospectively in each group. The final diagnosis of the bowel obstruction group was adhesive bowel obstruction in 16, colon cancer in 5, external hernia in 3 and other in 5. That in the appendicitis group was acute appendicitis in 25, colonic diverticulitis in 3, pelvic inflammatory disease in 3, ovarian hemorrhage in 2 and other in 5. The origin of perforation in the perforation group was upper digestive tract in 2 and lower digestive tract in 2. The sensitivity, specificity and accuracy of admission diagnosis in the emergency CT group was 91.1, 100 and 91.4%, respectively. The accuracy of admission diagnosis was 96.5% in the bowel obstruction group, 88.9% in the appendicitis group and 75.9% in the perforation group. Patients who could not be diagnosed precisely consisted of 6 patients in the emergency CT group. Those who could not be diagnosed precisely included 3 with pericecal abscess, 1 with acute appendicitis, 1 with stercoral perforation of the sigmoid colon and 1 with impacted bezoar in the small intestine. Evaluated retrospectively, 4 patients were able to be diagnosed by CT on admission. In diagnosis of acute abdomen, CT was useful in differential diagnosis of bowel obstruction and acute appendicitis, detection of fine free air, and determine of perforated sites. Emergency CT was thus

  5. Pattern and presentation of acute abdomen in a Nigerian teaching hospital

    John Owoade Agboola

    2014-01-01

    Full Text Available Background: Abdominal pain of sudden onset is the hallmark of most non-traumatic emergency surgical presentations. This presents a scenario of urgency to the young surgeon who has to determine which of a myriad of disease conditions the patient is presenting with. Such a physician has to rely on experience and a sound knowledge of the local aetiological spectrum in making a clinical diagnosis. Objective: To determine the epidemiology and aetiological spectrum of diseases presenting as acute abdomen in the adult population at the hospital surgical emergency unit. Patients and Methods: Two hundred and seventy-six patients presenting at the University of Ilorin Teaching Hospital emergency unit and managed by the general surgeons between 1 st of May 2009 and 30 th of April 2010 were recruited and followed-up throughout the period of admission. The biodata and clinical information inclusive of diagnosis, investigations, treatment modality and outcome were entered in a structured questioner. Standardised treatment was given to all patients and difficulties encountered in their management were also noted. The data collected was evaluated using SPSS16. Results: Acute abdomen constituted 9.6% of total surgical emergency admissions with patients aged 16-45 years constituting 78.3%. The commonest cause of acute abdomen was appendicitis (30.3% followed by intestinal obstruction (27.9%, perforated typhoid ileitis 14.9% and peptic ulcer disease (7.6%, respectively. Conclusion: The result from the study is similar to what has been reported in other tropical settings with inflammatory lesions being the major problem. There is also a rising incidence of post-operative adhesions and gradual decline in incidence of obstructed hernia.

  6. Usefulness of the helical CT in gastro intestinally caused acute abdomen

    At present, there is a vivid debate on the role of the Helical CT (HCT) in the acute abdomen, principally on the usefulness of the non contrast HCT. We aim to present the most common semiological findings and the differential diagnoses, and to give a short description of the indications and protocols, according to the existing literature and to our experience with HCT during the last three years. We believe that the generalization of the use of HCT in emergencies avoid unnecessary surgery and shorten observation times on many occasions, with clear benefits in the clinical management of the patients. (Author) 30 refs

  7. [Acute abdomen in patients with HIV/AIDS seen in a national hospital of Lima, Peru].

    Montoya, Leonor; Rodríguez, Ericka; Zúñiga, Grace; Yamamoto, Gaby; González, Elsa

    2014-01-01

    The aim of this study was to describe the features in the presentation and management of acute abdomen (AA) in patients with human immunodeficiency virus (HIV). We reviewed the medical records of 97 HIV patients who presented with AA and were seen in 2006-2011 at Cayetano Heredia National Hospital in Lima, Peru. 1.6% of immunosuppressed patients underwent surgery. Appendectomy was the most common surgical procedure (33.3%). Morbidity was 28.1% and postoperative mortality was 9.4%. Infection by mycobacterium tuberculosis was the most common cause of acute abdominal pain, at 26.8%. Data suggest that an early surgical decision for cases of AA in HIV patients may prevent significant morbidity and mortality. PMID:25418651

  8. A rare cause of acute abdomen: spontaneous common hepatic duct perforation.

    Pülat, Hüseyin; Karaköse, Oktay; Benzin, Mehmet Fatih; Sabuncuoğlu, Mehmet Zafer; Çetin, Recep

    2016-01-01

    Spontaneous extrahepatic bile duct perforation is generally seen in infants. Although rarely seen in adults, it may be seen with fatal bile peritonitis. Therefore, for a patient presenting with acute abdominal symptoms, differential diagnosis must be made with radiological imaging such as abdominal ultrasonography or computed tomography, without any loss of time. In these imaging tests, in cases of gallstone disease together with perihepatic free fluid or choledocus which can not be monitored, it should be considered in the differential diagnosis. An emergency surgical intervention should be planned to avoid serious complications. The aim of this paper was to present the rare cause of acute abdomen which developed associated with spontaneous common hepatic canal perforation in an adult. PMID:27135087

  9. Usefulness of the helical CT in gastro intestinally caused acute abdomen; Utilidad de la TC helicoidal en el abdomen agudo de origen gastrointestinal

    Cruz, R. A. de la; Martel, J.; Albillos, J. C.; Oliver, J. M.; Lopez, J.; Trapero, M. A. [Fundacion Hospital Alcorcon. Madrid (Spain)

    2000-07-01

    At present, there is a vivid debate on the role of the Helical CT (HCT) in the acute abdomen, principally on the usefulness of the non contrast HCT. We aim to present the most common semiological findings and the differential diagnoses, and to give a short description of the indications and protocols, according to the existing literature and to our experience with HCT during the last three years. We believe that the generalization of the use of HCT in emergencies avoid unnecessary surgery and shorten observation times on many occasions, with clear benefits in the clinical management of the patients. (Author) 30 refs.

  10. The value of the abdominal radiograph in the assessment of the acute abdomen- work in progress

    Full text: The value of the abdominal radiograph in the assessment of the acute abdomen was evaluated for those patients who also had abdominal ultrasound and/or CT. The value of each modality in patient management is reviewed. Retrospective review of 52 consecutive patients presented to a tertiary hospital emergency department with acute abdominal pain who underwent abdominal radiographs (AXR) and abdominal ultrasound (US) and / or computed tomography (CT) within 24 hours of presentation was undertaken. There were 37 males and 15 females. The mean age was 53 years (range 18-95y). Abdominal radiographs were reviewed by two radiologists.Two patients had two separate admissions one week apart. There were 35 normal abdominal radiographs. 19 studies showed clinically relevant abnormalities. Of the normal group, 14 out of 21 patients had abnormal findings on CT and 8 out of 16 had abnormal US examinations. Of the 19 patients with abnormal AXR, 17 out of 19 patients had abnormal CT and 2 out of 5 had abnormal ultrasound examinations. There were 5 cases where both CT scan and US was performed. The positive and negative predictive value for AXR vs CT scan was 89% and 33% respectively and for AXR vs US scan was 40% and 50% respectively. For patients with normal AXR and abnormal CT, there was only one case (a non calcified abdominal aortic aneurysm) which might have required immediate surgical intervention. The preliminary results suggest that the abnormal radiograph is sensitive in the detection of relevant abnormalities in the acute abdomen in the context of appropriate clinical selection. Both CT and ultrasound provide additional diagnostic accuracy for some indications.A further 50 patients are being reviewed and the combined results will be presented. Copyright (2002) Blackwell Science Pty Ltd

  11. Cisto de úraco em adultos simulando abdômen agudo Adults urachal cyst simulating acute abdomen

    Emanuel da Silva Vieira Júnior; Rone Antônio Alves de Abreu; Manlio Basilio Speranzini

    2007-01-01

    Urachus anomalies are generally asymptomatic, but when infected can simulate acute abdomen. This anomaly has to be deemed when abdominal tenderness is associated with inflammation signs in parumbilical or hypogastric regions. Ultrasonography has great sensibility to settle down the diagnosis as observed from our three cases. Ultrasonography images with air suggest intestinal fistula in most cases with sigmoid or ileum as shown here.

  12. Two cases of acute abdomen after an intravitreal injection of bevacizumab.

    Onoda, Yasutaka; Shiba, Tomoaki; Hori, Yuichi; Maeno, Takatoshi; Takahashi, Mao

    2015-01-01

    We report on a patient with ischemic colitis and another with paralytic ileus, both of whom experienced an acute abdomen after intravitreal injection of bevacizumab (IVB). Case 1 was a 78-year-old woman. Her medical history included surgery for colon carcinoma 10 years earlier. The patient developed acute severe abdominal pain and nausea the day after IVB for retinal vein occlusion with macular edema, and massive lower gastrointestinal bleeding occurred. Ischemic colitis was diagnosed. Case 2 was a 64-year-old man who presented with neovascular glaucoma with proliferative diabetic retinopathy. We performed vitreous surgery on the 9th day after IVB, and we reperformed IVB at the end of the vitreous surgery. On the first postoperative day, severe abdominal distension, vomiting and abdominal pain were observed, and paralytic ileus was diagnosed. It is possible that gastrointestinal disorders are induced after IVB, depending on the patient's background, including for example severe diabetes or a history of surgery for gastrointestinal cancer. Thus, ophthalmologists should apply alternative therapies instead of IVB to patients with severe diabetes mellitus or a history of gastrointestinal cancer. PMID:25960733

  13. Spontaneous Perforation of Pyometra Presenting as Acute Abdomen and Pneumoperitoneum Mimicking Those of Gastrointestinal Origin

    Takahiro Yamada

    2015-01-01

    Full Text Available Gastrointestinal (GI perforation accounts for over 90% of acute abdomen and pneumoperitoneum. The presence of pneumoperitoneum secondary to spontaneously perforated pyometra is an interesting yet confusing finding given the absence of gastrointestinal (GI perforation, because pyometra is more common in postmenopausal women. We report an instructive case of diffuse peritonitis caused by spontaneous perforation of pyometra. A 70-year-old postmenopausal female was admitted to surgical emergency with signs of diffuse peritonitis. After resuscitation, an emergency laparotomy was performed because of suspicion of GI perforation. At laparotomy, about 2,000 mL of purulent fluid was found to be present in peritoneal cavity, while GI tract was intact. A rent with a diameter of 5 mm was found on anterior fundus of uterus. A total abdominal hysterectomy with a bilateral salpingo-oophorectomy was performed. Despite intensive care and a course of antibiotics, the patient died of multiple organ failure resulting from sepsis on postoperative day 16. Our case illustrates the importance of clinical knowledge of acute gynecological diseases, which are not uncommonly encountered by the general surgeon. Moreover, good appreciation of pelvic anatomy and close collaboration with gynecology and GI surgery colleagues is essential as operative intervention is often required.

  14. Spontaneous perforation of pyometra presenting as acute abdomen and pneumoperitoneum mimicking those of gastrointestinal origin.

    Yamada, Takahiro; Ando, Nanako; Shibata, Naoshi; Suitou, Motomu; Takagi, Hiroshi; Matsunami, Kazutoshi; Ichigo, Satoshi; Imai, Atsushi

    2015-01-01

    Gastrointestinal (GI) perforation accounts for over 90% of acute abdomen and pneumoperitoneum. The presence of pneumoperitoneum secondary to spontaneously perforated pyometra is an interesting yet confusing finding given the absence of gastrointestinal (GI) perforation, because pyometra is more common in postmenopausal women. We report an instructive case of diffuse peritonitis caused by spontaneous perforation of pyometra. A 70-year-old postmenopausal female was admitted to surgical emergency with signs of diffuse peritonitis. After resuscitation, an emergency laparotomy was performed because of suspicion of GI perforation. At laparotomy, about 2,000 mL of purulent fluid was found to be present in peritoneal cavity, while GI tract was intact. A rent with a diameter of 5 mm was found on anterior fundus of uterus. A total abdominal hysterectomy with a bilateral salpingo-oophorectomy was performed. Despite intensive care and a course of antibiotics, the patient died of multiple organ failure resulting from sepsis on postoperative day 16. Our case illustrates the importance of clinical knowledge of acute gynecological diseases, which are not uncommonly encountered by the general surgeon. Moreover, good appreciation of pelvic anatomy and close collaboration with gynecology and GI surgery colleagues is essential as operative intervention is often required. PMID:25628913

  15. Acute abdomen in a patient with Mayer-Rokitansky-Kuster-Hauser syndrome

    Petrić Aleksandra

    2008-01-01

    Full Text Available Background. Mayer-Rokitansky-Kuster-Hauser (MRKH syndrome is a malformation of female genital tract (incidence 1 in 4000 female newborn children. It appears as a result of a disorder in the development of Millerian cannals. Etiology is unknown. Syndrome MRKH is the most frequent cause of primary amenorrhoea (90%. Patients with MRKH have a normal female phenotype, with normal pubic hairness and thelarche, and female karyotype (46XX followed by primary amenorrhoea. Hormonal status corresponds to healthy women, where the appearance of ovarian tumors and tumors on rudiment parts of uterus is possible. Case report. We presented a case of acute abdomen in a patient with previously not diagnosed MRKH. The diagnosis was done during the operation. Small pelvis and an abdominal part were filled with torquated tumor lump, where ovaries, oviducts, uterus or something resembling rudiment of uterus were not recognized through careful examination. Furthemore, the patient had a short, dead-end vagina. Tumorectomy was done and hystopathological finding showed the presence of vascular leiomyoma. Conclusion. The diagnosis of complex syndromes, such as MRKH, can, despite modern diagnostics, be absent for non-medical and psycho-social reasons. We can expect ovarian and uterine pathology on hypoplastic structures in these patients, as well as in healthy women. Vascular leiomyoma in the patients with MRKH was not found in the available literature.

  16. Jejunal Diverticulosis Presented with Acute Abdomen and Diverticulitis Complication: A Case Report

    Fidan, Nurdan; Mermi, Esra Ummuhan; Acay, Mehtap Beker; Murat, Muammer; Zobaci, Ethem

    2015-01-01

    Summary Background Jejunal diverticulosis is a rare, usually asymptomatic disease. Its incidence increases with age. If symptomatic, diverticulosis may cause life-threatening acute complications such as diverticulitis, perforation, intestinal hemorrhage and obstruction. In this report, we aimed to present a 67-year-old male patient with jejunal diverticulitis accompanying with abdominal pain and vomiting. Case Report A 67-year-old male patient complaining of epigastric pain for a week and nausea and fever for a day presented to our emergency department. Ultrasonographic examination in our clinic revealed diverticulum-like images with thickened walls adjacent to the small intestine loops, and increase in the echogenicity of the surrounding mesenteric fat tissue. Contrast-enhanced abdominal computed tomography showed multiple diverticula, thickened walls with showing contrast enhancement and adjacent jejunum in the left middle quadrant, increased density of the surrounding mesenteric fat tissue, and mesenteric lymph nodes. The patient was hospitalized by general surgery department with the diagnosis of jejunal diverticulitis. Conservative intravenous fluid administration and antibiotic therapy were initiated. Clinical symptoms regressed and the patient was discharged from hospital after 2 weeks. Conclusions In cases of diverticulitis it should be kept in mind that in patients with advanced age and pain in the left quadrant of the abdomen, diverticular disease causing mortality and morbidity does not always originate from the colon but might also originate from the jejunum. PMID:26715947

  17. Multiparasitic Infection (Hydatid Cyst of the Spleen and Ascaris Lumbricoides Infestation) Mimicking an Acute Surgical Abdomen – Case Report

    Molnar Călin; Vizitiu Alexandru; Deak Karoly; Russu Cristian; Tudor Adrian; Suciu Bogdan; Stolnicu Simona; Hulub Marius; Molnar Claudiu

    2016-01-01

    Hydatid cyst involving the spleen is a rare clinical condition (0.5-4%). We report a case of multi-parasitic infection in a 62 year old female (hydatid cyst and ascaris lumbricoides infestation), confirmed during surgery. The purpose of the paper is to emphasize on the rare association of the two parasitic infections, affecting two different organs (spleen and jejunum). The combined symptomatology of the two parasites could mimic an acute surgical abdomen.

  18. Cisto de úraco em adultos simulando abdômen agudo Adults urachal cyst simulating acute abdomen

    Emanuel da Silva Vieira Júnior

    2007-02-01

    Full Text Available Urachus anomalies are generally asymptomatic, but when infected can simulate acute abdomen. This anomaly has to be deemed when abdominal tenderness is associated with inflammation signs in parumbilical or hypogastric regions. Ultrasonography has great sensibility to settle down the diagnosis as observed from our three cases. Ultrasonography images with air suggest intestinal fistula in most cases with sigmoid or ileum as shown here.

  19. Management of the open abdomen: clinical recommendations for the trauma/acute care surgeon and general surgeon.

    Fernández, Luis G

    2016-09-01

    Traditionally, the surgical approach to managing abdominal injuries was to assess the extent of trauma, repair any damage and close the abdomen in one definitive procedure rather than leave the abdomen open. With advances in medicine, damage control surgery using temporary abdominal closure methods is being used to manage the open abdomen (OA) when closure is not possible. Although OA management is often observed in traumatic injuries, the extension of damage control surgery concepts, in conjunction with OA, for the management of the septic patient requires that the general surgeon who is faced with these challenges has a comprehensive knowledge of this complex subject. The purpose of this article is to provide guidance to the acute care and general surgeon on the use of OA negative pressure therapy (OA-NPT; ABTHERA™ Open Abdomen Negative Pressure Therapy System, KCI, an ACELITY Company, San Antonio, TX) for OA management. A literature review of published evidence, clinical recommendations on managing the OA and a case study demonstrating OA management using OA-NPT have been included. PMID:27547961

  20. Hematometra presenting as an acute abdomen in a 13-year-old postmenarchal girl: a case report

    Klimek Peter

    2012-12-01

    Full Text Available Abstract Introduction Most underlying diseases for abdominal pain in children are not dangerous. However some require rapid diagnosis and treatment, such as acute ovarian torsion or appendicitis. Since reaching a diagnosis can be difficult, and delayed treatment of potentially dangerous diseases might have significant consequences, exploratory laparoscopy is a diagnostic and therapeutic option for patients who have unclear and potentially hazardous abdominal diseases. Here we describe a case where the anomaly could not be identified using a laparoscopy in an adolescent girl with acute abdomen. Case presentation A 13-year old postmenarchal caucasian female presented with an acute abdomen. Emergency sonography could not exclude ovarian torsion. Accurate diagnosis and treatment were achieved only after an initial laparoscopy followed by a laparotomy and after a magnetic resonance imaging scan a further laparotomy. The underlying disease was hematometra of the right uterine horn in a uterus didelphys in conjunction with an imperforate right cervix. Conclusion This report demonstrates that the usual approach for patients with acute abdominal pain may not be sufficient in emergency situations.

  1. Hereditary angioderma: an uncommon cause of acute abdomen. Abdominal computed tomography and ultrasound findings; Angioedema hereditario: una causa infrecuente de abdomen agudo. Hallazgos en la TC e ecografia abdominal

    Cruz, R.A. de la; Oliver, J. M.; Bueno, A.; Albillos, J. C. [Fundacion Hospital Alcorcon. Madrid (Spain)

    2002-07-01

    We present an uncommon case of acute abdomen in a patient with hereditary angioderma. The ultrasound and CT findings described may suggest this diagnosis, thus avoiding useless surgical interventions in patients in whom the disease has not been previously diagnosed. (Author) 19 refs.

  2. Management of a Septic Open Abdomen Patient with Spontaneous Jejunal Perforation after Emergent C/S with Confounding Factor of Mild Acute Pancreatitis

    Yetisir, Fahri; Sarer, Akgün Ebru; Acar, Hasan Zafer; Osmanoglu, Gokhan; Özer, Mehmet; Yaylak, Faik

    2016-01-01

    Introduction. We report the management of a septic Open Abdomen (OA) patient by the help of negative pressure therapy (NPT) and abdominal reapproximation anchor (ABRA) system in pregnant woman with spontaneous jejunal perforation after emergent cesarean section (C/S) with confounding factor of mild acute pancreatitis (AP). Presentation of Case. A 29-year-old and 34-week pregnant woman with AP underwent C/S. She was arrested after anesthesia induction and responded to cardiopulmonary resuscitation (CPR). There were only ash-colored serosanguinous fluid within abdomen during C/S. After C/S, she was transferred to intensive care unit (ICU) with vasopressor support. On postoperative 1st day, she underwent reoperation due to fecal fluid coming near the drainage. Leakage point could not be identified exactly and operation had to be deliberately abbreviated due to hemodynamic instability. NPT was applied. Two days later source control was provided by conversion of enteroatmospheric fistula (EAF) to jejunostomy. ABRA was added and OA was closed. No hernia developed at 10-month follow-up period. Conclusion. NPT application in septic OA patient may gain time to patient until adequate source control could be achieved. Using ABRA in conjunction with NPT increases the fascial closure rate in infected OA patient. PMID:27006853

  3. Management of a Septic Open Abdomen Patient with Spontaneous Jejunal Perforation after Emergent C/S with Confounding Factor of Mild Acute Pancreatitis

    Fahri Yetisir

    2016-01-01

    Full Text Available Introduction. We report the management of a septic Open Abdomen (OA patient by the help of negative pressure therapy (NPT and abdominal reapproximation anchor (ABRA system in pregnant woman with spontaneous jejunal perforation after emergent cesarean section (C/S with confounding factor of mild acute pancreatitis (AP. Presentation of Case. A 29-year-old and 34-week pregnant woman with AP underwent C/S. She was arrested after anesthesia induction and responded to cardiopulmonary resuscitation (CPR. There were only ash-colored serosanguinous fluid within abdomen during C/S. After C/S, she was transferred to intensive care unit (ICU with vasopressor support. On postoperative 1st day, she underwent reoperation due to fecal fluid coming near the drainage. Leakage point could not be identified exactly and operation had to be deliberately abbreviated due to hemodynamic instability. NPT was applied. Two days later source control was provided by conversion of enteroatmospheric fistula (EAF to jejunostomy. ABRA was added and OA was closed. No hernia developed at 10-month follow-up period. Conclusion. NPT application in septic OA patient may gain time to patient until adequate source control could be achieved. Using ABRA in conjunction with NPT increases the fascial closure rate in infected OA patient.

  4. Abdomen - swollen

    Swollen belly; Swelling in the abdomen; Abdominal distention; Distended abdomen ... Abdominal swelling, or distention, is more often caused by overeating than by a serious illness. This problem also can be caused by: Air ...

  5. When and why use unenhanced computed tomography in patients with acute abdomen; Tomografia computadorizada sem contraste intravenoso no abdome agudo: quando e por que usar

    Freire Filho, Edison de Oliveira; D' Ippolito, Giuseppe; Szejnfeld, Jacob [Universidade Federal de Sao Paulo (UNIFESP/EPM), SP (Brazil). Dept. de Diagnostico por Imagem]. E-mail: eofilho@ig.com.br; Jesus, Paulo Eduardo Marinho de [Clinica Radiologica de Anapolis, GO (Brazil)

    2006-01-15

    The use of unenhanced computed tomography has been frequently recommended for the initial assessment of patients with clinical suspicion of acute abdomen instead of other diagnostic methods. The authors present a review of the literature on the main aspects, advantages, limitations and efficacy of unenhanced computed tomography for the diagnosis of acute appendicitis, renal colic, diverticulitis, acute pancreatitis, primary epiploic appendicitis, pneumoperitoneum and small bowel obstruction. The advantages and limitations of this technique are also discussed. (auth0008.

  6. Abdome agudo: ruptura espontânea de bexiga como um importante diagnóstico diferencial Acute abdomen: spontaneous bladder rupture as an important differential diagnosis

    Carlos Augusto Gomes; André Avarese de Figueiredo; Cleber Soares Júnior; José Murillo Bastos Netto; Fabrício Rodrigues Tassi

    2009-01-01

    A case of spontaneous perforation of the bladder in a diabetic female patient is reported. It is a rare clinical condition, that should be suspected in patients with a past history of radiotherapy to the pelvis, enterocystoplasty and those suspected of having a tumor in the bladder. A general surgeon should be aware of this possibility in the differential diagnosis of an acute abdomen.

  7. Expression and Significance of Toll-like Receptor 2, 4 of Peripheral Blood Mononuclear Cells in Acute Abdomen Patients Associated with Systemic Inflammatory Response Syndrome

    XIONG Jing; WANG Yang; ZHU Zhonghua; LIU Jianshe

    2006-01-01

    The changes of Toll-like receptor (TLR) 2, 4 of peripheral blood mononuclear cells (PBMCs) in the acute abdomen patients associated with systemic inflammatory response syndrome (SIRS) and their potential significance were explored. A clinical study was performed on 103 acute abdomen patients in whom 65 were associated with SIRS. Forty healthy individuals served as normal controls. The mRNA expression of TLR2, 4 was detected by RT-PCR, and the expression of TNF-αand IL-6 by ELISA. The level of plasma endotoxin, hospital stay and mortality were measured. It was found that the endotoxin level was increased to varying degrees in all the acute abdomen patients, and the endotoxin level was and hospital stay longer in SIRS group than in non-SIRS group (P<0.01).TLR2 mRNA, TLR4 mRNA, IL-6 and TNF-α could be detected with low value in normal controls,but they were up-regulated markedly on the 1 st day after admission. Then TLR4 mRNA, IL-6 and TNF-α were decreased gradually, but TLR2 mRNA maintained at a high level till the 5th day. These indexes above in SIRS group were higher than those in non-SIRS group (P<0.01). The results of correlation analysis revealed the expression of TLR2, 4 mRNA was positively correlated with the levels of TNF-α and IL-6, and the hospital stay. The results of Logistic regression demonstrated that overexpression of TLR2, 4 mRNA might result in higher risk of multiple organ dysfunction syndrome (MODS). It was concluded that in the acute abdomen patients associated with SIRS, the expression of TLR2, 4 in PBMCs was increased markedly, suggesting that TLR might play an important role in the pathogenesis of acute abdomen associated with SIRS.

  8. Fibroid degeneration in a postmenopausal woman presenting as an acute abdomen

    Rajesh Shrestha

    2015-02-01

    Full Text Available Uterine fibroid, one of the most common tumors in women, is estrogen dependent, which commonly regresses after menopause. Fibroid degeneration after menopause, therefore, is rare. Here the authors report a case of 56-year-old postmenopausal woman who presented with acute abdominal pain, low grade fever, and leukocytosis as a result of fibroid degeneration.

  9. Acute renal failure due to rhabdomyolyisis

    Nieto-Ríos, John Fredy

    2016-04-01

    Full Text Available Acute renal failure is a frequent cause of morbidity and mortality in emergency, hospitalization and critical care services. In 15 % of cases it is due to rhabdomyolysis, in which there is breakdown of skeletal muscle with massive necrosis and leakage of muscle cell contents into the circulation. It has many different etiologies. The rhabdomyolysis-induced acute kidney injury results from the combination of several mechanisms, including tubular obstruction, vasoconstriction and oxidative stress. The most important therapeutic measures are: Aggressive repletion of fluids, forced diuresis and avoidance of exposure to nephrotoxic substances. In cases of severe uremia, metabolic acidosis, hiperkalemia or fluid overload it is necessary to start renal replacement therapy. As a rule, kidney function is completely recovered, but these patients have higher risk of future chronic kidney disease.

  10. Acute Paraplegia due to Thoracic Hematomyelia

    Celik, Bahattin; Canbek, Ihsan; Karavelioğlu, Ergun

    2016-01-01

    Spontaneous intraspinal intramedullary hemorrhage is a rare entity with the acute onset of neurologic symptoms. The etiology of idiopathic spontaneous hematomyelia (ISH) is unknown, and there are few published case reports. Hematomyelia is mostly associated with trauma, but the other nontraumatic etiologies are vascular malformations, tumors, bleeding disorders, syphilis, syrinx, and myelitis. MRI is a good choice for early diagnosis. Hematomyelia usually causes acute spinal cord syndrome due to the compression and destruction of the spinal cord. A high-dose steroid treatment and surgical decompression and evacuation of hematoma are the urgent solution methods. We present idiopathic spontaneous hematomyelia of a previously healthy 80-year-old male with a sudden onset of back pain and paraplegia.

  11. Acute Abdomen in a Case With Noncommunicating Rudimentary Horn and Unicornuate Uterus

    Atmaca, Rusen; Germen, Aysegul Tezcan; Burak, Feza; Kafkasli, Ayse

    2005-01-01

    Unicornuate uterus with a rudimentary horn is the rarest congenital anatomic anomaly of the female genital system, causing many obstetrical and gynecologic complications. The frequency of this pathology is approximately 1/100 000. A rudimentary horn usually develops following insufficient development of mullerian ducts. These patients present with dysmenorrhea, dyspareunia, and chronic pelvic pain because of endometriosis and rarely with acute abdominal symptoms following distention and torsi...

  12. Spontaneously perforated pyometra: an unusual cause of acute abdomen and pneumoperitoneum

    Shapey, IM; Nasser, T; Dickens, P; Haldar, M; Solkar, MH

    2012-01-01

    Pneumoperitoneum is usually associated with gastrointestinal perforation or following surgical and endoscopic procedures. We report a rare case of spontaneously perforated pyometra presenting with generalised peritonitis and pneumoperitoneum. Perforation of the uterus is also unusual and often associated with the presence of an intrauterine device, a gravid uterus or malignancy. Our case illustrates the importance of clinical knowledge of acute and neoplastic gynaecological diseases, which ar...

  13. Diagnostic Algorithm in the Management of Acute Febrile Abdomen in Patients with Autosomal Dominant Polycystic Kidney Disease

    Neuville, Marie; Hustinx, Roland; Jacques, Jessica; Krzesinski, Jean-Marie

    2016-01-01

    Background Acute febrile abdomen represents a diagnostic challenge in patients with autosomal dominant polycystic kidney disease (ADPKD). Although criteria have been proposed for cyst infection (CyI) and hemorrhage (CyH), there is a lack of comparative assessments. Furthermore, distinguishing cystic from non-cystic complications remains problematic. Design ADPKD patients presenting with abdominal pain and/or fever between 01/2005 and 06/2015 were retrospectively identified in a systematic computerized billing database. CyH was defined as spontaneous intracystic density above 50 Hounsfield units on computed tomography (CT). CyI was definite if confirmed by cyst puncture, and probable if 4 criteria were met: 3-day fever, loin/liver tenderness, C-reactive protein (CRP) plasma levels >50mg/L and no CT evidence for CyH. Other episodes were grouped as inflammation of unknown origin (IUO). Results Among a cohort of 173 ADPKD patients, 101 presented with 205 episodes of abdominal pain (n = 172) and/or fever (n = 33). 20 patients experienced 30 CyH, whereas 16 presented 23 episodes of definite (n = 11) or probable (n = 12) CyI. 35 IUO were observed in 31 patients. Clinically, fever was observed in 7% vs. 100% vs. 66% of CyH, CyI and IUO, respectively. Biologically, CRP cut-off at 70 mg/dl showed 92% sensitivity and 81% specificity in CyI diagnosis. Urine or blood cultures remained sterile in >90% of CyH, but were contributive in 53.4% of CyI and IUO, with a 74.2% prevalence for E. coli. Radiologically, ultrasounds, CT and magnetic resonance diagnosed CyI in 2.6%, 20% and 16.7% of cases, respectively. 18F-FDG positron-emission tomography (PET)/CT was done within a median period of 7 days post antibiotics, and significantly changed patient management in 71.4%. Conclusions This retrospective single-center series underscores the usefulness of clinical–fever–and biological–CRP–parameters, but emphasizes the limitations of bacteriological and radiological investigations

  14. Acute abdomen in early pregnancy caused by torsion of bilateral huge multiloculated ovarian cysts

    Sathiyakala Rajendran; Suthanthira Devi

    2015-01-01

    The association of pregnancy and torsion of bilateral huge benign ovarian cyst is rare. We report a case of multigravida at 13 weeks of pregnancy presenting with acute onset of lower abdominal pain. Ultrasound revealed bilateral multiloculated ovarian cysts of size 10x10 cm on right side and 15x10cm on left side with evidence of torsion and a single live intrauterine fetus of gestational age 13 weeks 4 days. Emergency laparotomy was done with vaginal susten 200 mg as perioperative tocolysis. ...

  15. Torsion of para-ovarian cyst : a cause of acute abdomen.

    Puri Manju; Jain Kanika; Negi Rinku

    2003-01-01

    Torsion of uterine adnexa is an important cause of acute abdominal pain. Torsion of ovarian masses is quite common and isolated torsion of fallopian tube has also been reported in literature. However, torsion of para ovarian cyst is a very rare. We report a rare case of twisted para ovarian cyst resulting in secondary torsion of the fallopian tube. Torsion of fallopian tube and para ovarian cyst are usually seen in the reproductive age group. Physicians need to maintain a high index of suspic...

  16. Epstein-Barr Virus Myocarditis Presenting as Acute Abdomen in a Child: a Case Report

    Roshni Chakraborty

    2015-10-01

    Full Text Available Introduction Epstein-Barr  virus  (EBV  infection  can  present  with  a  variety  of  manifestation. Case Report  Here  we  present  a  case  of  a  7  year- old  immunocompetent  girl  who  came  with  acute  abdominal  pain ,  had  echocardiographic  evidence  of  myocardial  dysfunction  and  finally  was  diagnosed  as  a  case  of  serologically  proven  acute  EBV  infection. Conclusion Isolated  gastrointestinal  symptoms  can  be  a  presentation  of  Epstein-Barr  virus  myocarditis.

  17. Effect of contrast-enhanced computed tomography on diagnosis and management of acute abdomen in adults

    AIM: To determine the impact of computed tomography (CT) on the diagnosis and treatment plan in patients with acute abdominal pain. MATERIALS AND METHODS: A prospective study was undertaken in 125 adult patients presenting with acute abdominal pain (74 men and 51 women; 40.2 ± 19.3 years; range, 18-92). Changes in diagnosis, gain in percentage diagnostic certainty and changes of treatment plan of the surgeons in the emergency department before and after CT were evaluated. Pre- and post-CT diagnoses were compared with the final diagnoses. RESULTS: CT findings changed the initial diagnosis in 40 (32.0%) patients. The diagnostic certainty was 58.3 ± 22.9% before CT, and its gain after CT was 21.9 ± 18.5 points (P < 0.0001). Post-CT diagnoses were consistent with the final diagnosis in 116 patients (92.8%), while pre-CT diagnoses were correct in 89 patients (71.2%; P < 0.0001). Initial treatment plans were changed in 31 (24.8%) patients after CT. In 57 (45.6%) patients, CT information changed diagnoses and/or treatment plans. No significant differences were observed in the diagnosis, diagnostic certainty and treatment plan among four surgeons. CONCLUSION: Contrast-enhanced CT frequently changed the clinical diagnoses with increased diagnostic certainty and the initial treatment plans. Tsushima, Y. et al. (2002)

  18. Acute abdomen in early pregnancy caused by torsion of bilateral huge multiloculated ovarian cysts

    Sathiyakala Rajendran

    2015-10-01

    Full Text Available The association of pregnancy and torsion of bilateral huge benign ovarian cyst is rare. We report a case of multigravida at 13 weeks of pregnancy presenting with acute onset of lower abdominal pain. Ultrasound revealed bilateral multiloculated ovarian cysts of size 10x10 cm on right side and 15x10cm on left side with evidence of torsion and a single live intrauterine fetus of gestational age 13 weeks 4 days. Emergency laparotomy was done with vaginal susten 200 mg as perioperative tocolysis. Intra operatively, uterus was enlarged to 14 weeks size. Both ovaries were replaced with multiloculated cysts of size 15x10 cm on left side and 10x10 cm on right side. Ovarian pedicle was found to be twisted once on right side and twice on left side. On right side, untwisting of pedicle was done and the ovarian cyst was punctured at multiple sites to drain the clear fluid. Biopsy was taken from the right ovarian cyst wall. On left side, ovariotomy was done. Histopathology revealed mucinous cyst adenoma of left ovary and multiple corpus luteum in right ovarian biopsy specimen. The patient was followed up with regular antenatal check-ups and ultrasound to rule out the recurrence of ovarian cyst on right side. The patient successfully delivered a term male baby at 39 weeks. [Int J Reprod Contracept Obstet Gynecol 2015; 4(5.000: 1598-1601

  19. Acute hepatitis due to brucellosis: case report

    Nevil AYKIN

    2009-06-01

    Full Text Available Brucella infection is a systemic disease. It rarely causes local infections like hepatitis in gastrointestinal system. In this article we would like to present an acute hepatitis case related to brucella infection that followed up in our clinic. A male, 30 year-old patient hospitalized due to common muscle pain, high fever and vomiting. During the physical examination the patient’s skin, scleras and mucosal membranes were icteric, the liver was 2-3 cm palpable and tender. Laboratory findings were as follows: AST:1190 U/L; ALT:715 U/L; GGT:961 U/L; ALP:369 U/L; total bilirubin:4.6 mg/dL; direct bilirubin:2.1 mg/dL. Viral markers were found to be negative. We started treatment with streptomicine and doxicycline since, the patient’s standard brucella tube agglutination test was positive (1/60 and brucella spp produced in his blood culture. From the second day of the treatment, we started to get clinical response. On the 17th day of the treatment, he discharged from the hospital because ALT, AST and bilirubine level were found normal and his treatment was completed to the 8 weeks. Brucella is continuing to be an important health problem especially who live in surrounding countryside and have to keep in mind in the differential diagnosis of the acute hepatitis.

  20. Abdome agudo: ruptura espontânea de bexiga como um importante diagnóstico diferencial Acute abdomen: spontaneous bladder rupture as an important differential diagnosis

    Carlos Augusto Gomes

    2009-08-01

    Full Text Available A case of spontaneous perforation of the bladder in a diabetic female patient is reported. It is a rare clinical condition, that should be suspected in patients with a past history of radiotherapy to the pelvis, enterocystoplasty and those suspected of having a tumor in the bladder. A general surgeon should be aware of this possibility in the differential diagnosis of an acute abdomen.

  1. A case of intensive care unit-acquired weakness after emergency surgery for acute abdomen

    Tominaga, Tetsuro; Nonaka, Takashi; Takeshita, Hiroaki; Honda, Yuichiro; Nagura, Hiroki; Shiraishi, Toshio; Kunizaki, Masaki; Sumida, Yorihisa; Hidaka, Shigekazu; Sawai,Terumitsu; Nagayasu, Takeshi

    2016-01-01

    Introduction Surgeons often perform surgery for patients who are critically ill. Intensive care unit (ICU)-acquired weakness (ICUAW) is a condition in which systemic and prolonged muscle weakness occurs and causes worse short-term and long-term outcomes. Presentation of case A 60-year-old woman with sudden nausea and vomiting presented to our hospital and developed shock. Abdominal CT showed thickness of the descending colon and ascites. She was diagnosed with sepsis due to descending colon c...

  2. A case of intensive care unit-acquired weakness after emergency surgery for acute abdomen

    Tetsuro Tominaga; Takashi Nonaka; Hiroaki Takeshita; Yuichiro Honda; Hiroki Nagura; Toshio Shiraishi; Masaki Kunizaki; Yorihisa Sumida; Shigekazu Hidaka; Terumitsu Sawai; Takeshi Nagayasu

    2016-01-01

    Introduction: Surgeons often perform surgery for patients who are critically ill. Intensive care unit (ICU)-acquired weakness (ICUAW) is a condition in which systemic and prolonged muscle weakness occurs and causes worse short-term and long-term outcomes. Presentation of case: A 60-year-old woman with sudden nausea and vomiting presented to our hospital and developed shock. Abdominal CT showed thickness of the descending colon and ascites. She was diagnosed with sepsis due to descending co...

  3. Analgesia in patients with acute abdomen: does danger persist? Analgesia en el paciente con abdomen agudo: ¿persiste el peligro?

    Juan Camilo Correa Gallego; Edward Alexander Blandón Castaño

    2006-01-01

    INTRODUCTION: Acute abdominal pain is a very frequent cause of medical consultation. Early analgesia is not usually given to patients that present with it as their chief complaint, because of the many differential diagnoses that must be taken into consideration and also because of fear of the potential complications that may ensue if an early and accurate diagnosis is not made. Nowadays medical practice is evolving and it is pertinent to ask and answer whether it is still adequate to keep the...

  4. Improving the diagnosis of acute appendicitis in children with atypical clinical findings using the technetium-99m hexamethylpropylene amine oxime-labelled white-blood-cell abdomen scan

    Heading AbstractBackground. Diagnosing acute appendicitis in children with equivocal signs and symptoms may be difficult. The usual approach is hospital observation and frequent re-examination. However, many surgeons are reluctant to delay surgery because of the risk of perforation and a negative laparotomy.Objective. To assess and compare the value of the technetium-99m hexamethylpropylene amine oxime (99mTc-HMPAO)-labelled white-blood-cell (WBC) abdomen scan in the diagnosis of acute appendicitis in children with atypical clinical presentation.Patients and methods. Fifty children with acute right lower quadrant abdominal pain and possible acute appendicitis, but atypical findings were included. After IV injection of 99mTc-HMPAO-labelled WBCs, serial anterior abdomen scans were obtained using a gamma camera.Results. Thirty-three children underwent surgery, while 17 children were managed conservatively and were followed up for at least 1 month. Four children had false-positive results and one child had a false-negative scan result. The overall sensitivity, specificity, accuracy, positive predictive value and negative predictive value of the scan to diagnose acute appendicitis in children with atypical findings was 96.7, 80.0, 90.0, 87.8 and 94.1%, respectively.Conclusions. The 99mTc-HMPAO WBC abdomen scan is a potential tool for diagnosing acute appendicitis in children with atypical clinical findings. The high sensitivity and negative predictive value allows early discharge from the emergency department to avoid costly observation in hospital and potentially unnecessary surgery in those patients with negative scans. (orig.)

  5. Torsion of cystic ovary: an unusual cause of acute abdomen in midtrimester pregnancy

    Poornima C

    2014-08-01

    Full Text Available Torsion of ovary is an infrequent cause of surgical emergency in pregnancy. Most frequently ovarian torsion occurs in first trimester, occasionally in second and rarely in the third trimester. Diagnosis of ovarian torsion is challenging due to non-specific clinical features. We report here a case of dermoid cyst causing ovarian torsion in second trimester and imaging modalities for its diagnosis and management. A case of 19 year old primi at 24 weeks of gestational age came with complaints of pain in right iliac fossa for 2 days. USG done showed non vascular heterogeneous hyper echoic lesion in right adnexa, suggestive of torsion of right ovary with viable intrauterine fetus. She underwent emergency laparotomy, during which we removed necrotic and gangrenous right ovary and fallopian tube. Ovarian torsion is an infrequent cause of abdominal pain in pregnancy. Though it occurs most frequently in first trimester, it may occur in second trimester also. USG is an accurate tool in diagnosing torsion. Early surgical management is associated with favorable maternal and fetal outcome. [Int J Reprod Contracept Obstet Gynecol 2014; 3(4.000: 1134-1137

  6. Acute generalized exanthematous pustulosis due to tetrazepam.

    Thomas, E; Bellón, T; Barranco, P; Padial, A; Tapia, B; Morel, E; Alves-Ferreira, J; Martín-Esteban, M

    2008-01-01

    Tetrazepam is a benzodiazepine that is widely used in Spain as a muscle relaxant, with occasional cutaneous side effects. We report a patient who developed a generalized pruriginous cutaneous reaction compatible with acute generalized exanthematous pustulosis (AGEP) due to tetrazepam. Patch tests with bromazepam, diazepam, and tetrazepam were negative at 48 and 72 hours; however, the tetrazepam patch showed a positive reaction at 10 days. Immunohistochemical studies revealed a mononuclear infiltrate composed of CD4+ and CD8+ T lymphocytes. Analysis of interleukin (IL) 8 expression by quantitative polymerase chain reaction revealed increased IL-8 mRNA levels in patch test-positive skin. Lymphoblast transformation test (LTT) was positive with tetrazepam but not with diazepam. Positive patch test and LTT suggested that tetrazepam-specific lymphocytes might be responsible for a T cell-mediated reaction. These results support previous data suggesting an important role for IL-8 and drug-specific T cells in the pathogenesis ofAGEP and imply that the reaction was specific to tetrazepam with no cross-reactivity to other benzodiazepines. PMID:18447141

  7. Acute Pancreatitis Due to Pravastatin Therapy

    Anagnostopoulos GK

    2003-05-01

    Full Text Available CONTEXT: Few data exist about the incidence of drug-induced pancreatitis in the general population. Drugs are related to the etiology of pancreatitis in about 1.4-2% of cases. Statins are generally well tolerated. Acute pancreatitis has been reported in a few cases treated with atorvastatin, fluvastatin, lovastatin and simvastatin. CASE REPORT: We report the case of a 56-year-old patient who, after 6 months of treatment with pravastatin 20 mg once daily for hypercholesterolemia, presented with acute pancreatitis. Other causes of the disease were ruled out. Five months later, the patient, on his own initiative, reintroduced pravastatin and acute pancreatitis recurred after 3 days. CONCLUSION: To our knowledge this is the first report of pravastatin-induced pancreatitis and further strengthens the fact that statins may cause acute pancreatitis.

  8. Acute pancreatitis due to scrub typhus

    Atif Shaikh Iqbal Ahmed

    2014-01-01

    Full Text Available Scrub typhus is endemic in large parts of India and can cause multi-organ failure and death. Acute pancreatitis as a complication is very rare and is potentially fatal. This case series describes seven adult patients who presented with an acute febrile illness and were diagnosed to have scrub typhus with acute pancreatitis. The mean age of the seven patients with acute pancreatitis was 49.4 years, and mean duration of fever prior to presentation was 7.7 days. All seven patients had abdominal pain, and three had a pathognomonic eschar. The mean serum lipase level was 1,509 U/L (normal value: <190 U/L and the mean serum amylase level was 434 U/L (normal value: <200 U/L. Six patients had evidence of multi-organ dysfunction. Hematological and respiratory system dysfunction was seen in five patients, hepatic and renal dysfunction in four, and central nervous system dysfunction in three patients. Three patients who had ≥4 organs involved, died (mortality rate: 42.8%. Our case series shows that pancreatitis in scrub typhus is an extremely rare complication and when present, is associated with increased mortality (42.8%. Physicians may be familiar with the various complications of scrub typhus but less so with acute pancreatitis and hence may be underdiagnosed.

  9. Gastric Necrosis due to Acute Massive Gastric Dilatation

    Ibrahim Aydin

    2013-01-01

    Full Text Available Gastric necrosis due to acute massive gastric dilatation is relatively rare. Vascular reasons, herniation, volvulus, acute gastric dilatation, anorexia, and bulimia nervosa play a role in the etiology of the disease. Early diagnosis and treatment are highly important as the associated morbidity and mortality rates are high. In this case report, we present a case of gastric necrosis due to acute gastric dilatation accompanied with the relevant literature.

  10. Acute Respiratory Distress Due to Methane Inhalation

    Jo, Jun Yeon; Kwon, Yong Sik; Lee, Jin Wook; Park, Jae Seok; Rho, Byung Hak; Choi, Won-Il

    2013-01-01

    Inhalation of toxic gases can lead to pneumonitis. It has been known that methane gas intoxication causes loss of consciousness or asphyxia. There is, however, a paucity of information about acute pulmonary toxicity from methane gas inhalation. A 21-year-old man was presented with respiratory distress after an accidental exposure to methane gas for one minute. He came in with a drowsy mentality and hypoxemia. Mechanical ventilation was applied immediately. The patient's symptoms and chest rad...

  11. Emergency thyroidectomy: Due to acute respiratory failure

    Zulfu Bayhan; Sezgin Zeren; Bercis Imge Ucar; Isa Ozbay; Yalcin Sonmez; Metin Mestan; Onur Balaban; Nilufer Araz Bayhan; Mehmet Fatih Ekici

    2014-01-01

    INTRODUCTION: Giant cervical and mediastinal goiter may lead to acute respiratory failure caused by laryngotracheal compression and airway obstruction. Here, we present a case admitted to the emergency service with a giant goiter along with respiratory failure and poor general health status, which required urgent surgical intervention. PRESENTATION OF CASE: A 71-year-old female admitted to the emergency room with shortness of breath and poor general health status resulting from a giant cer...

  12. Acute renal failure due to ciprofloxacin.

    Allon, M; Lopez, E J; Min, K W

    1990-10-01

    Acute renal failure developed in three patients within a few days of starting ciprofloxacin hydrochloride therapy. An allergic interstitial nephritis was suggested by fever and eosinophiluria in one patient and by erythema multiforme in another. A kidney biopsy specimen confirmed this diagnosis in one patient. Renal function improved shortly after withdrawal of the drug in all three patients. Literature survey revealed an additional three patients with a similar complication. Allergic manifestations, such as fever or rash, were a feature in most reported cases. In view of this potential complication, renal function should be closely monitored in patients receiving ciprofloxacin therapy, especially if other potentially nephrotoxic drugs are prescribed concomitantly. PMID:2222106

  13. Acute Myocardial Infarction Due To Electrical Injury

    Uzkeser M et al.

    2011-01-01

    Rhythm abnormalities (conduction defects, tachycardia, and arrhythmia)due to electric shock are common. Rarely, myocardial infarction may beseen in these patients. This situation is generally caused by coronaryartery vasospasm and direct myocardial damage. In this report, wepresent a rare case of myocardial infarction due to electric shock.

  14. Early maternal death due to acute encephalitis

    M Vidanapathirana

    2014-03-01

    Full Text Available Maternal death in an unmarried woman poses a medico-legal challenge. A 24-year-old unmarried schoolteacher, residing at a boarding place, had been admitted to hospital in a state of cardiac arrest. At the autopsy, mild to moderate congestion of subarachnoid vessels and oedema of the brain was noted. An un-interfered foetus of 15 weeks with an intact sac and placental tissues were seen. Genital tract injuries were not present. Histopathological examination showed diffuse perivascular cuffing by mononuclear cells suggestive of viral encephalitis, considering the circumstances of death and the social stigma of pregnancy in this unmarried teacher, the possibility of attempted suicide by ingestion of a poison was considered. Abrus precatorius (olinda seeds commonly found in the area is known to produce acute encephalitis as well as haemorrhagic gastroenteritis and pulmonary congestion was also considered as a possible cause for this unusual presentation

  15. Clinical analysis of ovarian tumor in gynecologic acute abdomen%妇科急腹症中卵巢恶性肿瘤临床分析

    岳艳; 周希; 高霞; 黄光荣

    2012-01-01

    Objective To analyze the clinical features, diagnosis and treatment methods for ovarian malignant carcinoma in gynecologic acute abdomen. Methods Retrospectively analyze the clinical data of nine cases of malignant and borderline ovarian carcinoma which were hospitalized from March 2006 to February 2011 because of acute abdomen and summarize their clinical features. Results The intraoperative rapid frozen section pathological examination confirmed ovarian cancer in seven eases. Among the seven cases there were one cases of serous cystadenocarcinoma, two cases of borderline mucinous cystadenoma, three cases of yolk sac tumor and one cases of ovarian endometrioid carcinoma , and they were treated by staging surgery or cytoreductive surgery respectively. The other two cases were confirmed immature terato-mas by pathologic examination and then conducted a secondary staging surgery. Conclusion Ovarian malignant carcinoma could be found in gynecological acute abdomen, so it is of great importance in preoperative preparation, surgical incision selection, and operation method option.%目的 探讨妇科急腹症中卵巢恶性肿瘤的临床特点、诊断及治疗措施.方法 我院2006年3月至2011年2月收治的急腹症患者术后病检证实为卵巢恶性及交界性肿瘤9例,回顾性分析这9例的临床资料,总结其临床特点.结果 术中快速冰冻切片病理检查证实为卵巢恶性肿瘤7例,其中浆液性囊腺癌1例,交界性粘液性囊腺瘤2例,卵黄囊瘤3例,子宫内膜样肿瘤1例,分别行分期手术或肿瘤细胞减灭术;另2例术后病检证实为未成熟性畸胎瘤,再次行分期手术.结论 卵巢恶性肿瘤可见于妇科急腹症中,因此,急诊手术时对术前准备、手术切口选择及手术方式应有充分预见.

  16. Laparoscopia no abdome agudo inflamatório de difícil diagnóstico Laparoscopy in inflamatory acute abdomen of difficult diagnosis

    Antonio Carlos Valezi

    2003-08-01

    Full Text Available OBJETIVOS: O objetivo deste estudo foi analisar a eficácia do método laparoscópico em casos de abdome agudo inflamatório de difícil avaliação, quanto à acurácia, sensibilidade, especificidade e valores preditivos positivo e negativo. MÉTODO: Foram examinados, prospectivamente, 29 doentes com suspeita clínica de abdome agudo inflamatório, que após exames clínico e complementares não esclarecedores, foram submetidos à laparoscopia diagnóstica e/ou terapêutica. RESULTADOS: A precisão diagnóstica do exame foi de 96,5%. Com relação à terapêutica, 58,6 % dos doentes foram tratados por laparoscopia, 34,4% clinicamente e 6,8 % por laparotomia. A taxa de complicação foi de 10,3%, com ausência de mortalidade nesta série. Os doentes submetidos ao tratamento laparoscópico, tiveram alta hospitalar em média 36 horas após o procedimento. CONCLUSÕES: A laparoscopia mostrou-se um método de elevada acurácia diagnóstica, que permitiu manejo terapêutico satisfatório, associado à baixa morbidez e à recuperação pós-operatória precoce.OBJECTIVE: The aim of this study is to analize the efficacy of laparoscopy in cases of acute inflamatory abdomen of difficult diagnosis, according to accuracy, sensitivity, specificity and negative and positive predictive values. METHODS: The authors studied, prospectively, 29 patients with clinical suspicion of inflamatory acute abdomen, that, after inconclusive clinical and complemental investigations were submitted to diagnostic and / or therapeutic laparoscopy. RESULTS: In 96,5 % of the patients the procedure confirmed the diagnosis; 58,6 % of the patients were treated by laparoscopy, 6,8% by laparotomy and 34,4% received clinical treatment. The complication rate was 10,3 %, with no mortality in this study. Patients treated by laparoscopy were discharged from hospital in 36 hours after the procedure. CONCLUSIONS: Laparoscopy proved to be a good diagnostic and therapeutic method in acute

  17. Acute small bowel obstruction due to chicken bone bezoar

    Vetpillai P; Oshowo A

    2012-01-01

    Preadeepan Vetpillai,1 Ayo Oshowo21CT2 Surgery in General, Charing Cross Hospital, 2Colorectal and Laparoscopic Surgery, Whittington Hospital, London, UKAbstract: Acute intestinal obstruction due to foreign bodies, or bezoar, is a rare occurrence in an adult with a normal intestinal tract. We report an unusual case of a 43-year-old black man with no previous abdominal surgery and no significant medical history who presented with an acute episode of small bowel obstruction due to an impacted u...

  18. Tomografia computadorizada sem contraste intravenoso no abdome agudo: quando e por que usar When and why use unenhanced computed tomography in patients with acute abdomen

    Edison de Oliveira Freire Filho

    2006-02-01

    Full Text Available A tomografia computadorizada sem contraste intravenoso tem sido freqüentemente proposta na avaliação inicial de pacientes com suspeita de abdome agudo, ocupando o espaço de outros métodos diagnósticos. Os autores apresentam uma revisão bibliográfica dos principais aspectos e eficácia da tomografia computadorizada sem contraste intravenoso no diagnóstico de apendicite aguda, cólica nefrética, diverticulite, pancreatite aguda, apendicite epiplóica, pneumoperitônio e obstrução intestinal. Discutem quais as vantagens e limitações desta técnica de exame, bem como seus aspectos práticos.The use of unenhanced computed tomography has been frequently recommended for the initial assessment of patients with clinical suspicion of acute abdomen instead of other diagnostic methods. The authors present a review of the literature on the main aspects, advantages, limitations and efficacy of unenhanced computed tomography for the diagnosis of acute appendicitis, renal colic, diverticulitis, acute pancreatitis, primary epiploic appendicitis, pneumoperitoneum and small bowel obstruction. The advantages and limitations of this technique are also discussed.

  19. Development of acute dystonia in three brothers due to metoclopramide

    Ibrahim Silfeler

    2012-01-01

    Full Text Available One of the agents that cause dystonic reactions is metoclopramide. In this study, we presented three individuals of the same family who were admitted to our hospital while receiving the treatment of metoclopramide because of developing acute dystonic reaction. Appropriate doses of metoclopramide therapy had begun to all brothers with a diagnosis of gastroenteritis. After receiving the first dose of medication, acute dystonia was observed within half an hour in these brothers who used metoclopramide. Thus, if there is a patient who developed acute dystonia in the same family due to metoclopramide, avoiding from use of metoclopramide will be beneficial for other members of the family.

  20. Acute Acalculous Cholecystitis due to Viral Hepatitis A

    Safak Kaya; Ahmet Emre Eskazan; Nurettin Ay; Birol Baysal; Mehmet Veysi Bahadir; Arzu Onur; Recai Duymus

    2013-01-01

    Inflammation of the gallbladder without evidence of calculi is known as acute acalculous cholecystitis (AAC). AAC is frequently associated with gangrene, perforation, and empyema. Due to these associated complications, AAC can be associated with high morbidity and mortality. Medical or surgical treatments can be chosen according to the general condition of the patient, underlying disease and agent. Particularly in acute acalculous cholecystitis cases, early diagnosis and early medical treatme...

  1. Rhabdomyolysis and Acute Kidney Injury due to Severe Heat Stroke

    Carlos Fragachán G.; Máximo H. Trujillo

    2011-01-01

    We present a case of heat stroke (HS) and acute kidney injury (AKI) due to severe rhabdomyolysis in a 14-year-old previously healthy female patient. When she was practicing strenuous exercise she suffered acute seizures and high fever. These symptoms were followed by coma and multiple organ failure (MOF), which included AKI, encephalopathy, fulminant hepatic failure (FHF), and disseminated intravascular coagulation (DIC). The patient was managed in the ICU with renal replacement therapy, vent...

  2. Surgical Tips in Frozen Abdomen Management: Application of Coliseum Technique.

    Kyriazanos, Ioannis D; Manatakis, Dimitrios K; Stamos, Nikolaos; Stoidis, Christos

    2015-01-01

    Wound dehiscence is a serious postoperative complication, with an incidence of 0.5-3% after primary closure of a laparotomy incision, and represents an acute mechanical failure of wound healing. Relatively recently the concept of "intentional open abdomen" was described and both clinical entities share common pathophysiological and clinical pathways ("postoperative open abdominal wall"). Although early reconstruction is the target, a significant proportion of patients will develop adhesions between abdominal viscera and the anterolateral abdominal wall, a condition widely recognized as "frozen abdomen," where delayed wound closure appears as the only realistic alternative. We report our experience with a patient who presented with frozen abdomen after wound dehiscence due to surgical site infection and application of the "Coliseum technique" for its definitive surgical management. This novel technique represents an innovative alternative to abdominal exploration, for cases of "malignant" frozen abdomen due to peritoneal carcinomatosis. Lifting the edges of the surgical wound upwards and suspending them under traction by threads from a retractor positioned above the abdomen facilitates approach to the peritoneal cavity, optimizes exposure of intra-abdominal organs, and prevents operative injury to the innervation and blood supply of abdominal wall musculature, a crucial step for subsequent hernia repair. PMID:26064759

  3. Acute vertebrobasilar ischemic stroke due to electric injury.

    Singh Jain, Rajendra; Kumar, Sunil; Suresh, Desai Tushar; Agarwal, Rakesh

    2015-07-01

    Electrical injuries are most commonly due to household accidents.Various factors determine the severity of electric injury, including type of current, amperage, voltage, tissue resistance, pathway of current,and duration of contact with the body. Various types of neurologic damage due to electrical injury have been described in literature. It may manifest as peripheral nerve injury, spinal cord damage, seizures, cerebellarataxia, hypoxic encephalopathy, and intracerebral hemorrhage. Acute ischemic stroke is an infrequent complication of electrical injury. Herein,we report a case of middle-aged man, who accidentally sustained high voltage electrical injury followed by acute vertebrobasilar ischemic stroke. Magnetic resonance imaging of the brain showed acute infarctin bilateral cerebellar and medial occipital regions. Computed tomographic angiogram of the brain and neck vessels was normal. Possibly,in our patient, the mechanism could be related to direct vascular injury due to electric current. PMID:25684743

  4. Acute small bowel obstruction due to chicken bone bezoar

    Vetpillai P

    2012-12-01

    Full Text Available Preadeepan Vetpillai,1 Ayo Oshowo21CT2 Surgery in General, Charing Cross Hospital, 2Colorectal and Laparoscopic Surgery, Whittington Hospital, London, UKAbstract: Acute intestinal obstruction due to foreign bodies, or bezoar, is a rare occurrence in an adult with a normal intestinal tract. We report an unusual case of a 43-year-old black man with no previous abdominal surgery and no significant medical history who presented with an acute episode of small bowel obstruction due to an impacted undigested chicken bone.Keywords: small bowel obstruction, chicken bone, bezoar

  5. Sonographische Diagnostik beim akuten Abdomen bei Kindern und Erwachsenen

    Vauth, C; ENGLERT, H; Fischer, T.; Kulp, W; Greiner, W; Willich, SN; Stroever, B; Graf von der Schulenburg, JM

    2005-01-01

    Introduction The acute abdomen is the main term for an at first unclear emergency situation of the abdominal cavity. The acute abdomen belongs to the three most important reasons for the admission of patients into the emergency room. Further, this illness ranks 40% of all consultations in the ambulant care sector. The acute abdomen requires an early and direct diagnosis because of its potential of having a life threatening differential diagnosis. This HTA report aimed to assess the ultrasoun...

  6. Hematometra presenting as an acute abdomen in a 13-year-old postmenarchal girl: a case report

    Klimek Peter; Klimek Miriam; Kessler Ulf; Oesch Valerie; Wolf Rainer; Stranzinger Enno; Mueller Michael D; Zachariou Zacharias

    2012-01-01

    Abstract Introduction Most underlying diseases for abdominal pain in children are not dangerous. However some require rapid diagnosis and treatment, such as acute ovarian torsion or appendicitis. Since reaching a diagnosis can be difficult, and delayed treatment of potentially dangerous diseases might have significant consequences, exploratory laparoscopy is a diagnostic and therapeutic option for patients who have unclear and potentially hazardous abdominal diseases. Here we describe a case ...

  7. Hematometra presenting as an acute abdomen in a 13-year-old postmenarchal girl: a case report

    Klimek, Peter Michael; Klimek, Miriam; Kessler, Ulf; Oesch, Valerie; Wolf, Rainer; Stranzinger, Enno; Michael D. Mueller; Zachariou, Zacharias

    2012-01-01

    Introduction Most underlying diseases for abdominal pain in children are not dangerous. However some require rapid diagnosis and treatment, such as acute ovarian torsion or appendicitis. Since reaching a diagnosis can be difficult, and delayed treatment of potentially dangerous diseases might have significant consequences, exploratory laparoscopy is a diagnostic and therapeutic option for patients who have unclear and potentially hazardous abdominal diseases. Here we describe a case where...

  8. Acute Prostatitis Due to Brucellosis; Report of Two Cases

    Alper Ozorak

    2014-01-01

    Brucellosis is an endemic disease in Turkey. The clinical features of brucellosis are not disease specific; and almost every organ can be affected. In males, genitourinary localization is reported in 2%-20% of cases. Unilateral epididiymo-orchitis is the usual manifestation. Prostatitis due to brucellosis is a very rare condition. In this article we reported two cases exhibit acute prostatitis due to Brucellosis.

  9. Acute Anterolateral Myocardial Infarction Due to Aluminum Phosphide Poisoning

    Bita Dadpour; Zohre Oghabian

    2013-01-01

    Aluminum phosphide (AlP) is a highly effective rodenticide which is used as a suicide poison. Herein, a 24 year-old man who’d intentionally ingested about 1liter of alcohol and one tablet of AlP is reported. Acute myocardial infarction due to AlP poisoning has been occurred secondary to AIP poisoning. Cardiovascular complications are poor prognostic factors in AlP poisoning

  10. Acute Anterolateral Myocardial Infarction Due to Aluminum Phosphide Poisoning

    Bita Dadpour

    2013-08-01

    Full Text Available Aluminum phosphide (AlP is a highly effective rodenticide which is used as a suicide poison. Herein, a 24 year-old man who’d intentionally ingested about 1liter of alcohol and one tablet of AlP is reported. Acute myocardial infarction due to AlP poisoning has been occurred secondary to AIP poisoning. Cardiovascular complications are poor prognostic factors in AlP poisoning

  11. Acute Pancreatitis and Splenic Vein Thrombosis due to Hypertriglyceridemia

    Ercan Gündüz; Recep Dursun; Mustafa İçer; Yılmaz Zengin; Cahfer Güloğlu

    2015-01-01

    Acute pancreatitis (AP) is a condition characterised by the activation of the normally inactive digestive enzymes due to an etiological factor and digestion of the pancreatic tissues, resulting in extensive inflammation and leading to local, regional, and systemic complications in the organism. It may vary from the mild edematous to the hemorrhagic and severely necrotising form. The most common causes are biliary stones and alcohol abuse. In this case study, we would like to present a patient...

  12. Acute pulmonary alveolar proteinosis due to exposure to cotton dust

    Thind Gurcharan

    2009-01-01

    Full Text Available Secondary pulmonary alveolar proteinosis (PAP is rare but may occur in association with malignancy, certain infections, and exposure to inorganic or organic dust and some toxic fumes. This case report describes the second recorded case of PAP due to exposure to cotton dust. A 24-year-old man developed PAP after working as a spinner for eight years without respiratory protection. He was admitted as an emergency patient with very severe dyspnea for four months and cough for several years. Chest X-ray showed bilateral diffuse alveolar consolidation. He died 16 days later, and a diagnosis of acute pulmonary alveolar proteinosis was made at autopsy. The histopathology demonstrated alveoli and respiratory bronchioles filled with characteristic periodic acid Schiff-positive material, which also revealed birefringent bodies of cotton dust under polarized light. Secondary PAP can be fatal and present with acute respiratory failure. The occupational history and characteristic pathology can alert clinicians to the diagnosis.

  13. MDCT of the abdomen

    Multi-detector row computed tomography (MDCT) enables fast and thin acquisition of the abdominal anatomy. This allows multi-pass multi-planar studies that can be obtained during defined circulatory phases. When bolus timing is adequate, arterial phases with high contrast levels provide ''free lunch'' CT angiographies eliminating the need for diagnostic angiographies in most cases. In addition to established clinical indications for abdominal CT such as preoperative MDCT of the liver or pancreas, MDCT of the abdomen is especially gaining ground in the work up for acute abdominal pain and abdominal trauma and is opening new indications for MDCT of the gastrointestinal tract. Indications for gastrointestinal MDCT include tumors, bleeding and ischemia of the small and large bowel as well as diverticulitis. The question of whether to use positive or negative contrast material for bowel distention for MDCT of the gastrointestinal tract is still a controversial issue. In selected cases, modifying the protocol to perform a ''CT enteroclysis'' might improve sensitivity and specificity in depicting small bowel tumors or inflammatory changes such as in Crohn's disease. The most common gastrointestinal mesenchymal tumor is the gastrointestinal stromal tumor (GIST). MDCT may show hypervascular submucosal masses. Acute gastrointestinal (GI) bleeding is common with patients presenting with melena, hematemesis or hematochezia. In addition to the established initial work-up MDCT is beginning to establish itself for this indication. It may be especially helpful in the work up of obscure bleeding. Another relatively rare but important cause for acute abdominal pain is mesenteric ischemia. It may be caused by many conditions and may mimic various intestinal diseases. Bowel ischemia severity ranges from transient superficial changes of the intestinal mucosa to life-threatening transmural bowel wall necrosis. CT can demonstrate changes in ischemic bowel segments accurately, is often

  14. MDCT of the abdomen

    Aschoff, A.J. [Dept. for Diagnostic Radiology, Univ. Hospitals of Ulm (Germany)

    2006-01-10

    Multi-detector row computed tomography (MDCT) enables fast and thin acquisition of the abdominal anatomy. This allows multi-pass multi-planar studies that can be obtained during defined circulatory phases. When bolus timing is adequate, arterial phases with high contrast levels provide 'free lunch' CT angiographies eliminating the need for diagnostic angiographies in most cases. In addition to established clinical indications for abdominal CT such as preoperative MDCT of the liver or pancreas, MDCT of the abdomen is especially gaining ground in the work up for acute abdominal pain and abdominal trauma and is opening new indications for MDCT of the gastrointestinal tract. Indications for gastrointestinal MDCT include tumors, bleeding and ischemia of the small and large bowel as well as diverticulitis. The question of whether to use positive or negative contrast material for bowel distention for MDCT of the gastrointestinal tract is still a controversial issue. In selected cases, modifying the protocol to perform a 'CT enteroclysis' might improve sensitivity and specificity in depicting small bowel tumors or inflammatory changes such as in Crohn's disease. The most common gastrointestinal mesenchymal tumor is the gastrointestinal stromal tumor (GIST). MDCT may show hypervascular submucosal masses. Acute gastrointestinal (GI) bleeding is common with patients presenting with melena, hematemesis or hematochezia. In addition to the established initial work-up MDCT is beginning to establish itself for this indication. It may be especially helpful in the work up of obscure bleeding. Another relatively rare but important cause for acute abdominal pain is mesenteric ischemia. It may be caused by many conditions and may mimic various intestinal diseases. Bowel ischemia severity ranges from transient superficial changes of the intestinal mucosa to life-threatening transmural bowel wall necrosis. CT can demonstrate changes in ischemic bowel segments

  15. Laparoscopia no abdome agudo não traumático: estudo retrospectivo Laparoscopy in nontraumatic acute abdomen: retrospective study

    Marcos Bettini Pitombo

    1999-08-01

    Full Text Available Os autores analisaram, retrospectivamente, 117 pacientes portadores de abdome agudo não-traumático, submetidos à laparoscopia diagnóstica e/ou terapêutica, na Casa de Saúde Santa Martha, em Niterói. A precisão diagnóstica do exame laparoscópico foi de 96,6%. Com relação à terapêutica, 74,4% dos pacientes foram tratados por laparoscopia, 21,4% por laparotomia e 4,3% foram tratados clinicamente. A precocidade na realização da laparoscopia relacionou-se à maior taxa de sucesso com o tratamento laparoscópico (valor p The authors studied restropectively 117 patients with nontraumatic acute abdomen, who were submitted to diagnostic and therapeutic laparoscopy, at Casa de Saúde Santa Martha - Niterói. In 96,6% of the patients lhe procedure confirmed the diagnosis. 74,4% were treated by this method, 21,4% by laparotomy and 4,3% received clinical treatment. It was noted that the earlier the diagnostic laparoscopy was performed, the bigger were the chances of doing therapeutic laparoscopy (p value < 0,05. The patients treated by laparoscopic surgery were fed and were discharged from hospital earlier than the patients treated by laparotomy (p value < 0,05 and p < 0,01. The complication rate was 13,7% and the mortality rate was 2,6%. The authors conclude that laparoscopy is a good diagnostic and therapeutic method. There is also a good correlation with this method and a quicker recovering of the patients.

  16. Diagnostic criteria for acute liver failure due to Wilson disease

    Christoph Eisenbach; Olivia Sieg; Wolfgang Stremmel; Jens Encke; Uta Merle

    2007-01-01

    AIM: To describe the diagnostic criteria for acute liver failure due to Wilson disease (WD), which is an uncommon cause of acute liver failure (ALF).METHODS: We compared findings of patients presenting with ALF due to WD to those with ALF of other etiologies.RESULTS: Previously described criteria, such as low alkaline phosphatase activity, ratio of low alkaline phosphatase to total bilirubin or ratio of high aspartate aminotransferase (AST) to alanine aminotransferase (ALT), failed to identify patients with ALF due to WD. There were significant differences in low ALT and AST activities (53 ± 43 vs 1982 ± 938, P < 0.0001 and 87 ± 44 vs 2756 ± 2941, P = 0.037, respectively), low choline esterase activity (1.79 ± 1.2 vs 4.30 ± 1.2, P = 0.009), high urine copper concentrations (93.4 ± 144.0 vs 3.5 ± 1.8, P = 0.001) and low hemoglobin (7.0 ± 2.2 vs 12.6 ± 1.8, P < 0.0001) in patients with ALF caused by WD as compared with other etiologies. Interestingly, 4 of 7 patients with ALF due to WD survived without liver transplantation.CONCLUSION: In ALF, these criteria can help establish a diagnosis of WD. Where applicable, slit-lamp examination for presence of Kayser-Fleischer rings and liver biopsy for determination of hepatic copper concentration still remain important for the diagnosis of ALF due to WD. The need for liver transplantation should be evaluated carefully as the prognosis is not necessarily fatal.

  17. Bacteremia due to Aeromonas hydrophila in Acute Lymphoblastic Leukemia

    Aeromonas hydrophila (A. hydrophila) is a low virulent organism but may cause devastating fatal infections in immunocompromised host especially in liver cirrhosis. It is rarely reported to cause septicemia in a patient with Acute Lymphoblastic Leukemia (ALL). The mortality rate of septicemia due to A. hydrophila is 29% to 73%. We report a case of 59-year-old female patient who was a known case of ALL, presented with the complaints of fever, lethargy and generalized weakness for one month. After taking blood samples for investigations, empirical antimicrobial therapy was started. She did not improve after 48 hours of therapy. Meanwhile blood culture revealed pure growth of A. hydrophila. After sensitivity report was available, ciprofloxacin was started. Patient became afebrile after 48 hours of treatment with ciprofloxacin. It is very vital to correctly identified and treat bacteremia due to A. hydrophila especially in the underlying leukemic patient. (author)

  18. Acute kidney injury and rhabdomyolysis due to multiple wasp stings

    Hemachandar Radhakrishnan

    2014-01-01

    In most patients, wasp stings cause local reactions and rarely anaphylaxis. Acute kidney injury and rhabdomyolysis are unusual complications of wasp stings. We report a case of acute kidney injury and rhabdomyolysis secondary to multiple wasp stings. A 55-year-old farmer developed multi organ dysfunction with acute kidney injury and rhabdomyolysis 3 days after he had sustained multiple wasp stings. The etiology of acute kidney injury is probably both rhabdomyolysis and acute tubular necrosis....

  19. Acute Lung Injury Due To Carbon Monoxide Exposure

    Uzkeser M et al.

    2012-10-01

    Full Text Available A 20-year-old woman, who was found unconscious in the bed by the morning, was brought to emergency department. Her carboxyhemoglobin level was 20.2%. The portable chest X-ray showed bilaterally alveolar and interstitial infiltration. Initial pO 2 /FIO 2 ratio was calculated as 119 mmHg. Acute lung injury due to carbon monoxide intoxication was considered. She was intubated and mechanical ventilation was applied. In the second day of hospitalization, a clear improvement was observed on the chest X-ray. She was discharged without any complication on the seventh day of hospitalization. Early diagnosis and treatment may prevent progression of ARDS and progression of permanent damage, and may lead to complete recovery.

  20. Severe acute caffeine poisoning due to intradermal injections: Mesotherapy hazard

    Perković-Vukčević Nataša

    2012-01-01

    Full Text Available Introduction. Caffeine is indicated in the treatment of migraine headaches, as well as neonatal apnea and bradycardia syndrome. In mild poisoning, the most prevalent symptoms are nausea, vomiting, diarrhea, tremor, anxiety and headache. In more severe cases, symptoms consist of heart rythym abnormalities, myocardial infarction and seizures. Due to its common lipolytic effect, caffeine is used in mesotherapy, usually in combination with drugs of similar effect. We presented a patient with acute iatrogenic caffeine poisoning. Case report. A 51-year-old woman, with preexisting hypertension and hypertensive cardiomyopathy was subjected to cosmetic treatment in order to remove fat by intradermal caffeine injections. During the treatment the patient felt sickness, an urge to vomit, and a pronounced deterioration of general condition. Upon examination, the patient exhibited somnolence, hypotension and nonsustained ventricular tachycardia, which was sufficient enough evidence for further hospitalization. On admission to the intensive care unit the patient was anxious with increased heart rate, normotensive, with cold, damp skin, and visible traces of injection sites with surrounding hematomas on the anterior abdominal wall. Paroxysmal supraventricular tachycardia (PSVT on electrocardiographic monitoring was found. The laboratory analysis determined a lowered potassium level of 2.1 mmol/L (normal range 3,5 - 5.2 mmol/L, and a toxicological analysis (liquid chromatography with ultraviolet detection proved a toxic concentration of caffeine in plasma - 85.03 mg/L (toxic concentration over 25 mg/L. On application of intensive therapy, antiarrhythmics, and substitution of potassium, as well as both symptomatic and supportive therapy, there was a significant recovery. The patient was discharged without any sequele within four days. Conclusion. A presented rare iatrogenic acute caffeine poisoning occured due to massive absorption of caffeine from the

  1. Acute toxemic schistosomiasis complicated by a acute flaccid paraplegia due to schistosomal myeloradiculopathy in Sudan

    A 55-year old Sudanese physician presented with one month history of diarrhea, loss of weight 10 kg and low grade nocturnal fever. Following colonoscopy, he rapidly developed paraparesis and retention of urine. Magnetic resonance imaging (MRI) of the spinal cord showed low cord lesion suggestive of transverse myelitis. We present a detailed account of diagnostic and management challenges and a literature review of the final diagnosis of acute toxemic schistosomiasis, complicated by acute flaccid paraplegia due to schistosomal myeloradiculopathy. We are reporting this case to increase the awareness of physicians of schistosomal myeloradiculopathy, as it needs urgent specific treatment praziquantel and steroids. An early follow-up with MRI of the spinal cord 2 weeks treatment may help in preventing unnecessary neurosurgical intervention. Bilharziasis may be contracted on the banks of river White Nile in urban areas. Finally clinicians should make use of the Google search for diagnosis in difficult cases. (author)

  2. Análise retrospectiva de 287 casos de abdome agudo em ginecologia e obstetrícia Retrospective analysis of 287 cases of acute abdomen in gynecology and obstetrics

    Eddie Fernando Candido Murta

    2001-02-01

    Full Text Available OBJETIVO: O abdome agudo em ginecologia e obstetrícia apresenta baixo risco de vida para a paciente, entretanto, o retardo no diagnóstico e tratamento influencia na morbi-mortalidade. O objetivo deste trabalho foi estudar as principais causas de abdome agudo em tocoginecologia. MÉTODOS: Foram revisados 287 casos de abdome agudo em tocoginecologia de janeiro de 1987 a dezembro de 1997 atendidos na Disciplina de Ginecologia e Obstetrícia da Faculdade de Medicina do Triângulo Mineiro. RESULTADOS: Os resultados mostraram que a prenhez ectópica foi a mais freqüente causa de abdome agudo hemorrágico com 98,5% dos casos. Nestes casos, a dor pélvica foi o sintoma mais comum (69,1%. Todas as pacientes foram submetidas à laparotomia e salpingectomia foi realizada em 92,6% dos casos. A causa mais freqüente de abdome agudo inflamatório foi a doença inflamatória pélvica com 94,8%. A dor pélvica aguda estava presente em 91,5% dos casos e a febre em 56,2% casos. A penicilina foi usada com sucesso em 92,1% dos casos. Do total de 201 casos de doença inflamatória pélvica, 13 (6,5% foram submetidos à laparotomia. CONCLUSÕES: Os autores concluem que o abdome agudo de causa tocoginecológica apresenta quadro clínico variável, portanto, o ginecologista deve estar atento para estabelecer diagnóstico e tratamento precisos.BACKGROUND: The gynecology or obstetric acute abdomen in woman present a low risk, although the diagnosis and treatment may be a challenge. The aim of this study was to analize the most frequent causes of acute abdomen in gynecology and obstetrics. METHODS: We reviewed 287 cases, from January 1987 to December 1997, attending in Discipline of Gynecology and Obstetrics of the Faculty of Medicine of "Triângulo Mineiro". RESULTS: Ouur results showed that ectopic pregnancy was the most frequent cause of hemorrhagic acute abdomen, with 98.5% of the cases. Pelvic pain was the most common symptom (69.1%. All patients were submitted to

  3. An Acute Disseminated Encephalomyelitis Case due to Mycobacterium tuberculosis

    Hale Turan Özden

    2016-03-01

    Full Text Available Acute disseminated encephalomyelitis (ADEM is an inflammatory and demyelinating disorder of the central nervous system that is characterized by multifocal involvement of the white matter. Our patient was a 27-year-old female patient who had given birth to a baby with caesarean in another hospital. After four days upon the parturition, she was admitted to our hospital’s general intensive care unit with a poor general status, confusion and a fever. She was diagnosed with ADEM according to the clinical, laboratory and radiological findings. In addition to her antibiotic treatment (meropenem that had been given in the previous health care facility, corticosteroid therapy was also started. The patient passed away due to the ventilator-associated pneumonia infection on the 10th day of her admission. Mycobacterium tuberculosis proliferation was observed in the cerebrospinal fluid after her death. As it is reported in literature, tuberculosis is a rare cause of ADEM. In conclusion, it should be noted that M. tuberculosis can be a rare cause of ADEM in regions where the disease is endemic. J Microbiol Infect Dis 2016;6(1: 28-31

  4. Acute Dystonia Due to Citalopram Treatment: A Case Series

    Moosavi, S. Mohammad; Ahmadi, Mahshid; Monajemi, Mani B.

    2014-01-01

    Introduction: Abnormal movements such as acute dystonia, dyskinesia, parkinsonism, exacerbation of Parkinson disease, akathisia and possibly neuroleptic malignant syndrome may be associated with the use of selective serotonin reuptake inhibitors (SSRIs) rarely. Citalopram, a typical SSRI, used in serotonergic dysfunction related disorders, potentially can cause extrapyramidal symptoms such as acute dystonia. Methods: In a retrospective survey on patients referred to psychiatric clinic between...

  5. Acute Generalized Exanthematous Pustulosis Due to Insect Bites?

    Bhat, Yasmeen J; Iffat Hassan; Peerzada Sajad; Atiya Yaseen; Rohi Wani

    2015-01-01

    Acute generalized exanthematous pustulosis is a rare severe cutaneous adverse reaction pattern that is mostly caused by the intake of drugs and rarely associated with viral infections, food allergens or toxins. Here we present the report of three patients who got admitted in our hospital for generalized pustulosis and fever after insect bites. The diagnosis of acute generalized exanthematous pustulosis was made by EuroSCAR scoring. The drug etiology was excluded and spider bite was implicated...

  6. Endocardite infecciosa com apresentação inicial de abdome agudo Endocarditis infecciosa con presentación inicial de abdomen agudo Infective endocarditis with initial presentation of acute abdomen

    Humberto F. G Freitas

    2010-04-01

    Full Text Available Paciente de 35 anos de idade foi atendido em Serviço de Emergência com seis horas de dor em fossa ilíaca direita e febre. Feita hipótese diagnóstica de apendicite aguda e realizada laparotomia exploradora. com apendicectomia. O paciente retornou ao hospital três dias após alta hospitalar. prostrado. febril. com alteração de fala. diminuição de nível de consciência e com hemiparesia completa à esquerda. CT scan de crânio e punção de líquor normal. RMN de encéfalo revelou aspectos compatíveis com AVC isquêmico vertebro-basilar. Ecocardiograma transesofágico demonstrou vegetação em valva aórtica e insuficiência aórtica moderada e hemoculturas foram positivas para Enterococcus bovis.Paciente de 35 años de edad ingresó en el servicio de emergencia con seis horas de dolor en fosa ilíaca derecha y fiebre. Se llevó a cabo la hipótesis diagnóstica de apendicitis aguda y realizada laparotomía exploradora, con apendicectomía. El paciente regresó al hospital tres días tras alta hospitalaria, prostrado, febril, con alteración de habla, disminución de nivel de conciencia y con hemiparesia izquierda completa. Scanner de cráneo y punción de líquido cefalorraquídeo (LCR normal. RMN de encéfalo reveló aspectos compatibles con ACV isquémico vertebrobasilar. El ecocardiograma transesofágico demostró vegetación en válvula aórtica y insuficiencia aórtica moderada y hemocultivos fueron positivas para Enterococcus bovis.A 35-year-old patient was seen in an Emergency Department. with six hours of pain in the right iliac fossa and fever. The hypothesis diagnosis was acute appendicitis and an exploring laparotomy for appendectomy was carried out. The patient returned to the hospital three days after having been discharged. debilitated. feverish. having alterations in speech. reduction in the level of consciousness and complete hemiparesis to the left. The computed tomography scan of the skull and the liquor puncture were

  7. Acute Renal Failure due to Rhabdomyolysis Caused by Hypokalemia

    Ghacha Reda

    2001-01-01

    Full Text Available Rhabdomyolysis is not an uncommon cause of acute renal failure (ARF. It is usually caused by severe traumatic crush injury, severe exercise, septicemia, drug abuse, alcoholic intoxication, heat stroke and myopathy. In this case, we present a patient who developed rhabdomyolysis after severe hypokalemia (serum potassium 1.9mmol/L. This is an unusual cause of rhabdomyolysis even though hypokalemia is a common medical problem. This patient developed acute oliguric renal failure that required daily hemodialysis for 12 days, before start of recovery. This case demonstrates that hypokalemia is a preventable cause of rhabdomyolysis and ARF.

  8. Acute Renal Failure due to Non-Traumatic Rhabdomyolysis

    Nagehan Aslan

    2016-04-01

    Full Text Available Rhabdomyolysis is a musculoskeletal clinical and biochemical syndrome which is seen associated with traumatic and non-traumatic causes and is known as muscular dystrophy. Rhabdomyolysis which develops following crush-type trauma (Crush syndrome is rarely seen but is a well-known clinical event in the etiology of acute renal failure. Non-traumatic rhabdomyolysis is rare. The case is here presented of a patient who was diagnosed with rhabdomyolysis on presentation with acute renal failure and to whom repeated dialysis was applied.

  9. 小儿急腹征的早期诊断与手术时机的选择%Early diagnosis and selection of the operation occasion on the pedo-acute abdomen

    金恩鸿; 李林虎; 李光燮

    2012-01-01

    OBJECTIVE To summary the experience of early diagnosis and operation on pedo-acute abdomen. METHODS We retrospectively analyzed the clinical data on 318 pedo-patients with the actue abdomen treated in the general surgery of our hospital from May 2003 to July 2008. RESULTS 175 cases were treated by operation. Among them, 3 cases had the postoperative infection, and cured by the change dressings; 1 cage with the periappendiceal abscess occurred the stump fistula after the operation , and cured by the expectant treatment ; 1 case with the acute hemorrhagic enteritis died after the intestinal resection because of the toxic shock and the MODS. Non-operation cases were all cured after the expectant treatment. CONCLUSION Detail ask the case history, micromesh medical examination, is the base of the early diagnosis aad treatment for the pedo-acute abdomen; operating in time is a important treatment%目的 总结小儿急腹症的早期诊断及手术治疗的经验.方法 回顾性分析2003年5月~2010年7月某院普外科收治的318例小儿外科急腹症的临床资料.结果 行手术治疗175例,其中3例术后切口感染,均经切口开放换药后治愈,1例阑尾周围脓肿引流术后残端瘘,保守治疗治愈,1例因急性出血性肠炎伴腹膜炎、肠坏死行肠切除术,术后因中毒性休克、脏器衰竭死亡;非手术治疗的患儿经积极保守治疗后均治愈.结论 详细询问病史,细致的查体,结合必要的辅助检查是小儿急腹症早期诊断及治疗的基础;及时手术是小儿惠腹症的重要治疗方法.

  10. Sudden psychotic episode probably due to meningoencephalitis and Chlamydia pneumoniae acute infection

    Canas Nuno; Coromina Marta; Correa Bernardo; Xavier Miguel; Guimarães João

    2005-01-01

    Abstract Background Since 9% to 20% of all cases of acute psychosis presenting to an Emergency Department (ED) are due to a general medical condition, cautious medical workup should be mandatory in such patients. Differential diagnosis must consider conditions as diverse as renal failure or CNS infection. Acute Chlamydia pneumoniae infection usually causes a self-limited respiratory syndrome. Rarely, acute neurological complications occur, with acute meningoencephalitis most frequently report...

  11. Acute Carotid Artery Stent Thrombosis Due to Dual Antiplatelet Resistance

    Carotid artery stenting (CAS) is a revascularization modality that is an alternative to carotid endarterectomy. The efficacy of CAS in primary and secondary prevention from ischemic stroke has been demonstrated in various trials. Acute thrombosis of CAS is a rare complication that can lead to dramatic and catastrophic consequences. We discuss a case of acute CAS thrombosis in a patient who had previously undergone successful CAS. CAS was performed in a 73-year-old man who had had dysarthria lasting 2 weeks with 95 % stenosis in his left internal carotid artery. An acute cerebrovascular event resulting in right-sided hemiplegia developed 24 h after the procedure. Computed tomographic carotid angiography revealed complete occlusion of the stent with thrombus. The cause of stent thrombosis was thought to be antiaggregant resistance to both acetylsalicylic acid and clopidogrel. The most important cause of acute CAS thrombosis is inadequate or ineffective antiaggregant therapy. Evaluating patients who are candidates for CAS for acetylsalicylic acid and clopidogrel resistance may preclude this complication

  12. Acute Carotid Artery Stent Thrombosis Due to Dual Antiplatelet Resistance

    Köklü, Erkan, E-mail: drerkankoklu@gmail.com; Arslan, Şakir; Yüksel, İsa Öner; Bayar, Nermin [Antalya Education and Research Hospital, Clinic of Cardiology (Turkey); Koç, Pınar [Antalya Education and Research Hospital, Clinic of Radiology (Turkey)

    2015-08-15

    Carotid artery stenting (CAS) is a revascularization modality that is an alternative to carotid endarterectomy. The efficacy of CAS in primary and secondary prevention from ischemic stroke has been demonstrated in various trials. Acute thrombosis of CAS is a rare complication that can lead to dramatic and catastrophic consequences. We discuss a case of acute CAS thrombosis in a patient who had previously undergone successful CAS. CAS was performed in a 73-year-old man who had had dysarthria lasting 2 weeks with 95 % stenosis in his left internal carotid artery. An acute cerebrovascular event resulting in right-sided hemiplegia developed 24 h after the procedure. Computed tomographic carotid angiography revealed complete occlusion of the stent with thrombus. The cause of stent thrombosis was thought to be antiaggregant resistance to both acetylsalicylic acid and clopidogrel. The most important cause of acute CAS thrombosis is inadequate or ineffective antiaggregant therapy. Evaluating patients who are candidates for CAS for acetylsalicylic acid and clopidogrel resistance may preclude this complication.

  13. Cálculo biliar "perdido": um novo problema para o ginecologista na abordagem do abdome agudo? "Lost" gallstone: a new problem for the gynecologist in acute abdomen management ?

    José Carlos Menegoci

    1999-12-01

    Full Text Available Os autores relatam o caso de uma paciente com 35 anos de idade, submetida à colecistectomia videolaparoscópica há 1 ano e que apresentou quadro sugestivo de salpingite aguda com abscesso. Durante a laparotomia notou-se um abscesso que era limitado anteriormente pelo peritônio parietal e músculo reto anterior direito do abdome, e posteriormente pelo corno uterino e pelo ligamento redondo à direita. Neste abscesso havia estrutura a seguir identificada como cálculo biliar. São discutidos os aspectos relacionados à patogenia, tratamento e prevenção desta complicação que vem sendo relatada com freqüência em virtude do maior uso da cirurgia laparoscópica.The authors report a case of a thirty-five-year-old patient, submitted to videolaparoscopic cholecystectomy one year ago, who appearently had acute salpingitis with abscess. During the laparotomy an abscess was observed, anteriorly limited by parietal peritoneum and the abdominal right anterior rectus muscle, and posteriorly by the horn of the uterus and by the right round ligament. In this abscess there was a structure later identified as gallstone. The aspects related to the pathogenesis, treatment and prevention, which have been reported frequently due to the increasing number of laparoscopic surgeries, are discussed.

  14. Acute Gastric Bleeding Due to Giant Hyperplastic Polyp

    Bulent Aksel

    2013-04-01

    Full Text Available Hyperplastic gastric polyps account for the majority of benign gastric polyps. The vast majority of these lesions are small, asymptomatic and found incidentally on radiologic or endoscopic examination. Giant hyperplastic gastric polyps are uncommon and most of them are asymptomatic. We report a case of a 66-year-old woman who admitted because of acute gastric bleeding. The gastrin levels were within normal ranges. Esophagogastroduodenoscopy showed 12 cm pedunculated and multiple lobulated hyperplastic polyps arising from antrum with signs of diffuse oozing. The patient is treated by subtotal gastrectomy with Roux-Y gastrojejunostomy. Histological examination showed the presence of ulcers and regeneration findings with the contemporary occurrence of hyperplastic polyp. Giant hyperplastic gastric polyp should be kept in mind in the differential diagnosis of acute upper gastrointestinal bleeding.

  15. Probable acute disseminated encephalomyelitis due to Haemophilus influenzae meningitis.

    Beleza, Pedro; Ribeiro, Manuel; Pereira, João; Ferreira, Carla; Jordão, Maria José; Almeida, Fátima

    2008-05-01

    We report the case of a 17-year-old male on long-term steroid therapy for minimal lesion glomerulopathy who, after an upper respiratory infection, presented with Haemophilus influenzae type b meningitis. Twenty-four hours later he developed depression of consciousness which progressed to coma and left hemiparesis. Brain magnetic resonance imaging (MRI) revealed multiple lesions (hyperintense on T2 and slightly hypointense on Tl) involving mainly white matter suggestive of inflammation. MRI features were compatible with acute disseminated encephalomyelitis (ADEM), although a differential diagnosis included cerebritis or vasculitis, secondary to bacterial meningitis. The patient was treated with high-dose steroids which resulted in a gradual improvement followed by complete clinical recovery. We propose a diagnosis of ADEM was the best diagnosis because of the radiological features and response to steroids. The occurrence of ADEM associated with acute meningitis, however rare, represents an important diagnostic challenge for the clinician. PMID:18355336

  16. The value of vaginal colour to exceed in gynecologic acute abdomen%阴道彩超检查在诊断妇科急腹症方面的临床价值

    邵立志

    2014-01-01

    目的:分析阴道彩超检查在诊断妇科急腹症方面的临床价值。方法:对2014年3月~2014年6月某院收治的400例妇科急腹症患者的临床资料进行回顾性分析,将其平均分为观察组和对照组。为观察组患者进行阴道彩超检查,为对照组患者进行腹部彩超检查,并对比分析其病情的误诊率。结果:在观察组患者中,有9例患者的病情被误诊。在对照组患者中,有21例患者的病情被误诊。两组患者的误诊率相比较,差异显著,有统计学意义(P<0.05)。结论:与腹部彩超检查相比,阴道彩超检查在诊断妇科急腹症方面具有更高的临床价值,值得在临床上推广使用。Results: the observation group and control group,compared to the patient's diagnosis rate is higher than the control group,and the misdiagnosis rate is less than the control group,the differences between the two groups have statistical significance (P<0.05). Conclusion: vaginal colour to exceed and abdomen colour to exceed diagnose,compared in clinical diagnosis of acute abdominal pain of department of gynaecology diagnosis rate is high,has a strong application value.%Objective: to study the analysis of the vagina color ultrasound examination in clinical diagnosis of gynecologic acute abdomen effect and application value,and aims to improve the level of the clinical treatment of the disease. Methods: a retrospective analysis of a certain hospital in March 2014 to June 2014,400 cases treated by through the pathological diagnosis of gynecologic acute abdomen patients,the average is divided into two groups,observation group and control group respectively. Observation group of patients with vagina colour to exceed check,control group patients take abdominal colour to exceed,two diagnosis and pathological diagnosis,in comparison with the results of analysis to summarize the reasons for misdiagnosis Results: the observation group and control

  17. Fulminant hepatic failure (FHF) due to acute hepatitis C

    Younis, Bilal Bin; Arshad, Rozina; Khurhsid, Saima; Masood, Junaid; Nazir, Farhan; Tahira, Maham

    2015-01-01

    Acute hepatitis C (HCV) infection has been identified as an important cause of fulminant hepatic failure (FHF), characterized by rapid deterioration of liver function from massive hepatic necrosis leading to encephalopathy and multi-organ failure. We admitted a female patient at Shalamar Hospital with jaundice, fever, encephalopathy and coagulopathy of short duration with no history of any comorbidity. Her hepatitis viral screen revealed positive anti HCV. Her viral loads were also high. A di...

  18. Acute Liver Toxicity due to Efavirenz/Emtricitabine/Tenofovir

    Rashmee Patil

    2015-01-01

    Full Text Available The fixed-dose combination of Efavirenz/Emtricitabine/Tenofovir is a first-line agent for the treatment of HIV; however few cases have reported hepatotoxicity associated with the drug. We report a case of Efavirenz/Emtricitabine/Tenofovir-associated hepatotoxicity presenting mainly with hepatocellular injury characterized by extremely elevated aminotransferase levels, which resolved without acute liver failure or need for liver transplant referral.

  19. Acute respiratory failure due to ehrlichiosis - CT findings: case report

    Ehrlichiosis is a rare disease, with approximately 400 cases having been documented in the US since its recognition in 1986. Most of the reported cases were in the southeastern US, although 6 cases have been described in Washington state. Although most of these reported patients were admitted to hospital, severe complications developed in only a small proportion. Findings on chest imaging have been described in 3 children. To our knowledge, this is the first reported case of computed tomographic (CT) findings in a young adult with erhlichiosis in whom acute respiratory failure developed. (author)

  20. Reirradiation to the abdomen for gastrointestinal malignancies

    Reirradiation to the abdomen could potentially play a role in palliation of symptoms or local control in patients with gastrointestinal malignancies. Our goal was to retrospectively determine rates of toxicity, freedom from local progression and overall survival in gastrointestinal cancer patients treated with reirradiation to the abdomen. Between November 2002 and September 2008, 13 patients with a prior history of abdominal radiotherapy (median dose 45 Gy) were treated with reirradiation for recurrent or metastatic gastrointestinal malignancies. The median interval between the two courses of radiotherapy was 26 months. Patients were treated with a hyperfractionated accelerated regimen, using 1.5 Gy fractions twice daily, with a median dose of 30 Gy (range 24-48 Gy). Concurrent chemotherapy was administered to 8 (62%) patients. The 1-year rate of freedom from local progression was 50%, and the median duration of freedom from local progression was 14 months. The 1-year rate of overall survival was 62%, and the median duration of overall survival was 14 months. One patient developed grade 3 acute toxicity (abdominal pain and gastrointestinal bleeding), requiring hospitalization during radiotherapy; subsequently, that patient experienced a grade 4 late toxicity (gastrointestinal bleeding). No other patients developed grade 3-4 acute or late toxicity or required hospitalization during radiotherapy. Hyperfractionated accelerated reirradiation to the abdomen was well-tolerated with low rates of acute and late toxicity. Reirradiation could play a role in providing a limited duration of local control in gastrointestinal cancer patients with a history of prior abdominal radiotherapy

  1. Acute Otitis due to Vibrio fluvialis after Swimming

    Ping-Jen Chen

    2012-01-01

    Full Text Available A 40-year-old female presented with purulent exudate through the left auditive duct and pain in the left ear region, which intensified during mastication. After collection of the pus from the left ear lesion, amoxicillin-clavulanic acid for seven days was prescribed for a presumed diagnosis of acute otitis. Four days later, the pus culture grew V. fluvialis which is further identified by API 20E identification system (bioMérieux. Following the successful completion of a course of antibiotics, the patient recovered completely and without complication. To the best of our knowledge, this is the first case of Vibrio fluvialis otitis after swimming in an immunocompetent patient.

  2. Acute skin lesions due to localized ''hot particle'' radiation exposures

    Purpose of the studies was to determine incidence and severity of lesions resulting from localized deposition of dose to the skin from small (2 at 70μm depth) from isotopes having max beta particle energies from about 0.3-3 MeV. Incidence of erythema and scabs (indicating ulceration) were scored routinely for up to 71 days post-irradiation. Responses followed normal probability distributions, and thus, no true threshold could be defined. Ten and 50% incidence rates were deduced using probit analyses. Lowest dose producing 10% incidence was about 1 Gy for exposures to Yb-175 (0.5 MeV max energy) beta particles. Severity of lesions was estimated using diameters and persistence. From preliminary considerations of probability of induction, size, and persistence of acute lesions, a special limit for hot particle exposures in the range of 5-50 Gy may be reasonable, with an action level between about 1 Gy and the limit

  3. Pulmonary hypertension due to acute respiratory distress syndrome

    S.A. Ñamendys-Silva

    2014-10-01

    Full Text Available Our aims were to describe the prevalence of pulmonary hypertension in patients with acute respiratory distress syndrome (ARDS, to characterize their hemodynamic cardiopulmonary profiles, and to correlate these parameters with outcome. All consecutive patients over 16 years of age who were in the intensive care unit with a diagnosis of ARDS and an in situ pulmonary artery catheter for hemodynamic monitoring were studied. Pulmonary hypertension was diagnosed when the mean pulmonary artery pressure was >25 mmHg at rest with a pulmonary artery occlusion pressure or left atrial pressure <15 mmHg. During the study period, 30 of 402 critically ill patients (7.46% who were admitted to the ICU fulfilled the criteria for ARDS. Of the 30 patients with ARDS, 14 met the criteria for pulmonary hypertension, a prevalence of 46.6% (95% CI; 28-66%. The most common cause of ARDS was pneumonia (56.3%. The overall mortality was 36.6% and was similar in patients with and without pulmonary hypertension. Differences in patients' hemodynamic profiles were influenced by the presence of pulmonary hypertension. The levels of positive end-expiratory pressure and peak pressure were higher in patients with pulmonary hypertension, and the PaCO2 was higher in those who died. The level of airway pressure seemed to influence the onset of pulmonary hypertension. Survival was determined by the severity of organ failure at admission to the intensive care unit.

  4. [Risk of acute hepatic insufficiency in children due to chronic accidental overdose of paracetamol (acetaminophen)

    Hameleers-Snijders, P.; Hogeveen, M.; Smeitink, J.A.M.; Kramers, C.; Draaisma, J.M.T.

    2007-01-01

    Two girls aged 4 and 3 years, respectively, experienced acute liver failure due to accidental ingestion of supratherapeutic doses of paracetamol (90 mg/kg/day or more). Recognition of chronic paracetamol intoxication as a cause of acute hepatic failure is often delayed. It is important to consider t

  5. Papillary muscle rupture due to acute myocardial infarction followed by cardiogenic shock, pulmonary edema, and acute renal failure

    Ilić Radoje

    2005-01-01

    Full Text Available Aim. The case of successful surgical treatment of anterolateral papillary muscle rupture due to acute myocardial infarction with cardiogenic shock, pulmonary edema and acute renal failure. Case report. A 62-year old male from Belgrade with chest pain, hypotension and a new heart murmur refused hospitalization at the Military Medical Academy. On the third day of his illness he was readmitted to MMA as an emergency due to hemoptysis. Examination revealed mitral valve anterolateral papillary muscle rupture. The patient, with signs of cardiogenic shock and acute renal failure, was immediately operated on. The surgery was performed using extracorporeal circulation. An artificial mitral valve was implanted, and myocardial revascularization accomplished with one venous graft of the left anterior descending artery. On the second postoperative day, hemodialysis was carried out due to acute renal failure. On the 28th postoperative day, the patient was discharged from the hospital being hemodynamically stable with normal renal function and balanced anticoagulation. The case is interesting in terms of unrecognized papillary muscle rupture that led to the development of cardiogenic shock, hemoptysis and acute renal failure. Conclusion. Papillary muscle rupture is a fatal complication of acute myocardial infarction. Early recognition and urgent surgical intervention were lifesaving in the case of complete papillary muscle rupture. Surgical treatment, regardless of high risk, is the procedure of choice.

  6. Laparoscopy rol in acute cases of lower abdomen in women. Review of the last 10 years in the British Hospital Gynecology Service

    Acute lower abdominal episodes in women are the most frequent cause of consultation at the emergency room. The role of laparoscopy as a diagnostic and therapeutic tool, especially in women, has been well established. It allows the visualization of the entire abdominal cavity as well as the diagnosis delays and its complications in the evolution

  7. Severe acute caffeine poisoning due to intradermal injections: Mesotherapy hazard

    Perković-Vukčević Nataša; Babić Gordana; Šegrt Zoran; Vuković-Ercegović Gordana; Janković Snežana; Aćimović Ljubomir

    2012-01-01

    Introduction. Caffeine is indicated in the treatment of migraine headaches, as well as neonatal apnea and bradycardia syndrome. In mild poisoning, the most prevalent symptoms are nausea, vomiting, diarrhea, tremor, anxiety and headache. In more severe cases, symptoms consist of heart rythym abnormalities, myocardial infarction and seizures. Due to its common lipolytic effect, caffeine is used in mesotherapy, usually in combination with drugs of similar effect. We presented a patient wit...

  8. Acute pulmonary alveolar proteinosis due to exposure to cotton dust

    Thind Gurcharan

    2009-01-01

    Secondary pulmonary alveolar proteinosis (PAP) is rare but may occur in association with malignancy, certain infections, and exposure to inorganic or organic dust and some toxic fumes. This case report describes the second recorded case of PAP due to exposure to cotton dust. A 24-year-old man developed PAP after working as a spinner for eight years without respiratory protection. He was admitted as an emergency patient with very severe dyspnea for four months and cough for several years. Ches...

  9. Acute Psychotic Symptoms due to Benzydamine Hydrochloride Abuse with Alcohol

    Yahya Ayhan Acar; Mustafa Kalkan; Rıdvan Çetin; Erdem Çevik; Orhan Çınar

    2014-01-01

    Benzydamine hydrochloride is a locally acting nonsteroidal anti-inflammatory drug. Benzydamine hydrochloride overdose can cause stimulation of central nervous system, hallucinations, and psychosis. We presented a young man with psychotic symptoms due to benzydamine hydrochloride abuse. He received a total dose of 1000 mg benzydamine hydrochloride with alcohol for its hallucinative effects. Misuse of benzydamine hydrochloride must be considered in differential diagnosis of first-episode psycho...

  10. Acute Psychotic Symptoms due to Benzydamine Hydrochloride Abuse with Alcohol

    Yahya Ayhan Acar

    2014-01-01

    Full Text Available Benzydamine hydrochloride is a locally acting nonsteroidal anti-inflammatory drug. Benzydamine hydrochloride overdose can cause stimulation of central nervous system, hallucinations, and psychosis. We presented a young man with psychotic symptoms due to benzydamine hydrochloride abuse. He received a total dose of 1000 mg benzydamine hydrochloride with alcohol for its hallucinative effects. Misuse of benzydamine hydrochloride must be considered in differential diagnosis of first-episode psychosis and physicians should consider possibility of abuse in prescribing.

  11. Acute renal failure due to abdominal compartment syndrome: report on four cases and literature review

    Cleva Roberto de

    2001-01-01

    Full Text Available We report on 4 cases of abdominal compartment syndrome complicated by acute renal failure that were promptly reversed by different abdominal decompression methods. Case 1: A 57-year-old obese woman in the post-operative period after giant incisional hernia correction with an intra-abdominal pressure of 24 mm Hg. She was sedated and curarized, and the intra-abdominal pressure fell to 15 mm Hg. Case 2: A 73-year-old woman with acute inflammatory abdomen was undergoing exploratory laparotomy when a hypertensive pneumoperitoneum was noticed. During the surgery, enhancement of urinary output was observed. Case 3: An 18-year-old man who underwent hepatectomy and developed coagulopathy and hepatic bleeding that required abdominal packing, developed oliguria with a transvesical intra-abdominal pressure of 22 mm Hg. During reoperation, the compresses were removed with a prompt improvement in urinary flow. Case 4: A 46-year-old man with hepatic cirrhosis was admitted after incisional hernia repair with intra-abdominal pressure of 16 mm Hg. After paracentesis, the intra-abdominal pressure fell to 11 mm Hg.

  12. Nutrition Support in the Open Abdomen.

    Moore, Scott M; Burlew, Clay Cothren

    2016-02-01

    Early provision of enteral nutrition (EN) in critically ill and injured patients has become standard practice in surgical intensive care units (ICUs) due to its proven role in reducing septic complications. Increasingly, intensivists are confronted with patients with an open abdomen due to the use of damage control surgery and the recognition of the abdominal compartment syndrome; the role and timing of EN in these challenging patients continue to be debated. Patients with an open abdomen are often among the sickest in the ICU and hence could benefit from early nutrition support. However, the exposed abdominal viscera can understandably create anxiety regarding the initiation of EN; there is theoretic concern over exacerbation of bowel distention with resultant inability to close the abdomen and an increased aspiration risk due to paralytic ileus. Recent studies have investigated the utility of EN in the patient with an open abdomen, addressing these clinical concerns. The goal of this clinical review is to provide guidance to physicians caring for these complex patients. PMID:26673199

  13. Acute colonic obstruction due to benign prostatic hypertrophy.

    Mac Giobuin, S

    2012-02-01

    A seventy two year old man presented to the Emergency Department with clinical features of colonic obstruction. Subsequent radiological investigations confirmed this impression and revealed the aetiology to be compression of the sigmoid colon against the sacrum by a massively distended urinary bladder. Chronic urinary retention due to benign prostatic hypertrophy is an extremely unusual cause of large bowel obstruction. Little in this patient\\'s clinical findings suggested this aetiology. We reviewed the literature in this area and highlight the benefits of CT scanning over contrast studies.

  14. Effectiveness of Thrombolytic Therapy in Acute Embolic Stroke due to Infective Endocarditis

    Sontineni, Siva P.; Mooss, Aryan N.; Andukuri, Venkata G.; Susan Marie Schima; Dennis Esterbrooks

    2009-01-01

    Objective. To identify the role of thrombolytic therapy in acute embolic stroke due to infective endocarditis. Design. Case report. Setting. University hospital. Patient. A 70-year-old male presented with acute onset aphasia and hemiparesis due to infective endocarditis. His head computerized tomographic scan revealed left parietal sulcal effacement. He was given intravenous tissue plasminogen activator with significant resolution of the neurologic deficits without complications. Main Outcome...

  15. Acute oxalate nephropathy due to ‘Averrhoa bilimbi’ fruit juice ingestion

    Bakul, G.; Unni, V. N.; Seethaleksmy, N. V.; A Mathew; Rajesh, R; Kurien, G.; J. RAJESH; Jayaraj, P. M.; Kishore, D. S.; Jose, P. P.

    2013-01-01

    Irumban puli (Averrhoa bilimbi) is commonly used as a traditional remedy in the state of Kerala. Freshly made concentrated juice has a very high oxalic acid content and consumption carries a high risk of developing acute renal failure (ARF) by deposition of calcium oxalate crystals in renal tubules. Acute oxalate nephropathy (AON) due to secondary oxalosis after consumption of Irumban puli juice is uncommon. AON due to A. bilimbi has not been reported before. We present a series of ten patien...

  16. An unusual cause of acute kidney injury due to oxalate nephropathy in systemic scleroderma.

    Mascio, Heather M; Joya, Christie A; Plasse, Richard A; Baker, Thomas P; Flessner, Michael F; Nee, Robert

    2015-08-01

    Oxalate nephropathy is an uncommon cause of acute kidney injury. Far rarer is its association with scleroderma, with only one other published case report in the literature. We report a case of a 75-year-old African-American female with a history of systemic scleroderma manifested by chronic pseudo-obstruction and small intestinal bacterial overgrowth (SIBO) treated with rifaximin, who presented with acute kidney injury with normal blood pressure. A renal biopsy demonstrated extensive acute tubular injury with numerous intratubular birefringent crystals, consistent with oxalate nephropathy. We hypothesize that her recent treatment with rifaximin for SIBO and decreased intestinal transit time in pseudo-obstruction may have significantly increased intestinal oxalate absorption, leading to acute kidney injury. Oxalate nephropathy should be considered in the differential diagnosis of acute kidney injury in scleroderma with normotension, and subsequent evaluation should be focused on bowel function to include alterations in gut flora due to antibiotic administration. PMID:25500295

  17. Clinical effect of fast track surgery nursing for acute abdomen complicated with depression%快速康复外科护理应用于急腹症并发抑郁症患者的临床成效

    古金花; 邹艳花; 陈小银

    2015-01-01

    Objective To explore the effect of implementing fast rehabilitation surgery nursing on the postoperative condition and mood of acute abdomen complicated with depressive disorder,and accumulate experience for the high quality of nursing service in this group. Methods 39 cases of acute abdomen complicated with depression patients were selected in our hospital in 2010 August to 2012year in July in Department of general surgery were set as the control group,routine nursing intervention,the implementation of the department of general surgery;43 cases of acute abdomen complicated with depression patients were selected in our hospital in 2012 August to 2014 year in July in department of general surgery were set as the study group,the implementation of fast track surgery,nursing intervention.Two groups of patients in hospitalization day and intervention the end of 5D underwent brief depression rating scale(BPRS)assessment,two patients were also recorded after the group eating time,ambulation time,medical expenses,hospitalization time,complications rate. Results The study group the next activity time,postoperative eating time,hospitalization time was shorter than the control group(P 0.05)after the intervention,the study group;anxiety depression factor,lack of energy factor,thinking disorder factor and hostile factors were lower than the control group(P < 0.05),activated factor was higher than that in control group(P < 0.05). Conclusion For patients with acute abdomen complicated with depression,the concept of rapid rehabilitation surgery can promote the rehabilitation of patients with the disease prognosis,reduce the incidence of complications,and help to improve the emotional state of patients, promote the social function of the early return, achieved satisfactory clinical results.%目的:探究急腹症并发抑郁症患者实施快速康复外科护理对其术后病情康复及情绪状况的影响,并为这类人群的优质护理服务积累经验。

  18. Sudden psychotic episode probably due to meningoencephalitis and Chlamydia pneumoniae acute infection

    Canas Nuno

    2005-09-01

    Full Text Available Abstract Background Since 9% to 20% of all cases of acute psychosis presenting to an Emergency Department (ED are due to a general medical condition, cautious medical workup should be mandatory in such patients. Differential diagnosis must consider conditions as diverse as renal failure or CNS infection. Acute Chlamydia pneumoniae infection usually causes a self-limited respiratory syndrome. Rarely, acute neurological complications occur, with acute meningoencephalitis most frequently reported. Diagnosis requires a high level of suspicion and is difficult to confirm. Case report We describe a 22 year-old female Caucasian who, three days after a mild pharingitis, developed an acute psychosis with exuberant symptoms interspersed with periods of lucidity, in a background of normal consciousness and orientation. Initial medical and imagiological workup were inconclusive. After 20 days of unsuccessful treatment with antipsychotics she developed a high fever and was re-evaluated medically. Lumbar puncture revealed an inflammatory cerebrospinal fluid. MRI showed irregular thickening and nodularity of the lateral ventricles' lining. An anti-Chlamydia pneumoniae IgM antibody titter of 85 IU/ml was detected. All symptoms cleared after treatment with antibiotics and corticosteroids. Conclusion This is, to our knowledge, the first reported case of acute CP-associated meningoencephalitis manifesting as an acute psychotic episode. It illustrates the principle that non-organic psychiatric syndromes must remain a diagnosis of exclusion in first-time acute psychosis.

  19. A case of acute psychosis due to vitamin b12 deficiency

    Sayın, Selim; Arslan, Erol; Demirbaş, Şeref; ESER, Mithat; Kenan SAĞLAM

    2014-01-01

    Patients with vitamin B12 deficiency may present with hematologic, neuropsychiatric and cardiovascular symptoms. A clinical Picture of acute psychosis can be seen in rare cases and if not corrected, vitamin B12 deficiency can lead to permanent demage. Acute psychosis and symptoms of anemia with sixty-year-old male patient was evaluated and found that vitamin B12 deficiency due to the terminal ileitis. The patient was healed without permanent damage with replacement therapy.The diagnosis and t...

  20. A Case with Repeated Recurrent Acute Coronary Syndrome due to Pseudoephedrine Use: Kounis Syndrome

    Metin Çeliker

    2014-01-01

    Full Text Available Allergic reaction-associated acute coronary syndrome picture is defined as Kounis syndrome. Although drug use is the most common cause of allergic reaction, foods and environmental factors may also play a role in the etiology. Herein, a case with acute coronary syndrome that developed two times at 8-month interval due to pseudoephedrine use for upper respiratory tract infection is presented.

  1. Acute Respiratory Failure due to Neuromyelitis Optica Treated Successfully with Plasmapheresis

    Massa Zantah; Coyle, Timothy B.; Debapriya Datta

    2016-01-01

    Neuromyelitis Optica (NMO) is a demyelinating autoimmune disease involving the central nervous system. Acute respiratory failure from cervical myelitis due to NMO is known to occur but is uncommon in monophasic disease and is treated with high dose steroids. We report a case of a patient with NMO who developed acute respiratory failure related to cervical spinal cord involvement, refractory to pulse dose steroid therapy, which resolved with plasmapheresis.

  2. Acute Respiratory Failure due to Neuromyelitis Optica Treated Successfully with Plasmapheresis

    Massa Zantah

    2016-01-01

    Full Text Available Neuromyelitis Optica (NMO is a demyelinating autoimmune disease involving the central nervous system. Acute respiratory failure from cervical myelitis due to NMO is known to occur but is uncommon in monophasic disease and is treated with high dose steroids. We report a case of a patient with NMO who developed acute respiratory failure related to cervical spinal cord involvement, refractory to pulse dose steroid therapy, which resolved with plasmapheresis.

  3. Acute Neonatal Parotitis with Late-Onset Septic Shock due to Streptococcus agalactiae

    Boulyana, M.

    2014-01-01

    Acute neonatal parotitis (ANP) is a very rare disease. Most cases are managed conservatively; early antibiotics and adequate hydration may reduce the need for surgery. The most common cause of ANP is Staphylococcus aureus. We report a rare case of acute neonatal parotitis with late-onset septic shock due to Streptococcus agalactiae. The diagnosis was confirmed with ultrasound and isolation of Streptococcus agalactiae from blood culture. The patient was treated successfully with 10 days of int...

  4. Splenic artery pseudoaneurysm due to acute pancreatitis in a 6-year-old boy with acute lymphoblastic leukaemia treated with L-aspariginase

    Larsen, Cæcilie Crawley; Laursen, Christian B; Dalby, Kasper;

    2014-01-01

    Acute pancreatitis is a rare phenomenon in children but its incidence seems to be increasing. In children, it is generally caused due to systemic illness, biliary disease, trauma, idiopathy and side effects of medicines like L-aspariginase. Acute pancreatitis is difficult to diagnose in children...... pseudoaneurysm due to acute pancreatitis in a 6-year-old boy with acute lymphoblastic leukaemia treated with L-aspariginase. He presented with fever, irritability and pain in his left groin region....

  5. Acute oxalate nephropathy due to ‘Averrhoa bilimbi’ fruit juice ingestion

    Bakul, G.; Unni, V. N.; Seethaleksmy, N. V.; Mathew, A.; Rajesh, R.; Kurien, G.; Rajesh, J.; Jayaraj, P. M.; Kishore, D. S.; Jose, P. P.

    2013-01-01

    Irumban puli (Averrhoa bilimbi) is commonly used as a traditional remedy in the state of Kerala. Freshly made concentrated juice has a very high oxalic acid content and consumption carries a high risk of developing acute renal failure (ARF) by deposition of calcium oxalate crystals in renal tubules. Acute oxalate nephropathy (AON) due to secondary oxalosis after consumption of Irumban puli juice is uncommon. AON due to A. bilimbi has not been reported before. We present a series of ten patients from five hospitals in the State of Kerala who developed ARF after intake of I. puli fruit juice. Seven patients needed hemodialysis whereas the other three improved with conservative management. PMID:23960349

  6. Acute pancreatitis complicating severe dengue

    Vishakha Jain; O P Gupta; Tarun Rao; Siddharth Rao

    2014-01-01

    Dengue is an arthropod borne viral infection endemic in tropical and subtropical continent. Severe dengue is life threatening. Various atypical presentations of dengue have been documented. But we present a rare and fatal complication of severe dengue in form of acute pancreatitis. A 27-year-old male had presented with severe dengue in decompensated shock and with pain in abdomen due to pancreatitis. The pathogenesis of acute pancreatitis in dengue is not clearly understood, but various mecha...

  7. Acute pancreatitis due to ascariasis: a sonographic pictorial essay on four cases.

    Lynser, Donboklang; Thangkhiew, R S; Laloo, Demitrost; Hek, M D; Marbaniang, Evarisalin; Tariang, Satisfy

    2016-06-01

    Ascariasis is the commonest helminthic disease to infect humans. Due to their wandering nature, the roundworms from the second part of the duodenum migrate through the biliary opening into the hepatobiliary and pancreatic ducts. Ascariasis is the most common parasitic cause of pancreatitis in endemic region. Pancreatitis can result due to pancreatic ascariasis, biliary ascariasis or both. Pancreatitis due to ascariasis can be severe and life-threatening. We present a pictorial essay of acute pancreatitis due to ascariasis on four cases. PMID:27059341

  8. Abdome agudo perfurativo por corpo estranho em paciente com situs inversus totalis Perfurative acute abdomen due to foreign body in patient with situs inversus totalis

    André Vitorio Câmara Oliveira; Carlos Eduardo Costa Maranhão; Clístenes Dejane Sobral Coelho; Sabine de Lucena Martins Ferreira; Bruno Nogueira Bezerra Tavares; Larissa Cavalcanti Barros

    2008-01-01

    INTRODUÇÃO: Situs inversus totalis é descoberta importante para a conduta clínica cirúrgica. Corpo estranho no intestino grosso pode ocorrer devido a ingestão ou introdução anal. A perfuração intestinal é acompanhada de elevada morbidade e constitui-se em desafio aos cirurgiões. RELATO DO CASO: Paciente, masculino, 28 anos, deficiente mental, com dor e distensão abdominal há sete dias, anorexia há dois, parada de eliminação de gases e fezes, sem vômitos. Ao exame apresentava dispnéia leve, de...

  9. IMPORTANCE OF MUSCLE MASS IN ACUTE TUBULAR NECROSIS DUE TO RHABDOMYOLISIS: CASE REPORT

    Özge Onur; Özlem Güneysel; Serkan Eroğlu; Arzu Denizbaşı; Erol Ünlüer

    2006-01-01

    30 years old male patient presented to our emergency clinic with complaint of left upper quadrant pain. We learned there has been a fight, he was assaulted with fists and iron bricks to his abdomen and right arm. Clinical examination revealed echymotic areas in his thorax, back and right arm; tenderness at left upper quadrant of abdomen. In laboratuary tests creatinin phosphokinase (CPK), creatinin(Cr) and potassium(K) levels were high. The patient admitted to emergency service with diagnosis...

  10. Acute Pancreatitis due to Rupture of the Hydatid Cyst into the Biliary Tract: A Case Report

    Zulfu Bayhan

    2014-02-01

    Full Text Available Hydatid disease is still endemic in our country and in many parts of the world. Liver is the most common site of hydatid disease. Rupture of hydatid cysts of liver into the biliary ducts can be seen as a complication. Obstructive jaundice, acute cholangitis and much more rarely acute pancreatitis may occur due to rupture of hydatid cysts into the biliary ducts. In this case report, a 38-year-old male patient with findings of acute pancreatitis and obstructive jaundice due to rupture of hydatid cyst into the biliary tract were presented . In our case, Endoscopic retrograde cholangiopancreatography (ERCP was performed to the patient with diagnostic and therapeutic purposes. Parts of germinative membrane located within the common bile duct and causing the obstruction of papillary orifice was seen in ERCP. Germinative membrane components were removed during the process. Endoscopic sphincterotomy was performed to the patient. After the procedure, the clinical findings and laboratory findings of the patient returned to normal rapidly. As a result, it should be noted that rupture of hepatic hydatid cysts into the bile ducts might be a rare cause of biliary pancreatitis. It must be kept in mind that endoscopic sphincterotomy and endoscopic removal of cyst membranes is a very important method for the diagnosis and treatment of the acute pancreatitis and obstructive jaundice due to rupture of hydatid cyst into the biliary tract. [Natl J Med Res 2014; 4(1.000: 92-94

  11. Point-of-Admission Serum Electrolyte Profile of Children less than Five Years Old with Dehydration due to Acute Diarrhoea

    Okposio, Matthias Mariere; Onyiriuka, Alphonsus Ndidi; Abhulimhen-Iyoha, Blessing Imuetiyan

    2015-01-01

    Background/Objective: Fluid, electrolytes and acid base disturbances are responsible for most deaths due to acute diarrhoea. The aim of this study is to describe the point-of-admission serum electrolyte profile of children with dehydration due to acute diarrhoea. Methods: In this cross-sectional study, the serum electrolyte levels of 185 children with dehydration due to acute diarrhoea were assessed at the point of admission at the Diarrhoea Treatment and Training Unit of the University of Be...

  12. Ventricular enlargement due to acute hypernatremia in a patient with a ventriculoperitoneal shunt.

    Andres, Robert H; Pendharkar, Arjun V; Kuhlen, Dominique; Mariani, Luigi

    2010-07-01

    Patients requiring CSF shunts frequently have comorbidities that can influence water and electrolyte balances. The authors report on a case involving a ventriculoperitoneal shunt in a patient who underwent intravenous hyperhydration and withdrawal of vasopressin substitution prior to scheduled high-dose chemotherapy regimen for a metastatic suprasellar germinoma. After acute neurological deterioration, the patient underwent CT scanning that demonstrated ventriculomegaly. A shunt tap revealed no flow and negative opening pressure. Due to suspicion of proximal shunt malfunction, the comatose patient underwent immediate surgical exploration of the ventricle catheter, which was found to be patent. However, acute severe hypernatremia was diagnosed during the procedure. After correction of the electrolyte disturbances, the patient regained consciousness and made a good recovery. Although rare, the effects of acute severe hypernatremia on brain volume and ventricular size should be considered in the differential diagnosis of ventriculoperitoneal shunt failure. PMID:19911884

  13. Recurrent Episodes of Acute Pancreatitis Due to Duodenal Gangliocytic Paraganglioma: Report of a Case

    Natalia Asimakopoulou

    2014-03-01

    Full Text Available Context Gangliocytic paraganglioma is a rare tumor, almost always located in the second portion of the duodenum, andmanifested with upper gastrointestinal bleeding and abdominal pain. To date, only one case of duodenal gangliocyticparaganglioma presented with recurrent acute pancreatitis has been reported in the literature. Case report We present a72-year-old woman admitted to the hospital due to recurrent episodes of acute pancreatitis. Paraclinical examinationsshowed a polypoid mass in the second portion of duodenum which was removed surgically by local excision. Thepreoperative differential diagnosis was suggestive with gastrointestinal stromal tumor or adenoma. The histopathologyexamination revealed a duodenal gangliocytic paraganglioma. After a follow up period of seventeen months the patientremained without clinical evidence of tumor recurrence. Conclusion Our case report draws attention to the need forincluding in our differential diagnosis of recurrent acute pancreatitis the mechanical obstruction of the pancreatic duct dueto this tumor.

  14. Acute-on-chronic liver failure due to bacterial infection in liver cirrhosis: causes and management

    Han, Tao

    2015-01-01

    Bacterial infection is a common complication in patients with liver cirrhosis, and acute-on-chronic liver failure due to bacterial infection has become a serious clinical problem. There are still many problems in the research on the pathogenesis and management of bacterial infection in liver cirrhosis, such as insidious onset, difficult early diagnosis, and increased multi-drug resistant bacteria. This article reviews the research progress in the causes and management of bacterial infection i...

  15. GISTs múltiplos em neurofibromatose tipo 1: diagnóstico incidental em paciente com abdome agudo Multiple GISTs in neurofibromatosis type 1: incidental diagnosis in a patient with acute abdomen

    Tomaz de Jesus Maria Grezzana-Filho

    2009-03-01

    Full Text Available INTRODUÇÃO: Tem sido descrito na literatura incidência aumentada de tumores estromais gastrointestinais (GISTs em portadores de neurofibromatose tipo 1. Estes tumores tipicamente ocorrem no intestino delgado e, frequentemente, são múltiplos. RELATO DO CASO: Diagnóstico incidental de GIST em um paciente portador de neurofibromatose tipo 1 com abdome agudo. No trans-operatório foi identificada apendicite retrocecal perfurada e massa neoplásica no jejuno proximal. A referida lesão ocupava aproximadamente 70% da circunferência do órgão e não apresentava invasão de estruturas adjacentes. Além disso, observaram-se dezenas de pequenos nódulos disseminados por toda a extensão do jejuno e íleo. O anatomopatológico revelou neoplasia compatível com GIST, com grau moderado de atipias, baixo índice mitótico (BACKGROUND: The literature described an increased incidence of gastrointestinal stromal tumors (GISTs in patients with neurofibromatosis type 1. These tumors typically occur in the small intestine, and frequently are multiple. Often the behavior of the tumor in this association is more favorable than in sporadic cases. CASE REPORT: Incidental diagnosis of GIST was done in a patient with neurofibromatosis type 1 during treatment for acute abdomen. Trans-operatively was identified a retrocecal perforated appendicitis and a neoplastic mass in the proximal jejunum. The lesion occupied approximately 70% of the circumference of the organ and had no invasion of adjacent structures. Moreover, there were dozens of small nodules scattered throughout the length of the jejunum and ileum. The pathology revealed malignancy consistent with GIST, with moderate degree of atypia, low mitotic index (<5 / 50 and absence of necrosis. In immunohistochemical analysis, the neoplastic cells were positive for CD-34 and CD-117 (c-KIT, and negative for desmin. After surgery, the use of Imatinib chemotherapy was indicated. After a follow-up period of 12 months

  16. Post-renal acute renal failure due to a huge bladder stone

    Orcun Celik

    2014-06-01

    Full Text Available A 63-year old male was referred to our emergency unit due to acute renal failure. The level of serum renal function tests levels, blood urea nitrogen (BUN/creatinine, were 63 mmol/L/848 μmol/L. CT (Computarised Tomography scan showed a huge bladder stone (5 cm x 6 cm x 5 cm with increased bladder wall thickness. Post-renal acute renal failure due to bilateral ureterohydronephrosis was diagnosed. The huge bladder stone was considered to be the cause of ureterohydronephrosis and renal failure. The patient was catheterised and received haemodialysis immediately. He received haemodialysis four times during ten days of hospitalization and the level of serum renal function tests levels (BUN/ creatinine decreased 18 mmol/L/123 μmol/L. After improvement of renal function, we performed cystoscopy that demonstrated normal prostatic urethra and bladder neck and bilaterally normal ureteral orifices. Bladder wall was roughly trabeculated and Bladder outlet was completely obstructed by a huge bladder stone. After cystoscopy open, cystolithotomy was performed to remove calcium phosphate and magnesium ammonium phosphate stone weighing 200 g removed. Four days after operation the patient was discharged uneventfully and urethral catheter was removed on the seventh day. Post-renal acute renal failure due to large bladder stones is rare in literature. According to the our knowledge; early diagnosis of the stone avoid growth to large size and prevent renal failure.

  17. Acute metabolic decompensation due to influenza in a mouse model of ornithine transcarbamylase deficiency

    Peter J. McGuire

    2014-02-01

    Full Text Available The urea cycle functions to incorporate ammonia, generated by normal metabolism, into urea. Urea cycle disorders (UCDs are caused by loss of function in any of the enzymes responsible for ureagenesis, and are characterized by life-threatening episodes of acute metabolic decompensation with hyperammonemia (HA. A prospective analysis of interim HA events in a cohort of individuals with ornithine transcarbamylase (OTC deficiency, the most common UCD, revealed that intercurrent infection was the most common precipitant of acute HA and was associated with markers of increased morbidity when compared with other precipitants. To further understand these clinical observations, we developed a model system of metabolic decompensation with HA triggered by viral infection (PR8 influenza using spf-ash mice, a model of OTC deficiency. Both wild-type (WT and spf-ash mice displayed similar cytokine profiles and lung viral titers in response to PR8 influenza infection. During infection, spf-ash mice displayed an increase in liver transaminases, suggesting a hepatic sensitivity to the inflammatory response and an altered hepatic immune response. Despite having no visible pathological changes by histology, WT and spf-ash mice had reduced CPS1 and OTC enzyme activities, and, unlike WT, spf-ash mice failed to increase ureagenesis. Depression of urea cycle function was seen in liver amino acid analysis, with reductions seen in aspartate, ornithine and arginine during infection. In conclusion, we developed a model system of acute metabolic decompensation due to infection in a mouse model of a UCD. In addition, we have identified metabolic perturbations during infection in the spf-ash mice, including a reduction of urea cycle intermediates. This model of acute metabolic decompensation with HA due to infection in UCD serves as a platform for exploring biochemical perturbations and the efficacy of treatments, and could be adapted to explore acute decompensation in other

  18. Abdomen X-Ray (Radiography)

    ... News Physician Resources Professions Site Index A-Z X-ray (Radiography) - Abdomen Abdominal x-ray uses a very ... of an abdominal x-ray? What is abdominal x-ray? An x-ray (radiograph) is a noninvasive medical ...

  19. A Rare Side Effect due to TNF-Alpha Blocking Agent: Acute Pleuropericarditis with Adalimumab

    Hakan Ozkan

    2013-01-01

    Full Text Available Tumor necrosis factor-alpha antagonism is an important treatment strategy in patients with rheumatoid arthritis, psoriatic arthritis, vasculitis, and ankylosing spondylitis. Adalimumab is one of the well-known tumor necrosis factor-alpha blocking agents. There are several side effects reported in patients with adalimumab therapy. Cardiac side effects of adalimumab are rare. Only a few cardiac side effects were reported. A 61-year-old man treated with adalimumab for the last 6 months due to psoriatic arthritis presented with typically acute pleuropericarditis. Chest X-ray and echocardiography demonstrated marked pericardial effusion. Patient was successfully evaluated for the etiology of acute pleuro-pericarditis. Every etiology was excluded except the usage of adalimumab. Adalimumab was discontinued, and patient was treated with 1200 mg of ibuprofen daily. Control chest X-ray and echocardiography after three weeks demonstrated complete resolution of both pleural and pericardial effusions. This case clearly demonstrated the acute onset of pericarditis with adalimumab usage. Acute pericarditis and pericardial effusion should be kept in mind in patients with adalimumab treatment.

  20. MR imaging of the abdomen in pregnancy

    Sonography is still the method of choice for imaging diseases in pregnant women. The changed physiognomy of the women increases the known limitations of sonography while the advantages of MRI (large field of view, excellent soft-tissue contrast, sensitive diagnosis of edema) are not affected. The available sequences allow the differentiation of various pathologies. Most of these can frequently be visualized without intravenous administration of contrast material. Although the significance of techniques like DWI and ASL has not yet been explored, initial descriptions are promising and MR imaging in pregnancy will be increasingly important in the future. Therefore, knowledge of the most frequent diseases in pregnancy and their image appearance is relevant to radiologists. The advantages of MRI in comparison to sonography and its important role in imaging pathologies of the acute abdomen in pregnancy are illustrated and discussed. (orig.)

  1. [MR imaging of the abdomen in pregnancy].

    Klasen, J; Antoch, G; Blondin, D

    2011-06-01

    Sonography is still the method of choice for imaging diseases in pregnant women. The changed physiognomy of the women increases the known limitations of sonography while the advantages of MRI (large field of view, excellent soft-tissue contrast, sensitive diagnosis of edema) are not affected. The available sequences allow the differentiation of various pathologies. Most of these can frequently be visualized without intravenous administration of contrast material. Although the significance of techniques like DWI and ASL has not yet been explored, initial descriptions are promising and MR imaging in pregnancy will be increasingly important in the future. Therefore, knowledge of the most frequent diseases in pregnancy and their image appearance is relevant to radiologists. The advantages of MRI in comparison to sonography and its important role in imaging pathologies of the acute abdomen in pregnancy are illustrated and discussed. PMID:21487979

  2. 49 CFR 572.186 - Abdomen assembly.

    2010-10-01

    ... 49 Transportation 7 2010-10-01 2010-10-01 false Abdomen assembly. 572.186 Section 572.186... Dummy, 50th Percentile Adult Male § 572.186 Abdomen assembly. (a) The abdomen assembly (175-5000) is part of the dummy assembly shown in drawing 175-0000 including load sensors specified in §...

  3. A case of acute epididymo-orchitis due to Pseudomonas aeruginosa presenting as ARDS in an immunocompetent host

    Sameer; Singhal; DD; Wagh; Shivali; Kashikar; Yeshwant; Lonkar

    2011-01-01

    Acute eididymo-orchitis is the most common cause of intrascrolal inflammation,and retrograde ascent of pathogens is the usual route of infection.Here we intend to present a case of young hoy. not sexually active,suffering from acute epididymo-orchitis due lo Pseudomonas aeruginosa presented with acute respiratory distress syndrome.Proper timely diagnosis of the primary cause and prompt treatment including support with nun invasive ventilation lead lo a favourable outcome in the same case.

  4. A case of acute epididymo-orchitis due to Pseudomonas aeruginosa presenting as ARDS in an immunocompetent host

    Sameer Singhal; DD Wagh; Shivali Kashikar; Yeshwant Lonkar

    2011-01-01

    Acute eididymo-orchitis is the most common cause of intrascrotal inflammation, and retrograde ascent of pathogens is the usual route of infection. Here we intend to present a case of young boy, not sexually active, suffering from acute epididymo-orchitis due to Pseudomonas aeruginosa presented with acute respiratory distress syndrome. Proper timely diagnosis of the primary cause and prompt treatment including support with non invasive ventilation lead to a favourable outcome in the same case.

  5. Association between acute motor axonal neuropathy and septic shock due to Acinetobacter baumannii.

    Toscani, Lucia; Guarducci, Diletta; Matà, Sabrina; Furlan, Tiziana; Ballo, Piercarlo

    2015-12-01

    In this report, we describe a case of acute motoral axonal neuropathy (AMAN) following septic shock due to Acinetobacter baumannii. The aetiology of AMAN is still not fully clarified. An association with a potential infection by Campylobacter jejuni, resulting in stimulation of autoimmune response against gangliosides mediated by a phenomenon of molecular mimicry, is believed to play a major role. Since the lipopolysaccharide of A. baumannii has a structure that is similar to that of C. jejuni, we hypothesise that the infection by A. baumannii in our patient may have had a pathogenic role in the development of the neurological picture via a mechanism of molecular mimicry. PMID:26700086

  6. Acute pulmonary oedema due to single dose acetazolamide taken after cataract surgery.

    Guven Yilmaz, Suzan; Palamar, Melis; Gurgun, Cemil

    2016-01-01

    An increase in intraocular pressure following cataract surgery is very common. The main reason for this condition is viscoelastic agent remaining in the eye, which leads to mechanical obstruction of the trabecular meshwork. Prophylaxis with oral acetazolamide is frequently practised to prevent this early rise in intraocular pressure in the preoperative and postoperative periods. We report a case of an 81-year-old man with acute pulmonary oedema due to prophylactic acetazolamide intake after cataract surgery. The case is presented in order to draw attention to this serious complication. PMID:27170607

  7. Rhabdomyolysis, acute kidney injury and transverse myelitis due to naive heroin exposure

    Ankur Gupta

    2011-01-01

    Full Text Available Heroin exposure can cause various complications like seizures, stroke, spongiform encephalopathy, transverse myelopathy, plexopathy, compartment syndrome, rhabdomyolysis and renal failure due to various mechanisms. We report here a young male who smoked heroin for the first time and developed transverse myelitis, rhabdomyolysis and acute kidney injury requiring dialysis. His renal recovery was complete by four weeks, while neurological improvement occurred 8 to 12 weeks later. This case suggests a common pathogenic mechanism of heroin intoxication involving multiple systems of the body.

  8. Electrical burns of the abdomen

    Rakesh Kumar Srivastava

    2013-01-01

    Full Text Available A 35-year-old male farmer came in contact with 11,000 volts high tension electric wire and sustained full thickness burn wounds over scapula, upper limb and anterior abdominal wall along with perforation of the intestine. Patient was initially managed conservatively in general surgery ward and was referred to us after 3 days with necrosis of the burned skin and muscles over the shoulder and abdomen. Patient was initially managed conservatively and then thorough debridement of the necrotic skin over the left shoulder and upper arm was done and the area was split skin grafted. Patient developed enterocutaneous fistula, which healed over a period of 8 weeks. The granulating wound over the abdomen was also skin grafted and patient was discharged after 18 days. About 4 months, after the discharge patient presented with ventral hernia. Repair of ventral hernia by synthetic mesh application and reconstruction of the abdominal wall with a free tensor fascia lata flap was done over the mesh, but the flap failed. Then after debridement two random pattern transposition skin flaps, one from the right upper and another from the left lower abdomen were transposed over the abdominal wound and donor area was skin grafted. Patient was discharged after 17 days.

  9. Mesenteric tumor due to chronic anisakiasis

    Pablo Menéndez

    2015-09-01

    Full Text Available Intestinal anisakiasis is a rare parasitic disease and difficult to diagnose due to symptoms are not specific, so it is considered an underdiagnosed disease. The clinical suspicion with a correct diagnosis of anisakiasis allows the establishment of a correct treatment; in most cases, the resolution is possible with conservative treatment, avoiding unnecessary surgery to the preoperative differential diagnosis of acute abdomen. We report the case of a patient who required urgent surgery secondary to an exacerbation of chronic anisakiasis.

  10. LAPAROSCOPIC CHOLECYSTECTOMY FOR ACUTE CHOLECYSTITIS DUE TO CHOLELITHIASIS IN GERIATRIC PATIENTS

    D. Vasincu

    2007-07-01

    Full Text Available This study is focused on the results of laparoscopic cholecystectomy for acute cholecystitis due to cholelithiasis in geriatric patients. The records of all patients from „St. Joan” Emergency Hospital Iaşi from January 2001 to December 2005 and from General Surgery Clinic in S. Orsola - M. Malpighi Hospital Bologna – Italia from January 2003 to December 2004 who undergo cholecystectomy were reviewed. The entire series consists of 557 patients. This report identifies 161 patients who were aged 65 years or older at the time of laparoscopic cholecystectomy. The results are reported in three progressive age groups: 65 to 74, 75 to 84, and over 85 years. At 101 geriatric patients was practiced laparoscopic cholecystectomy. Gallstones were present in all patients. In this series of laparoscopic cholecystectomy, 32.6% had an emergency procedure and the remainder had an elective or semielective procedure. The conversion rate was 5.6%. 74.2% of the patients were discharged home after 3-5 days of postoperative observation. Laparoscopic cholecystectomy is a safe procedure and should be recommended for all geriatric patients who have acute cholecystitis due to cholelithiasis before the development of complications.

  11. Evidence Report: Risk of Acute Radiation Syndromes Due to Solar Particle Events

    Carnell, Lisa; Blattnig, Steve; Hu, Shaowen; Huff, Janice; Kim, Myung-Hee; Norman, Ryan; Patel, Zarana; Simonsen, Lisa; Wu, Honglu

    2016-01-01

    Crew health and performance may be impacted by a major solar particle event (SPE), multiple SPEs, or the cumulative effect of galactic cosmic rays (GCR) and SPEs. Beyond low-Earth orbit, the protection of the Earth's magnetosphere is no longer available, such that increased shielding and protective mechanisms are necessary in order to prevent acute radiation sickness and impacts to mission success or crew survival. While operational monitoring and shielding are expected to minimize radiation exposures, there are EVA scenarios outside of low-Earth orbit where the risk of prodromal effects, including nausea, vomiting, anorexia, and fatigue, as well as skin injury and depletion of the blood-forming organs (BFO), may occur. There is a reasonable concern that a compromised immune system due to high skin doses from a SPE or due to synergistic space flight factors (e.g., microgravity) may lead to increased risk to the BFO. The primary data available at present are derived from analyses of medical patients and persons accidentally exposed to acute, high doses of low-linear energy transfer (LET) (or terrestrial) radiation. Data more specific to the space flight environment must be compiled to quantify the magnitude of increase of this risk and to develop appropriate protection strategies. In particular, information addressing the distinct differences between solar proton exposures and terrestrial exposure scenarios, including radiation quality, dose-rate effects, and non-uniform dose distributions, is required for accurate risk estimation.

  12. Therapeutic options for acute cough due to upper respiratory infections in children.

    Paul, Ian M

    2012-02-01

    Cough due to upper respiratory tract infections (URIs) is one of the most frequent complaints encountered by pediatric health-care providers, and one of the most disruptive symptoms for children and families. Despite the frequency of URIs, there is limited evidence to support the few therapeutic agents currently available in the United States (US) to treat acute cough due to URI. Published, well-designed, contemporary research supporting the efficacy of narcotics (codeine, hydrocodone) and US Food and Drug Administration (FDA)-approved over-the-counter (OTC) oral antitussives and expectorants (dextromethorphan, diphenhydramine, chlophedianol, and guaifenesin) is absent for URI-associated pediatric cough. Alternatively, honey and topically applied vapor rubs may be effective antitussives. PMID:21892785

  13. Small bowel perforation due to fish bone: A case report.

    Pulat, Huseyin; Karakose, Oktay; Benzin, Mehmet Fatih; Benzin, Seyma; Cetin, Recep

    2015-09-01

    Accidental ingestion of foreign bodies are a common condition in clinical practice. However, small bowel perforation which dues to ingestion foreign bodies has been rarely seen. In this article, we report a case of small bowel perforation which dues to ingestion foreign body. A 80-year-old female patient, presenting with complaints of acute abdomen, was admitted to the emergency department. She denied abdominal pain, nausea and vomiting. The patient had tenderness and defense on the right lower quadrant. Contrast enhanced abdominal computed tomography has been used on the patient's diagnosis. This revealed small bowel perforation due to the ingestion of foreign body. The patient was operated emergency. A microperforation due to fish bone was detected on the terminal ileum. The patient underwent debridement and primary repair. The patient was discharged postoperative 7th day without problem. Bowel perforation due to the ingestion of foreign bodies should be considered in the differential diagnosis of acute abdomen. PMID:27239615

  14. MRI of the fetal abdomen; MRT des fetalen Abdomens

    Hoermann, M.; Brugger, P.C.; Witzani, L.; Prayer, D. [Medizinische Universitaet Wien (Austria). Universitaetsklinik fuer Radiodiagnostik

    2006-02-15

    Magnetic resonance imaging (MRI) is an important diagnostic component for central nervous system and thoracic diseases during fetal development. Although ultrasound remains the method of choice for observing the fetus during pregnancy, fetal MRI is being increasingly used as an additional technique for the accurate diagnosis of abdominal diseases. Recent publications confirm the value of MRI in the diagnosis of fetal gastrointestinal tract and urogenital system diseases. The following report provides an overview of MRI-examination techniques for the most frequent diseases of the abdomen. (orig.) [German] Die MRT ist ein wichtiger Bestandteil zur Diagnostik des zentralen Nervensystems und thorakaler Erkrankungen in der fetalen Entwicklung. Wenngleich der Ultraschall die Methode der Wahl zur Ueberwachung des Feten in der Schwangerschaft bleibt, bekommt die fetale MRT als zusaetzliche Untersuchungstechnik zur akkuraten Diagnostik abdomineller Erkrankungen immer groessere Bedeutung. Die neueren Publikationen bestaetigen v. a. den Stellenwert der MRT in der Diagnose von Erkrankungen des fetalen Gastrointestinaltrakts und des Urogenitalsystems. Im Folgenden soll ein Ueberblick ueber die MR-Untersuchungstechnik der haeufigsten Erkrankungen des Abdomens gegeben werden. (orig.)

  15. MRI of the fetal abdomen

    Magnetic resonance imaging (MRI) is an important diagnostic component for central nervous system and thoracic diseases during fetal development. Although ultrasound remains the method of choice for observing the fetus during pregnancy, fetal MRI is being increasingly used as an additional technique for the accurate diagnosis of abdominal diseases. Recent publications confirm the value of MRI in the diagnosis of fetal gastrointestinal tract and urogenital system diseases. The following report provides an overview of MRI-examination techniques for the most frequent diseases of the abdomen. (orig.)

  16. Hemograma e proteinograma plasmático de eqüinos hígidos e de eqüinos acometidos por abdômem agudo, antes e após laparotomia Hemogram and plasma proteins of healthy horses and horses with acute abdomen before and after laparotomy

    J.J. Fagliari

    2002-12-01

    Full Text Available Foram examinados 20 eqüinos adultos, 10 sadios e 10 acometidos por abdômen agudo, submetidos à laparotomia. O exame clínico e a colheita de amostras de sangue foram realizados antes da laparotomia e diariamente, a partir da cirurgia, até o 10º dia após a intervenção. Constatou-se elevação da temperatura retal, das freqüências cardíaca e respiratória, do número de hemácias e de leucócitos, do volume globular e dos valores das proteínas plasmáticas após a cirurgia, em ambos os grupos, porém com valores mais elevados nos animais enfermos, especialmente do número de neutrófilos. O proteinograma plasmático dos eqüinos com abdômen agudo mostrou que houve elevação significativa nas concentrações de proteínas na fase aguda com maiores valores ao redor de 48 horas após a cirurgia. Os resultados indicaram que o padrão de elevação e decréscimo dessas proteínas pode ser útil na definição do prognóstico do quadro clínico de abdômen agudo e da recuperação cirúrgica dos eqüinos.Hemogram and plasma protein concentrations of healthy horses and horses affected with acute abdomen before and after laparotomy were determined to investigate if these determinations can be of help on the diagnosis and prognosis of the post-operative intercurrence. The body temperature, respiratory and heart rates, red blood cell, leukocyte and neutrophil counts, packed cell volume, and plasma protein concentrations increased after laparotomy, mainly in sick horses. Acute phase protein concentrations were higher in the horses affected with acute abdomen than in the healthy horses with the highest values detected at about 48 hours after surgery. The results suggest that determining the level of these proteins can be useful for the diagnosis and prognosis of post-operative recovery after laparotomy in healthy horses and in horses affected with acute abdomen.

  17. Acute liver failure due to Human Herpesvirus 6 in an infant

    G.M. Tronconi

    2012-10-01

    Full Text Available We report a case of a 4-months infant with fever in the absence of other specific symptoms that has rapidly and unexpectedly developed acute liver failure (ALF with coagulopathy and complicated with bone marrow failure without encephalopathy. The main viral infection agents (hepatitis virus A, B, C, Citomegalovirus, Ebstain Barr virus, Parvovirus B19, Adenovirus, drug-induced hepatotoxicity and metabolic disorders associated to ALF were excluded. Quantitative determination of Human Herpesvirus 6 (HHV6 genome was positive with a significant number of copies for mL. A favorable evolution of the clinical symptoms and a progressive hematochemical resolution were obtained. Plasma and Vitamin K were administrated as a support therapy for treating coagulopathy. The present case report and the cases’ review from the literature, evidence the importance of always including screening for HHV6 infection in the diagnostic approach to acute onset of liver failure. HHV6 is a common virus in the pediatric population with a greater number of cases of fulminant viral non-A, non-B, non-C hepatitis in immunocompetent patients due to this virus: these forms have often a high mortality rate and maybe necessitate liver transplantation; for this reason correct etiological agent identification is mandatory for the prognosis and it has to be based on the quantitative search of the virus’s genome. Pathogenesis of liver-induced damage associated to HHV6 remains unclear; however in vitro studies demonstrate the potential hepatotoxicity effects of this virus.

  18. [Acute liver failure due to human herpesvirus 6 in an infant].

    Tronconi, G M; Mariani, B; Pajno, R; Fomasi, M; Cococcioni, L; Biffi, V; Bove, M; Corsin, P; Garbetta, G; Barera, G

    2012-01-01

    We report a case of a 4-months infant with fever in the absence of other specific symptoms that has rapidly and unexpectedly developed acute liver failure (ALF) with coagulopathy and complicated with bone marrow failure without encephalopathy. The main viral infection agents (hepatitis virus A, B, C, Citomegalovirus, Ebstain Barr virus, Parvovirus B19, Adenovirus), drug-induced hepatotoxicity and metabolic disorders associated to ALF were excluded. Quantitative determination of Human Herpesvirus 6 (HHV6) genome was positive with a significant number of copies for mL. A favorable evolution of the clinical symptoms and a progressive hematochemical resolution were obtained. Plasma and Vitamin K were administrated as a support therapy for treating coagulopathy. The present case report and the cases' review from the literature, evidence the importance of always including screening for HHV6 infection in the diagnostic approach to acute onset of liver failure. HHV6 is a common virus in the pediatric population with a greater number of cases of fulminant viral non-A, non-B, non-C hepatitis in immunocompetent patients due to this virus: these forms have often a high mortality rate and maybe necessitate liver transplantation; for this reason correct etiological agent identification is mandatory for the prognosis and it has to be based on the quantitative search of the virus's genome. Pathogenesis of liver-induced damage associated to HHV6 remains unclear; however in vitro studies demonstrate the potential hepatotoxicity effects of this virus. PMID:23342747

  19. Acute Compartment Syndrome of the Foot due to Infection After Local Hydrocortisone Injection: A Case Report.

    Patil, Sampat Dumbre; Patil, Vaishali Dumbre; Abane, Sachin; Luthra, Rohit; Ranaware, Abhijit

    2015-01-01

    High-energy trauma associated with calcaneal fracture or Lisfranc fracture dislocation and midfoot crushing injuries are known causes of compartment syndrome in the foot. Suppurative infection in the deep osseofascial compartments can also cause compartment syndrome. We describe the case of a 29-year-old female who had developed a suppurative local infection that resulted in acute compartment syndrome after receiving a local hydrocortisone injection for plantar fasciitis. We diagnosed the compartment syndrome, and fasciotomy was promptly undertaken. After more than 2 years of follow-up, she had a satisfactory functional outcome without substantial morbidity. To our knowledge, no other report in the English-language studies has described compartment syndrome due to abscess formation after a local injection of hydrocortisone. The aim of our report was to highlight this rare, but serious, complication of a routine outpatient clinical procedure. PMID:24838218

  20. [Subdural empyema due to gemella morbillorum as a complication of acute sinusitis].

    Boto, Leonor Reis; Calado, Cláudia; Vieira, Marisa; Camilo, Cristina; Abecasis, Francisco; Campos, Alexandre R; Correia, Manuela

    2011-01-01

    Subdural empyema is a life-threatening infection that may complicate acute sinusitis. The authors report the case of a previously healthy 10 year-old girl who presented with subdural empyema due to Gemella morbillorum after an untreated maxillary, ethmoidal and esphenoidal sinusitis. Despite immediate drainage of the empyema and underlying primary infection and treatment with broad spectrum antibiotics, she later developed frontal cerebritis and refractory intracranial hypertension, needing urgent decompressive craniectomy. She recovered gradually, maintaining to date slight right hemyparesis and aphasia. Even though it is considered a low virulence organism, G. morbillorum has been increasingly described in central nervous system infection. In this case, the prompt institution of broad spectrum antibiotics and surgical drainage, as well as the agressive treatment of complications, including decompressive craniectomy, were crucial to the patient's recovery. PMID:22015038

  1. Unusual presentations of acute kidney injury and neurologic complications due to snake bite

    Hamid Noshad

    2015-06-01

    Full Text Available Introduction: Vascularity of kidneys is very high, so these organs are potentially susceptible to be affected with toxins including snake venom. Hypersensitivity to snake venous could cause some neurological problem. Case Report: We present a 14-year-old boy with acute kidney injury (AKI due to snake bite. After a few days, kidney failure with hematuria was developed. His serum creatinine level rose to 3 mg/dl and following 2 weeks gradually and decreased to normal level without any special treatment except for anti-venom, which was not prescribed inappropriate time (this type of AKI is not reported previously. He had seizure attacks, which were according to magnetic resonance imaging due to posterior reversible encephalopathy syndrome (PRES (This neurologic complication has been seen in other kidney injuries but up to now it was not reported in snake bite victims. Conclusion: Sanke venom could cause PRES due to AKI and seizure could be one of the most important complications in snake bite.

  2. How to deal with an open abdomen?

    De Waele, Jan; Kaplan, Mark; Sugrue, Michael; Sibaja, Pablo; Bjorck, Martin

    2015-01-01

    Appropriate open abdomen treatment is one of the key elements in the management of patients who require decompressive laparotomy or in whom the abdomen is left open prophylactically. Apart from fluid control and protection from external injury, fluid evacuation and facilitation of early closure are now the goals of open abdomen treatment. Abdominal negative pressure therapy has emerged as the most appropriate method to reach these goals. Especially when combined with strategies that allow pro...

  3. MR imaging of the abdomen in pregnancy; MR-Diagnostik des Abdomens in der Schwangerschaft

    Klasen, J.; Antoch, G.; Blondin, D. [Duesseldorf Univ. (Germany). Inst. fuer Diagnostische und Interventionelle Radiologie

    2011-06-15

    Sonography is still the method of choice for imaging diseases in pregnant women. The changed physiognomy of the women increases the known limitations of sonography while the advantages of MRI (large field of view, excellent soft-tissue contrast, sensitive diagnosis of edema) are not affected. The available sequences allow the differentiation of various pathologies. Most of these can frequently be visualized without intravenous administration of contrast material. Although the significance of techniques like DWI and ASL has not yet been explored, initial descriptions are promising and MR imaging in pregnancy will be increasingly important in the future. Therefore, knowledge of the most frequent diseases in pregnancy and their image appearance is relevant to radiologists. The advantages of MRI in comparison to sonography and its important role in imaging pathologies of the acute abdomen in pregnancy are illustrated and discussed. (orig.)

  4. Brain injury due to acute organophosphate poisoning Magnetic resonance imaging manifestation and pathological characteristics

    2007-01-01

    BACKGROUND: Acute organophosphate poisoning can cause injuries of multiple visceras; especially,central nervous system injury can increase risk factors of patients with severe acute organophosphate poisoning. An application of modem image may increase diagnostic rate of brain injury in an earlier period and provide evidences for clinical treatment.OBJECTIVE: To reveal imaging manifestations, pathological characteristics and multi-ways injured mechanism of brain injury due to acute organophosphate poisoning.DESIGN: Contrast observational study.SETTING: Department of Medical Image, the Second Hospital of Hebei Medical University.MATERIALS: The experiment was carried out in the Department of Nerve Molecule Imaging Medicine and Laboratory of Neurology, the Second Hospital of Hebei Medical University from August 2003 to February 2004. A total of 30 healthy cats weighing 2.8 - 3.5 g and of both genders were selected from Animal Experimental Center of Hebei Medical University.METHODS: Thirty healthy cats were randomly divided into control group (n =5) and intoxication group (n=25). Cats in the control group were subcutaneously injected with 0.3 mL/kg saline at four points; while, cats in the intoxication group were subcutaneously injected with 400 g/L 0.3 mL/kg O,O-dimethyl-S-(methoxycarbonylmethyl) thiophosphate at four points. Two minutes after intoxication, cats received muscular injection with 0.5 mg/kg atropine sulfate, and then, brain tissues were collected from parietal lobe, basal ganglia, hippocampus, cerebellum and brain stem were observed at 3, 6, 24 hours, 3 and 7 days after intoxication respectively under optic microscope and electron microscope and expressions of acetylcholinesterase (AChE), choline acetyltransferase (ChAT), glial fibrillary acidic protein (GFAP),glutamic acid (Glu) and γ-amino butyric acid after immunohistochemical staining.MAIN OUTCOME MEASURES: Results of MRI examinations; histological changes under optic microscope and electron

  5. Leucograma e teores plasmáticos de proteínas de fase aguda de eqüinos portadores de abdômen agudo e submetidos à laparotomia Leukogram and plasma acute phase protein concentrations in horses with acute abdomen submitted to treatment by laparotomy

    J.J. Fagliari

    2008-04-01

    Full Text Available Foram examinados 20 eqüinos adultos portadores de abdômen agudo e submetidos à laparotomia. Dez recuperaram-se sem intercorrência pós-operatória (G1 e 10 foram a óbito sete a 10 dias após a cirurgia, com sinais de choque séptico (G2. Avaliaram-se temperatura retal, freqüências cardíaca e respiratória, tempo de preenchimento capilar e teores plasmáticos das proteínas de fase aguda - fibrinogênio, ceruloplasmina, proteína C-reativa, antitripsina, haptoglobina e glicoproteína ácida -, antes e até sete dias após a laparotomia. As leucometrias às 72h e no sétimo dia pós-operatório dos eqüinos que foram a óbito foram, respectivamente, 34,6% e 57,1%, mais altas que a dos animais curados. Os maiores valores de proteína de fase aguda ocorreram no sétimo dia após a cirurgia; os percentuais de elevação de fibrinogênio, antitripsina, glicoproteina ácida, proteína C-reativa, ceruloplasmina e haptoglobina de eqüinos do G2 em relação ao G1 foram 46,8%, 67,9%, 91,9%, 112,2%, 126,9% e 186,2%, respectivamente.Twenty adult horses with acute abdomen were examined and submitted to treatment by laparotomy; ten had no postoperative complication (group 1, and ten showed septic shock symptom and died from seven to ten days after surgery (group 2. Body temperature, heart and respiratory rates, filling capillary time, and plasma acute phase protein concentrations - fibrinogen, ceruloplasmin, C-reactive protein, antitrypsin, haptoglobin, and acid glycoprotein - were evaluated before laparotomy and until seven days after surgery. White blood cell counts at 72h and seven days after surgery in group 2 animals were, respectively, 34.6% and 57.1%, and were higher than those measured in group 1 horses. The highest values of acute phase proteins occurred on the seventh day after surgery. The increase percentages of fibrinogen, antitrypsin, acid glycoprotein, C-reactive protein, ceruloplasmin, and haptoglobin plasma concentrations in group 2

  6. Acute transplant renal artery thrombosis due to distal renal artery stenosis: A case report and review of the literature

    Fallahzadeh, Mohammad Kazem; Yatavelli, Rajini Kanth; Kumar, Ajay; Singh, Neeraj

    2014-01-01

    Background: Acute renal artery thrombosis is a devastating complication of renal transplantation that can result in graft loss if not detected early. Surgical and technical errors are the major cause of renal artery thrombosis. In this article, for the first time, we are reporting a case of acute renal artery thrombosis that developed early post-transplantation due to distal renal artery stenosis. Case Presentation: A 71-year-old woman presented with nausea, vomiting and decreased urine outpu...

  7. Radiodiagnosis programs for the recognition of acute surgical diseases of the abdominal organs, retroperitoneal space and complications thereof

    Program for complex use of X-ray and ultrasonic diagnostic methods, X-ray computerized tomography was worked out in diseases of the abdominal organs, retroperitoneal space. Creation of such program was necessary due to acute surgical intervention in diseases of these organs (1750 patients with clinical picture of acute abdomen, 1350 patients with acute diseases of abdomen cavity organs). Obtaining of momentary information for diagnosis is required in most of cases. Schemes are suggested for complex usage of these diagnostic methods in different pathology, clinical symptoms, severity in patient state, technical possibilities of medical establishments

  8. 肠脂肪酸结合蛋白在急腹症患者中鉴别急性肠缺血的价值%The value of serum intestinal fatty acid binding protein measurement in discriminating intestinal ischemia in patients with acute abdomen

    石卉; 吴本俨; 刘文徽; 苏斌斌; 李婷婷

    2012-01-01

    目的 评估肠脂肪酸结合蛋白( I-FABP)在急腹症患者中鉴别急性肠缺血的价值.方法 2009年11月至2011年8月解放军总医院151例住院急腹症患者及17例健康对照者纳入本研究,测定其血清I-FABP水平,根据ROC曲线计算I-FABP诊断急性肠缺血的临界值、敏感性、特异性、阳性似然比、阴性似然比、阳性预测值、阴性预测值,评估其诊断及鉴别诊断价值.结果 151例急腹症患者中急性肠缺血24例,非肠缺血127例.肠缺血组的I-FABP水平[(109.67 ±48.82)μg/L]明显高于非肠缺血组[(36.78±11.25) μg/L]和健康对照组[(8.33±6.25) μg/L],P值均<0.01.I-FABP的诊断临界值为87.52 μg/L,I-FABP诊断急性肠缺血的敏感度为0.762,阴性预测值为0.963,阳性似然比3.05,阴性似然比0.24.结论 血清I-FABP用于鉴别急腹症中急性肠缺血患者具有临床诊断价值.%Objective To assess the differential diagnostic value of serum intestinal fatty acid binding protein (I-FABP) in distinguishing intestinal ischemia patients from acute abdomen patients.Methods A total of 151 patients with acute abdomen and 17 healthy controls from the PLA General Hospital were enrolled from November,2009 to August,2011. Serum I-FABP levels were measured by ELISA.According to the ROC curve,the cut-off value,sensitivity,specificity,positive likelihood ratio (PLR),negative likelihood ratio ( NLR),positive predietive value (PPV) and negative predictive value (NPV) were calculated. Results Of the 151 acute abdomen patients,there were 24 intestinal ischemia patients and 127 without intestinal ischemia.Serum I-FABP level in intestinal ischemia group [( 109.67 ±48.82) μg/L]was significantly higher than those in patients without intestinal ischemia [(36.78 ± 11.25) μg/L]and healthy controls[(8.33 ±6.25) μg/L]( all P values <0.01 ).The serum I-FABP cut-off value for the diagnosis of intestinal ischemia was 87.52 μg/L.Serum I-FABP was efficient in terms of

  9. 血浆PTX3检测在预测急腹症并发全身炎症反应综合征患者预后中的临床意义%Clinical Significance of Plasma PTX3 Detection in Predicting the Prognosis of Patients with Acute Abdomen Comeplicated with Systemic Inflammatory Response Syndrom e

    朱世纯; 李倩; 张文丽; 蒙国光; 李广洲

    2014-01-01

    To observe the dynamic changes in serum cytokines levels of PTX3 and investigate the clinical significance of plasma PTX3 detection in predicting the prognosis of patients with acute abdomen complicated with systemic inflammatory response syndrome(SIRS).Method:107 patients with acute abdomen complicated with systemic inflammatory response syndrome were selected,the peripheral venous blood were collected on the day of admission,and 1,5 days after admission respectively.The levels of pentraxin 3(PTX3)were detected by enzyme-linked immunosorbent assay,selected 60 healthy persons as control group,and compared with their results.Result:The levels of PTX3 in 107 patients with acute abdomen complicated with systemic inflammatory response syndrome at each monitoring point were significantly higher than those in the control group,and the levels of PTX3 in the complication group at each monitoring point were significantly higher than those in the no complication group,the differences were statistically significant(P<0.05). Conclusion:In acute abdomen patients combined with SIRS,the levels of PTX3 are increased.PTX3 elevated levels and systemic inflammatory response syndrome is closely related to the severity and postoperative complications.%目的:观察急腹症并发全身炎症反应综合征(systemic inflammatory response syndrome,SIRS)患者血浆正五聚素(pentraxin 3,PTX3)水平的动态变化,探讨PTX3在预测急腹症并发全身炎症反应综合征患者预后中的临床意义。方法:选取107例符合SIRS诊断的急腹症患者,分别于入院当日(0 d)及入院后1、5 d清晨采集空腹外周静脉血,用酶联免疫吸附法(ELISA)检测PTX3的血浆浓度,并设60例健康体检者为对照组予以比较。结果:107例急腹症并发全身炎症反应综合征患者的各监测点的PTX3水平均明显高于对照组,且并发症组患者血浆各监测点的PTX3水平均明显高于无并发症组,差

  10. Acute Kidney Injury due to Crescentic Glomerulonephritis in a Patient with Polycystic Kidney Disease

    Maggard, Reuben; Makary, Raafat; Monteiro, Carmela l.; James, Leighton R.

    2013-01-01

    Polycystic kidney disease is an inherited condition, characterized by the development of cysts in the kidney, as well as in other organs. Patients with polycystic kidney can suffer from the same causes of acute kidney injury as the general population. Nephritic syndrome is an uncommon cause of acute kidney injury in the general population and less common in patients with polycystic kidney disease. We report the second case of crescentic glomerulonephritis, causing acute kidney injury, in a pa...

  11. A Case of Recurrent Acute Pancreatitis Due to Intra-Articular Corticosteroid Injection

    Patompong Ungprasert

    2014-03-01

    Full Text Available Context Corticosteroid is a well-established cause of drug-induced pancreatitis. However, acute pancreatitis from intraarticularinjection of corticosteroid has never been described. Case report A 69-year-old male presented with acuteabdominal pain and was diagnosed with acute pancreatitis. The patient had one episode of acute pancreatitis two yearearlier. Both episodes occurred after intra-articular cortisone injection. Investigations for other causes of pancreatitis werenegative. Conclusion We report the first case of acute pancreatitis from intra-articular corticosteroid injection. Physiciansshould be aware of this adverse reaction of corticosteroid that can even occur with local administration.

  12. Acute Kidney Injury and Quadriparesis Due to Rosuvastatin Induced Rhabdomyolysis- A Case Report.

    Suthar, Kamlesh S; Vanikar, Aruna V; Trivedi, Hargovind L

    2015-05-01

    Statins as lipid lowering drugs, are safe and effective in reducing cardiovascular disease risk, but rarely produce myopathy like myalgia, myositis or rhabdomyolysis. We report the case of Rosuvastatin induced rhabdomyolytic acute renal failure and quadriparesis in a 67-year old male, a known case of type-2 diabetes mellitus and with a history of coronary angioplasty four months back. He was on antihypertensive, oral hypoglycemic and antiplatelet medications with Rosuvastatin 40mg/day. He was admitted with altered sensorium, breathlessness, vomiting, muscle weakness and decreased urine output and had raised serum creatinine, creatinine phosphokinase and myoglobin. After ruling out all other causation for rhabdomyolysis, we stopped Rosuvastatin and started supportive management and hemodialysis. Patient showed gradual recovery in renal function and quadriparesis. Patient was discharged with good urine output and on antihypertensive, hypoglycemic drug and diet restrictions for lipid control. He recovered completely and had normal renal function with well controlled lipid level on follow up of 6 months after discharge. Thus, prompt diagnosis of Rhabdomyolysis due to Rosuvastatin in absence of other aetiology and the multidisciplinary management can prevent further complication with favorable outcome. PMID:26155510

  13. Paraquat poisoning: an experimental model of dose-dependent acute lung injury due to surfactant dysfunction

    M.F.R. Silva

    1998-03-01

    Full Text Available Since the most characteristic feature of paraquat poisoning is lung damage, a prospective controlled study was performed on excised rat lungs in order to estimate the intensity of lesion after different doses. Twenty-five male, 2-3-month-old non-SPF Wistar rats, divided into 5 groups, received paraquat dichloride in a single intraperitoneal injection (0, 1, 5, 25, or 50 mg/kg body weight 24 h before the experiment. Static pressure-volume (PV curves were performed in air- and saline-filled lungs; an estimator of surface tension and tissue works was computed by integrating the area of both curves and reported as work/ml of volume displacement. Paraquat induced a dose-dependent increase of inspiratory surface tension work that reached a significant two-fold order of magnitude for 25 and 50 mg/kg body weight (P<0.05, ANOVA, sparing lung tissue. This kind of lesion was probably due to functional abnormalities of the surfactant system, as was shown by the increase in the hysteresis of the paraquat groups at the highest doses. Hence, paraquat poisoning provides a suitable model of acute lung injury with alveolar instability that can be easily used in experimental protocols of mechanical ventilation

  14. [Primary-care morbidity and true morbidity due to acute respiratory infections].

    Pérez Rodríguez, A E; González Ochoa, E; Bravo González, J R; Carlos Silva, L; Linton, T

    1992-01-01

    The present work presents the study of morbidity due to acute respiratory infections (ARI) in areas of the town of Lisa in Ciudad Habana, and Isla Juventud (Cuba), to characterize different aspects of morbidity measured by health care attendance and to measure true morbidity. About 90% of consultations for ARI were first-time consultations, while their ratio to further consultations was 5.3. True morbidity rates (TMR), obtained trough active research, ranged from 110.4 to 163.4 cases per 1000 inhabitants, considerably higher than morbidity rates measured by primary care consultations (MRPCC) in the same time period. The true morbidity index (TMI), as measured by the ratio of the two previous rates, ranged from 5 to 15. A high proportion (47.6%) of cases reported no medical care attendance. These results provide approximate estimates of true morbidity in the study area, and allow the establishment of a new control program, also improving epidemiologic surveillance within primary care activities. PMID:1624233

  15. Efficacy of extracorporeal albumin dialysis for acute kidney injury due to cholestatic jaundice nephrotoxicity.

    Sens, Florence; Bacchetta, Justine; Rabeyrin, Maud; Juillard, Laurent

    2016-01-01

    We report a case of a 37-year-old man with Maturity Onset Diabetes of the Youth (MODY) type 5, admitted for an episode of cholestasis and a simultaneous acute kidney injury (AKI). Chronic liver disease was due to a mutation in the transcription factor 2 (TCF2) gene, thus highlighting the need for a close liver follow-up in these patients. AKI was attributed to a cholemic nephropathy based on the following rationale: (1) alternative diagnoses were actively ruled out; (2) the onset of AKI coincided with the onset of severe hyperbilirubinaemia; (3) renal pathology showed large bile tubular casts and a marked tubular necrosis and (4) creatinine serum dramatically decreased when bilirubin levels improved after the first sessions of extracorporeal albumin dialysis (ECAD), thus suggesting its role in renal recovery. Even though cholestasis can precipitate renal injury, the diagnosis of cholemic nephropathy could require a renal biopsy at times. Future studies should confirm the benefits of ECAD in cholemic nephropathy. PMID:27389722

  16. Noninvasive ventilation in acute respiratory failure due to H1N1 influenza

    Mohapatra, Prasanta R.; Naveen Dutt; Sushant Khanduri; Baijayantimala Mishra; Janmeja, Ashok K

    2011-01-01

    We present a case of severe H1N1 influenza with hypoxemic acute respiratory failure necessitating mechanical ventilation benefited from noninvasive positive pressure ventilation (NIPPV). The NIPPV may be of great use in treating patients with H1N1-related acute respiratory distress syndrome in a resource poor setting or when invasive ventilator is unavailable.

  17. Acute respiratory failure due to thyroid storm developing immediately after delivery

    Kitazawa, Chie; Aoki, Shigeru; Takahashi, Tsuneo; Hirahara, Fumiki

    2015-01-01

    Key Clinical Message Acute respiratory failure occurs in less than 0.1% of pregnancies. Thyroid storm should be included in the differential diagnosis of possible causes of acute respiratory failure occurring immediately after delivery, and delivery is a high risk factor for thyroid storm in pregnant women with thyrotoxicosis.

  18. A Rare and Unexpected Side-Effect of Cannabis Use: Abdominal Pain due to Acute Pancreatitis

    Mehmet Husamettin Akkucuk; Mustafa Erbayrak

    2015-01-01

    Acute pancreatitis is a frequently encountered disorder in patients presenting to emergency units. Biliary system disorders, alcohol consumption, infections, and drugs are among the causes of acute pancreatitis. However, it is sometimes difficult to determine the etiology of this disorder, particularly if the patient does not wish to disclose his consumption of cannabis, the use of which is illegal.

  19. Severe acute pancreatitis due to tamoxifen-induced hypertriglyceridemia with diabetes mellitus

    Kim, Young Ae; Lee, Sol; Jung, Ji Woong; Kwon, Yu Jin; Lee, Gyeong Bok; Shin, Dong Gue; Park, Sang Su; Yun, Jin; Jang, Yong-Seog

    2014-01-01

    The side effects of tamoxifen are generally mild, including the effect on lipoprotein metabolism. However, there are few cases of severe tamoxifen induced hypertriglyceridemia. Hypertriglyceridemia is a marked risk factor for acute pancreatitis and approximately 2% to 5% of cases of acute pancreatitis are related to drugs. We report on tamoxifen-induced hypertriglyceridemia and acute pancreatitis in a 40 years old woman with type 2 diabetes mellitus occurred by dexamethasone. She was treated with insulin infusion and fenofibrate, and goserelin acetate was started instead of tamoxifen after discharge from the hospital. Also, probable pathogenic hypotheses about the correlation between tamoxifen and dexamethasone induced type 2 diabetes mellitus on severe acute pancreatitis are provided. Clinicians should take care of risks of severe acute pancreatitis on using tamoxifen, especially for patients with dexamethasone induced diabetes mellitus. These individuals should undergo pre-post tamoxifen lipid screening and careful history taking of drugs, including dexamethasone. PMID:25035662

  20. Acute Coronary Syndrome Due to Spontaneous Coronary Artery Dissection in a Middle-Aged Man

    Davran Cicek

    2014-08-01

    Full Text Available True spontaneous coronary artery dissection (SCAD is an extremely rare but important cause of acute coronary syndrome, with only about 200 cases reported in the literature. Diagnosis is often made at autopsy. Risk factors include oral contraceptive use, atherosclerotic disease and the peripartum period. SCAD should be considered when a healthy young patient presents with the onset of acute myocardial ischemic syndrome. A timely diagnosis and intervention are mandatory as SCAD can cause sudden death. We present a case of SCAD with an uncommon clinical presentation of acute coronary syndrome and without identifiable risk factors, and successfully treated with non-invasive (medical therapy.

  1. Small Cell Carcinoma of the Lung Presented as Acute Pancreatitis. Case Report and Review of the Literature

    Abdulzahra Hussain

    2012-11-01

    Full Text Available Context Small cell carcinoma of the lung is an aggressive cancer with gloomy prognosis. Links to acute pancreatitis is extremely rare. Case report We are reporting a 53-year-old patient who was admitted because of acute pancreatitis. She had no history of gallstones, alcohol abuse, medications or any other predisposition for acute pancreatitis. Further investigations of blood, CT of chest abdomen and neck and ultrasound scan of abdomen, bone marrow and neck lymph node biopsies confirmed advanced small cell carcinoma of the lung with hypercalcemia, which was the only definite cause of acute pancreatitis. The patient made good recovery from pancreatitis after controlling the hypercalcemia. She was referred to respiratory team for further management of lung cancer. Conclusion Acute pancreatitis due to hypercalcemia of advanced small cell carcinoma of the lung is an extremely rare condition. Acute pancreatitis due to hypercalcemia should be thoroughly investigated to exclude serious pathology as in our case.

  2. Acute renal failure due to phenazopyridine (Pyridium) overdose: case report and review of the literature.

    Onder, Ali Mirza; Espinoza, Veronica; Berho, Mariana E; Chandar, Jayanthi; Zilleruelo, Gaston; Abitbol, Carolyn

    2006-11-01

    Phenazopyridine (Pyridium) is a commonly used urinary tract analgesic. It has been associated with yellow skin discoloration, hemolytic anemia, methemoglobinemia, and acute renal failure, especially in patients with preexisting kidney disease. We report a 17-year-old female with vertically transmitted human immunodeficiency virus (HIV) infection, presenting with acute renal failure and methemoglobinemia following a suicidal attempt with a single 1,200 mg ingestion of Pyridium. She had no prior evidence of HIV nephropathy. The patient had a progressive nonoliguric renal failure on the 3rd day following the ingestion. She was treated with N-acetylcysteine, intravenous carnitine, and alkalinization of the urine. Her kidney biopsy revealed acute tubular necrosis with no glomerular changes. After 7 days of conservative management, she was discharged home with normal kidney function. To our knowledge, this is the second smallest amount of Pyridium overdose resulting in acute renal failure with no previous history of kidney disease. PMID:16897003

  3. Thiamine Deficiency in a Developed Country: Acute Lactic Acidosis in Two Neonates Due to Unsupplemented Parenteral Nutrition.

    Salvatori, Guglielmo; Mondì, Vito; Piersigilli, Fiammetta; Capolupo, Irma; Pannone, Veronica; Vici, Carlo Dionisi; Rizzo, Cristiano; Dotta, Andrea

    2016-08-01

    Thiamine is a water-soluble vitamin implicated in several metabolic processes. Its deficiency, due to prolonged parenteral nutrition without adequate vitamin supplementation, can lead to multiorgan failure characterized by cardiovascular impairment and metabolic acidosis refractory to bicarbonate administration. Only thiamine administration allows the remission of symptoms. We report 2 preterm infants with acute thiamine deficiency due to prolonged parenteral nutrition without adequate vitamin supplementation. PMID:25591974

  4. Acute respiratory distress syndrome due to viral pneumonitis in case of varicella zoster in adult: case report

    Anaz Binazeez; Saurabh Kothari; Dhaval Dave; Manish Pendse; Divya Lala; Smita Patil; Archana Bhate

    2015-01-01

    Chickenpox, is a highly contagious disease caused by infection with varicella zoster virus (VZV). The disease is often more severe in adults than children. Here we present a case of adult male suffering from chicken pox who presented with complication of acute respiratory distress syndrome [ARDS] due to viral pneumonitis. Due to his late presentation, despite of giving antivirals, patient had a fatal outcome. So this case highlights the necessity and importance of early administration of a...

  5. A homosexual japanese man with acute hepatitis due to hepatitis B virus genotype ae, concurrent with amebic colitis

    Sakaguchi,Kohsaku

    2007-02-01

    Full Text Available We report herein a case with acute hepatitis due to hepatitis B virus genotype Ae, concurrent with amebic colitis. A 39-year-old homosexual Japanese man was admitted to our hospital with jaundice. Laboratory tests showed an elevation of transaminase and positivity for hepatitis B surface antigen and IgM-type antibody to hepatitis B core antigen. The hepatitis B virus genotype was determined to be Ae. Furthermore, a mud-like stool with blood and mucous had sometimes been noted during the past 3 years, and amebic colitis was shown by colonofi berscopy during hospitalization. The patient was diagnosed with acute hepatitis B, concurrent with amebic colitis, and was successfully treated with lamivudine and metronidazole. In Japanese patients with acute hepatitis B virus genotype A infection, homosexual activity tends to be high. Furthermore, in Japanese homosexual men, amebiasis has been increasing. Thus, in Japanese patients with acute hepatitis B, a determination of genotype should be performed in order to investigate the route of transmission of hepatitis B virus, and a search for amebiasis should be performed in patients with acute hepatitis due to hepatitis B virus genotype A. Furthermore, education of homosexual men regarding hepatitis B virus, hepatitis B virus vaccination, and amebiasis is urgently required.

  6. Perforated appendicitis masquerading as acute pancreatitis in a morbidly obese patient

    Michael J Forster; Jacob A Akoh

    2008-01-01

    Diagnosis and treatment of common conditions in morbidly obese patients still pose a challenge to physicians and surgeons. Sometimes too much reliance is put on investigations that can lead to a misdiagnosis. This case demonstrates an obese woman admitted under the medical team with a presumed diagnosis of pneumonia, who was later found to have an acute abdomen and raised amylase, which led to an assumed diagnosis of pancreatitis. She died within 24 h of admission and post mortem confirmed the cause of death as systemic sepsis due to perforated appendicitis, with no evidence of pancreatitis. Significantly elevated serum amylase level may occur in non-pancreatitic acute abdomen.

  7. Perforated appendicitis masquerading as acute pancreatitis in a morbidly obese patient.

    Forster, Michael-J; Akoh, Jacob-A

    2008-03-21

    Diagnosis and treatment of common conditions in morbidly obese patients still pose a challenge to physicians and surgeons. Sometimes too much reliance is put on investigations that can lead to a misdiagnosis. This case demonstrates an obese woman admitted under the medical team with a presumed diagnosis of pneumonia, who was later found to have an acute abdomen and raised amylase, which led to an assumed diagnosis of pancreatitis. She died within 24 h of admission and post mortem confirmed the cause of death as systemic sepsis due to perforated appendicitis, with no evidence of pancreatitis. Significantly elevated serum amylase level may occur in non-pancreatitic acute abdomen. PMID:18350613

  8. Acute Placental Infection Due to Klebsiella pneumoniae: Report of a Unique Case

    Sheikh, Salwa S.; Amr, Samir S.; Janice M. Lage

    2005-01-01

    A 40-year-old woman, gravida 9, with seven healthy children and a history of one abortion (p 7 + 1) , presented at 18 weeks of gestation with fever and malodorous vaginal discharge. Ultrasound revealed a macerated fetus. The placenta showed acute chorioamnionitis and acute villitis with microabscess formation. Blood and vaginal cultures both grew Klebsiella pneumoniae. This is the first reported case in English literature of Klebsiella pneumoniae causing suppurative placentitis leading to fet...

  9. Acute placental infection due to Klebsiella pneumoniae: report of a unique case.

    Janice M. Lage; Amr, Samir S.; Sheikh, Salwa S.

    2005-01-01

    A 40-year-old woman, gravida 9, with seven healthy children and a history of one abortion (p 7 + 1) , presented at 18 weeks of gestation with fever and malodorous vaginal discharge. Ultrasound revealed a macerated fetus. The placenta showed acute chorioamnionitis and acute villitis with microabscess formation. Blood and vaginal cultures both grew Klebsiella pneumoniae. This is the first reported case in English literature of Klebsiella pneumoniae causing suppurative placentitis leading to fet...

  10. Hematocolpos as a Result of Delayed Treatment of Acute Straddle Injury in an Adolescent Girl

    Hae Jin Hwang; Hyun Wook Lim; Young Shin Han; Jeong In Choi; Min Jeong Kim

    2016-01-01

    Accidental genital trauma is most commonly caused by straddle-type injuries and is usually treatable by nonoperative management, and most of the injuries have a good prognosis. When the bleeding occurred due to straddle injury in adolescent girl, experienced gynecological examination and treatment were very important. We experienced a case of straddle injury to the posterior fourchette that caused acute hematocolpos due to delayed adequate treatment with hypotension and acute abdomen in an ad...

  11. Continuous Regional Arterial Infusion Therapy for Acute Necrotizing Pancreatitis Due to Mycoplasma pneumoniae Infection in a Child

    A case of acute necrotizing pancreatitis due to Mycoplasma pneumoniae infection was treated in an 8-year-old girl. She experienced acute pancreatitis during treatment for M. pneumoniae. Contrast-enhanced computed tomographic scan revealed necrotizing pancreatitis. The computed tomographic severity index was 8 points (grade E). A protease inhibitor, ulinastatin, was provided via intravenous infusion but was ineffective. Continuous regional arterial infusion therapy was provided with gabexate mesilate (FOY-007, a protease inhibitor) and meropenem trihydrate, and the pancreatitis improved. This case suggests that infusion therapy is safe and useful in treating necrotizing pancreatitis in children.

  12. Acute ischemic stroke in a child due to basilar artery occlusion treated successfully with a stent retriever.

    Savastano, Luis; Gemmete, Joseph J; Pandey, Aditya S; Roark, Christopher; Chaudhary, Neeraj

    2016-08-01

    Ischemic strokes in childhood are rare. Thrombolytic therapy with intravenous (IV) tissue plasminogen activator (tPA) has been the main intervention for the management of pediatric stroke patients, but safety data are lacking and efficacy has been questioned. Recently, successful endovascular treatments for acute ischemic stroke in children have been reported with increasing frequency, suggesting that mechanical thrombectomy can be a safe and effective treatment. We present the case of a 22-month-old child with acute ischemic stroke due to basilar artery occlusion that was successfully treated with a stent retriever. PMID:26156170

  13. Utilidad de la anamnesis y de las técnicas inmunológicas en el diagnóstico de la anisakidosis en pacientes con abdomen agudo Usefulness of anamnesis and inmunological techniques in the diagnosis of anisakidosis in patients with acute abdomen

    A. del Rey-Moreno

    2008-03-01

    Full Text Available Introducción: Anisakis simplex puede producir síntomas digestivos y alérgicos. En este trabajo se evalúan los antecedentes epidemiológicos y los resultados inmunológicos para diferenciar entre pacientes con anisakidosis y aquellos con otras patologías digestivas que cursan con dolor abdominal. Pacientes y método: estudio de cohortes realizado con 134 pacientes: 52 fueron diagnosticados de anisakidosis por los hallazgos quirúrgicos y anatomopatológicos y/o seroconversión específica frente a A. simplex (grupo A y en 82 pacientes la anisakidosis fue excluida como diagnóstico (grupo NA: no-anisakidosis. Se han evaluado el antecedente de ingesta de pescado crudo, la prueba cutánea en prick (PC y el inmunoblot IgE como elementos de diagnóstico. Resultados: los pacientes de los grupos A y NA mostraron resultados diferentes respecto a la de ingesta de pescado crudo (p Introduction: Anisakis simplex can be a cause of digestive symptoms. Our aim was to evaluate the epidemiological antecedents and immunological data available for a differentiation between patients with anisakidosis and those with other acute abdominal problems. Patients and methods: this is a prospective cohort study involving 134 patients with acute abdominal problems: 52 patients were diagnosed with anisakidosis by means of surgical and pathological findings and/or specific IgE seroconversion against Anisakis simplex (group A, and in 82 patients anisakidosis had been ruled out (group NA: non-anisakidosis. We evaluated the antecedent of raw fish ingestion, the skin prick test, and IgE immunoblotting as diagnostic tools. Results: patients in groups A and NA differ in terms of prior raw fish ingestion (p < 0.0001 and positive SPT (p < 0.0001, with their respective negative predictive values (NPV being 98.39% (95%CI: 90.17-99.92 and 95.56% (95%CI: 83.64-99.23. Regarding immunoblotting, in 86.2% of patients in group A a band of 60 kDa was detected, which was also detected in 19

  14. Acute intermittent porphyria and pregnancy: an obstetric challenge

    Pragati Meena

    2016-02-01

    Full Text Available Acute intermittent porphyria is a rare autosomal dominant disease caused by a mutation in the gene coding for the porphobillinogen deaminase enzymes in heam biosynthesis. The disease manifests as acute attacks of neuropsychiatric dysfunction and neurovisceral manifestations presenting as acute abdomen. In pregnancy, 54% patient has exacerbation of attacks in the form of seizures and acute abdomen occurs due to hormonal changes. Prevalence of acute intermittent porphyria is 1-2/200000 in general. Here we report a case of 36 year old women, G4P1L2A2 presenting at 10+4 weeks of gestation requesting pregnancy termination. Patient was diagnosed as case of acute intermittent porphyria with porphyic polyneuropathy 6 months back. At that time her main symptoms were acute pain abdomen with numbness and weakness in all four limbs. Her urinary porphobillinogen and 5 ALA raised. Her CECT of brain and nerve conduction studies were normal. Since then she is on Tablet Gabapentin 300 mg H.S. She underwent successful pregnancy termination by suction and evacuation under spinal anesthesia and she refused for copper-T insertion. Only safe drugs were used for procedure and she was discharged with advice of barrier contraception. [Int J Reprod Contracept Obstet Gynecol 2016; 5(2.000: 542-544

  15. Soporte nutricional en pacientes con abdomen abierto Nutricional support in patients with open abdomen

    J. O. Velázquez G.

    2007-04-01

    disminuir la respuesta hipermetabólica así como la morbilidad y mortalidad.Objective: We have designed a protocol to evaluate the tolerance, effectiveness and the nutritional support in post-surgical patients with an open abdomen. Patients and methods: We have made a prospective descriptive study of patients submitted to surgery and left with an open abdomen with a Bogotá bag, and have received nutritional support. The patients who have stayed for less than 4 days with the open abdomen where excluded. A group received total parenteral nutrition (TPN with mixtures all in one; another group received enteral nutrition (EN through a needle catheter jejunostomy (NCJ and a third group received mixed nutritional support. To evaluate the tolerance to EN, we have included those patients receiving this type of nutrition for at least 4 consecutive days without having diarrhea or pain. A jejunostomy catheter was placed in all patients by need o puncturing during the surgical act. Setting: The Surgical Department I of Ángel Larralde University Hospital, I.V.S.S. Valencia - Venezuela, during the period from May 2002 to May 2005. Results: 24 patients entered the study, 46% recived mixed nutritional support (Enteral and Parenteral, 33% exclusively TPN, and 31% exclusively EN. 75% have evolved favorably, discharged to their home in good general condition; 25% died from multiple organ failure due to severe sepsis. About nutritional support, 66% of the patients did not present complications; 21% of those receiving TPN presented hyperglycemia; and 13% of those receiving EN presented diarrhea. About EN effectiveness, 69% of the patients have reached 80% of the estimated caloric objective within days 4-5 from the beginning of formula administration. Conclusions: The integral care of the patients with an open abdomen, added to a nutritional support regimen tailored to each patient’s condition can help decreasing the hypermetabolic response, as well as moridity and mortality.

  16. A porcine model of acute, haematogenous, localized osteomyelitis due to Staphylococcus aureus

    Johansen, Louise Kruse; Frees, Dorte; Aalbæk, Bent;

    2011-01-01

    A porcine model of acute, haematogenous, localized osteomyelitis was established. Serial dilutions of Staphylococcus aureus [5–50–500–5000–50 000 CFU/kg body weight (BW) suspended in saline or saline alone] were inoculated into the right brachial artery of pigs (BW 15 kg) separated into six groups...... developed microabscesses in bones of the infected legs. In the centre of microabscesses, S. aureus was regularly demonstrated together with necrotic neutrophils. Often, bone lesions resulted in trabecular osteonecrosis. The present localized model of acute haematogenous osteomyelitis revealed a pattern of...

  17. Severe Acute Pancreatitis Due to Tamoxifen-Induced Hypertriglyceridemia with Positive Rechallenge

    Jaballah Sakhri

    2010-07-01

    Full Text Available Context Pancreatitis is a very rare adverse effect of tamoxifen with only six cases of tamoxifen-associated pancreatitis reported in the English literature until now. In these cases, rechallenge with tamoxifen was not carried out. Case report We report a case of recurrent severe acute pancreatitis in a 44-year-old female induced by tamoxifen therapy and review the literature with regards to tamoxifen-associated pancreatitis. Conclusion Clinicians should be aware of the risks of developing severe acute pancreatitis when using tamoxifen therapy. If tamoxifen is suspected as the probable causative agent, rechallenge with this drug should be prohibited.

  18. Pretransplant HLA mistyping in diagnostic samples of acute myeloid leukemia patients due to acquired uniparental disomy

    Dubois, V.; Sloan-Bena, F.; Cesbron, A.; Hepkema, B. G.; Gagne, K.; Gimelli, S.; Heim, D.; Tichelli, A.; Delaunay, J.; Drouet, M.; Jendly, S.; Villard, J.; Tiercy, J-M

    2012-01-01

    Although acquired uniparental disomy (aUPD) has been reported in relapse acute myeloid leukemia (AML), pretransplant aUPD involving chromosome 6 is poorly documented. Such events could be of interest because loss of heterozygosity (LOH) resulting from aUPD in leukemic cells may lead to erroneous res

  19. Acute hepatitis due to dengue virus in a chronic hepatitis patient

    L.J Souza

    2008-10-01

    Full Text Available We present a case of acute hepatitis caused by dengue virus, with a significant increase in aspartate transferase and alanine transferase levels in a chronic hepatitis patient attended at the Cane Sugar Planters Hospital of Campos dos Goytacazes, RJ.

  20. Acute steatohepatitis, due to extreme metabolic dysregulation, as the first presentation of non-alcoholic fatty liver disease

    Georgios Kranidiotis; Angeliki Angelidi; Emmanouel Sevdalis; Thomas-Nikolaos Telios; Alexandra Gougoutsi; Andreas Melidonis

    2013-01-01

    Non-alcoholic fatty liver disease (NAFLD) is a slowly progressive chronic disease, with a high prevalence among obese, dyslipidemic or diabetic people, commonly presented as an asymptomatic mild elevation of serum aminotransferases. We report a patient who experienced an acute form of non-alcoholic steatohepatitis, as the first manifestation of NAFLD, due to exacerbation of pre-existing metabolic disorders by an extremely unhealthy lifestyle. A 50-year old, obese, diabetic man presented with ...

  1. Acute Presentation of Lumbar Spinal Schwannoma Due to Torsion: A Case Report

    Khanna, Ryan; Ortmeier, Thomas C; Tapia-Zegarra, Gino G; Lindley, Timothy E; Smith, Zachary A; Dahdaleh, Nader S

    2016-01-01

    Although schwannomas are common spinal tumors with insidious presentations, acute neurological deterioration is an extremely rare manifestation that can occur in the setting of tumor torsion and infarction. The present case reports an unusual presentation of a spinal schwannoma that underwent torsion and infarction. A 65-year-old male presented initially with acute radicular pain progressing to cauda equina syndrome and confusion. MRI of the lumbar spine revealed an intradural extramedullary lesion at the level of L1/L2 measuring 1.1x0.9 cm. Intraoperatively, a reddish mass was seen caudally twisted around itself. Gross total resection was achieved with a final diagnosis of schwannoma with areas of infarction. At his six week follow up clinical visit, the patient was asymptomatic and his neurological exam was normal. The neurosurgeon should be aware of such atypical radiographic and clinical presentation amongst the spectrum of clinical manifestation of these nerve sheath tumors.  PMID:27226945

  2. Prolonged dysphagia due to Listeria-rhombencephalitis with brainstem abscess and acute polyradiculoneuritis.

    Smiatacz, Tomasz; Kowalik, Maciej Michal; Hlebowicz, Maria

    2006-06-01

    We report a case of previously healthy student with acute rhombencephalitis and brainstem abscess caused by Listeria monocytogenes. The disease begun with uncharacteristic prodromal symptoms of gastrointestinal infection followed by headache and vertigo. After hospital admission the patient rapidly deteriorated, presenting pronounced dysphagia and respiratory failure requiring mechanical ventilation. The diagnosis was established upon clinical symptoms of infection, brainstem involvement, typical MRI findings and positive for L. monocytogenes blood culture. Infection was complicated by acute, demyelinating neuropathy, diagnosed upon clinical symptoms of frail palsy confirmed by ENG. Initially introduced empirical doxycyclin/ceftriaxon treatment was subsequently changed to targeted ampicillin/gentamycin therapy, mechanical ventilation, intravenous human immunoglobulin treatment, tracheostomy and endoscopic gastrostomy. Prolonged dysphagia resolved after rehabilitation. After one year the patient remains well with only slight dysmetria. PMID:16260041

  3. Acute Renal Failure due to Copper Sulfate Poisoning; a Case Report

    Fakhrossadat Mortazavi

    2009-03-01

    Full Text Available Background:Copper sulfate is a blue and odorless salt with various industrial, chemical, agricultural and medicinal applications. Copper sulfate poisoning is rare in children. Case Presentation:A 23-month old boy accidentally ingested a solution of copper sulfate, used as a disinfectant agent in animal husbandry. He was referred to Children's Hospital of Tabriz because of frequent vomiting and lethargy. The major systemic complications were intravascular hemolysis, anemia and acute renal failure. The patient was successfully treated with multiple packed cell transfusions, dimercaprol, penicillamine and peritoneal dialysis. Plasma copper level 15 days after ingestion was 216 ?g/dl.Conclusion:Copper sulfate is a highly toxic agent that, when ingested, can cause local and systemic damage including coma, shock, severe intravascular hemolysis, hepatotoxicity and acute renal failure with high mortality.

  4. Endovascular stent graft treatment of acute thoracic aortic transections due to blunt force trauma.

    Bjurlin, Marc A

    2012-02-01

    Endovascular stent graft treatment of acute thoracic aortic transections is an encouraging minimally invasive alternative to open surgical repair. Between 2006 and 2008, 16 patients with acute thoracic aortic transections underwent evaluation at our institution. Seven patients who were treated with an endovascular stent graft were reviewed. The mean Glasgow Coma Score was 13.0, probability of survival was .89, and median injury severity score was 32. The mean number of intensive care unit days was 7.7, mean number of ventilator support days was 5.4, and hospital length of stay was 10 days. Mean blood loss was 285 mL, and operative time was 143 minutes. Overall mortality was 14%. Procedure complications were a bleeding arteriotomy site and an endoleak. Endovascular treatment of traumatic thoracic aortic transections appears to demonstrate superior results with respect to mortality, blood loss, operative time, paraplegia, and procedure-related complications when compared with open surgical repair literature.

  5. Lingual Haematoma due to Tenecteplase in a Patient with Acute Myocardial Infarction

    Muhlis Bal

    2013-01-01

    Full Text Available The use of intravenous thrombolytic agents has revolutionised the treatment of acute myocardial infarction. However, the improvement in mortality rate achieved with these drugs is tempered by the risk of serious bleeding complications, including intracranial haemorrhage. Tenecteplase is a genetically engineered mutant tissue plasminogen activator. Haemorrhagic complications of tissue plasminogen activator (tPA are well known. Compared to other tPAs, tenecteplase use leads to lower rates of bleeding complications. Here, we report a case of unusual site of spontaneous bleeding, intralingual haematoma during tenecteplase therapy following acute myocardial infarction, which caused significant upper airway obstruction and required tracheotomy to maintain the patient’s airway. Clinical dilemmas related to securing the airway or reversing the effects of tissue plasminogen activator are discussed.

  6. Acute Presentation of Lumbar Spinal Schwannoma Due to Torsion: A Case Report.

    Choy, Winward; Khanna, Ryan; Ortmeier, Thomas C; Tapia-Zegarra, Gino G; Lindley, Timothy E; Smith, Zachary A; Dahdaleh, Nader S

    2016-01-01

    Although schwannomas are common spinal tumors with insidious presentations, acute neurological deterioration is an extremely rare manifestation that can occur in the setting of tumor torsion and infarction. The present case reports an unusual presentation of a spinal schwannoma that underwent torsion and infarction. A 65-year-old male presented initially with acute radicular pain progressing to cauda equina syndrome and confusion. MRI of the lumbar spine revealed an intradural extramedullary lesion at the level of L1/L2 measuring 1.1x0.9 cm. Intraoperatively, a reddish mass was seen caudally twisted around itself. Gross total resection was achieved with a final diagnosis of schwannoma with areas of infarction. At his six week follow up clinical visit, the patient was asymptomatic and his neurological exam was normal. The neurosurgeon should be aware of such atypical radiographic and clinical presentation amongst the spectrum of clinical manifestation of these nerve sheath tumors. PMID:27226945

  7. Erythema multiforme due to arsenic trioxide in a case of acute promyelocytic leukemia: A diagnostic challenge.

    Badarkhe, Girish V; Sil, Amrita; Bhattacharya, Sabari; Nath, Uttam Kumar; Das, Nilay Kanti

    2016-01-01

    Erythema multiforme (EM) is an acute, self-limited, Type IV hypersensitivity reactions associated with infections and drugs. In this case of acute promyelocytic leukemia, EM diagnosed during the induction phase was mistakenly attributed to vancomycin used to treat febrile neutropenia during that period. However, the occurrence of the lesions of EM again during the consolidation phase with arsenic trioxide (ATO) lead to a re-evaluation of the patient and both the Naranjo and World Health Organization-Uppsala Monitoring Centre scale showed the causality association as "probable." The rash responded to topical corticosteroids and antihistamines. This rare event of EM being caused by ATO may be attributed to the genetic variation of methyl conjugation in the individual which had triggered the response, and the altered metabolic byproducts acted as a hapten in the subsequent keratinocyte necrosis. PMID:27114640

  8. Erythema multiforme due to arsenic trioxide in a case of acute promyelocytic leukemia: A diagnostic challenge

    Girish V Badarkhe

    2016-01-01

    Full Text Available Erythema multiforme (EM is an acute, self-limited, Type IV hypersensitivity reactions associated with infections and drugs. In this case of acute promyelocytic leukemia, EM diagnosed during the induction phase was mistakenly attributed to vancomycin used to treat febrile neutropenia during that period. However, the occurrence of the lesions of EM again during the consolidation phase with arsenic trioxide (ATO lead to a re-evaluation of the patient and both the Naranjo and World Health Organization-Uppsala Monitoring Centre scale showed the causality association as “probable.” The rash responded to topical corticosteroids and antihistamines. This rare event of EM being caused by ATO may be attributed to the genetic variation of methyl conjugation in the individual which had triggered the response, and the altered metabolic byproducts acted as a hapten in the subsequent keratinocyte necrosis.

  9. Acute liver failure due to primary amyloidosis in a nephrotic syndrome: a swiftly progressive course.

    Cardoso, Brigite Aguiar; Leal, Rita; Sá, Helena; Campos, Mário

    2016-01-01

    AL amyloidosis is a clonal plasma cell proliferative disorder characterised by extracellular tissue deposits of insoluble fibrils derived from κ or λ immunoglobulin light chains. The most common organs affected by AL amyloidosis are the kidney, presenting with nephrotic syndrome and/or progressive renal dysfunction, and the heart, with restrictive cardiomyopathy. Hepatic deposition of fibrils occurs in half the cases but the liver is rarely the predominantly affected organ. The most common presentation of hepatic amyloidosis is hepatomegaly with elevated alkaline phosphatase. Acute liver failure with cholestasis and jaundice is a rare complication, with a prevalence of approximately 5%, and is usually associated with a worse prognosis. We report a case of a 39-year-old man admitted to our nephrology department with an unusual presentation of primary amyloidosis with nephrotic syndrome and acute liver failure, complicated by obstructive cholestasis resulting in death 2 months after diagnosis. PMID:26965175

  10. Acute Hydrocephalus due to Secondary Leptomeningeal Dissemination of an Anaplastic Oligodendroglioma

    Friederike Knerlich-Lukoschus; Heinz-Herrmann Hugo; Stark, Andreas M.; H. Maximilian Mehdorn

    2009-01-01

    Secondary leptomeningeal dissemination of oligodendroglioma is very rare. We report the case of a 38-year-old Caucasian male who presented with acute hydrocephalus. 8 months before, the patient had undergone craniotomy for right frontal anaplastic oligodendroglioma, WHO grade III. By that time, there was no evidence of tumor dissemination. MRI now ruled out local tumor progression but revealed meningeal contrast enhancement along the medulla, the myelon, and the cauda equina. Repeated lumbar ...

  11. Severe Acute Pancreatitis Due to Tamoxifen-Induced Hypertriglyceridemia with Positive Rechallenge

    Jaballah Sakhri; Houssem Harbi; Rached Ltaief; Chaker Ben Salem; Neila Fathallah

    2010-01-01

    Context Pancreatitis is a very rare adverse effect of tamoxifen with only six cases of tamoxifen-associated pancreatitis reported in the English literature until now. In these cases, rechallenge with tamoxifen was not carried out. Case report We report a case of recurrent severe acute pancreatitis in a 44-year-old female induced by tamoxifen therapy and review the literature with regards to tamoxifen-associated pancreatitis. Conclusion Clinicians should be aware of the risks of developing sev...

  12. Acute kidney injury and disseminated intravascular coagulation due to mercuric chloride poisoning

    Dhanapriya, J.; Gopalakrishnan, N; Arun, V.; Dineshkumar, T.; Sakthirajan, R.; Balasubramaniyan, T.; Haris, M

    2016-01-01

    Mercury is a toxic heavy metal and occurs in organic and inorganic forms. Inorganic mercury includes elemental mercury and mercury salts. Mercury salts are usually white powder or crystals, and widely used in indigenous medicines and folk remedies in Asia. Inorganic mercury poisoning causes acute kidney injury (AKI) and gastrointestinal manifestations and can be life-threatening. We describe a case with unknown substance poisoning who developed AKI and disseminated intravascular coagulation (...

  13. Acute liver failure due to Human Herpesvirus 6 in an infant

    G.M. Tronconi; B. Mariani; R. Pajno; M. Fomasi; L. Cococcioni; Biffi, V.; Bove, M.; P. Corsin; G. Garbetta; Barera, G

    2012-01-01

    We report a case of a 4-months infant with fever in the absence of other specific symptoms that has rapidly and unexpectedly developed acute liver failure (ALF) with coagulopathy and complicated with bone marrow failure without encephalopathy. The main viral infection agents (hepatitis virus A, B, C, Citomegalovirus, Ebstain Barr virus, Parvovirus B19, Adenovirus), drug-induced hepatotoxicity and metabolic disorders associated to ALF were excluded. Quantitative determination of Human Herpesvi...

  14. Acute respiratory distress syndrome due to pulmonary involvement by neoplastic plasma cells in multiple myeloma

    Marmor, D B; Farber, J. L.; Gottlieb, J E

    2006-01-01

    Pulmonary involvement with multiple myeloma occurs infrequently and may be difficult to distinguish from more common primary lung tumours, metastatic disease, or other pleural and parenchymal abnormalities. A patient who developed acute respiratory distress syndrome (ARDS) was subsequently found to have multiple myeloma with involvement of lung parenchyma by neoplastic plasma cells. Only one other report of ARDS in association with multiple myeloma was found, and there are no previous reports...

  15. Acute respiratory distress syndrome due to viral pneumonitis in case of varicella zoster in adult: case report

    Anaz Binazeez

    2015-12-01

    Full Text Available Chickenpox, is a highly contagious disease caused by infection with varicella zoster virus (VZV. The disease is often more severe in adults than children. Here we present a case of adult male suffering from chicken pox who presented with complication of acute respiratory distress syndrome [ARDS] due to viral pneumonitis. Due to his late presentation, despite of giving antivirals, patient had a fatal outcome. So this case highlights the necessity and importance of early administration of antivirals, especially in adult pox, to tackle the complications of disease and get a favourable outcome. [Int J Res Med Sci 2015; 3(12.000: 3924-3927

  16. Linfangioma cístico do mesentério: uma rara apresentação de abdômen agudo Mesenteric cystic lymphangioma: an uncommon presentation of an acute abdomen

    Florentino de Araújo Cardoso Filho; Fábio Machado Landim; Fernanda Braga Perdigão

    2000-01-01

    Mesenteric cyst is a rare intra abdominal pathology. The incidence ranges from 1/100,000 to 1/250,000 hospital admissions. The authors present a case of a female patient, 20 years old, with abdominal pain for four months which three days had an acute onset of abdominal pain, and ultrasound revealed a cyst of mesentery within a dense fluid. The patient had been submitted to a laparotomy, and resection of the cyst. We emphasized the clinical symptoms, diagnostic evaluation and the therapeutic o...

  17. Linfangioma cístico do mesentério: uma rara apresentação de abdômen agudo Mesenteric cystic lymphangioma: an uncommon presentation of an acute abdomen

    Florentino de Araújo Cardoso Filho

    2000-04-01

    Full Text Available Mesenteric cyst is a rare intra abdominal pathology. The incidence ranges from 1/100,000 to 1/250,000 hospital admissions. The authors present a case of a female patient, 20 years old, with abdominal pain for four months which three days had an acute onset of abdominal pain, and ultrasound revealed a cyst of mesentery within a dense fluid. The patient had been submitted to a laparotomy, and resection of the cyst. We emphasized the clinical symptoms, diagnostic evaluation and the therapeutic of this condition.

  18. Metformin induced acute pancreatitis

    Alsubaie, Sadeem; Almalki, Mussa H.

    2013-01-01

    Acute pancreatitis frequently presents with abdomen pain but may presents with various skin manifestations as rash and rarely, pancreatic panniculitis. Metformin, one of the most effective and valuable oral hypoglycemic agents in the biguanide class was linked to acute pancreatitis in few cases. Here, we report a case of metformin induce acute pancreatitis in young healthy man with normal renal function.

  19. Self-expanding endoluminal prosthesis in an acute occlusion due to left colon tumor

    Endoscopic use of self-expanding prostheses is described in two patients with acute mechanical occlusion of left colon, treated in the emergence service of our center allowing us to improve the hydroelectric symptomatic status of patients, as well as the colon preparation. This latter avoided an emergence surgery and decompression colostomy; surgery was programmed for the subsequent five ones. Anatomicalpathological results confirmed the presence of large seal-ring colon's adenocarcinomas in the descendent colon in a patient, and in the sigmoid colon in another one.. (author)

  20. Acute renal failure due to rhabdomyolysis following dengue viral infection: a case report

    Wijesinghe, Aruna; Gnanapragash, Nanthini; Ranasinghe, Gayan; Ragunathan, Murugapillai K

    2013-01-01

    Introduction With more than one-third of the world’s population living in areas at risk for transmission, dengue fever is a leading cause of illness and death in the tropics and subtropics. Despite the high incidence of dengue fever, rhabdomyolysis leading to acute renal failure is an extremely rare complication of dengue fever. Only a few such cases have been reported in the literature. Case presentation We describe the case of a 42-year-old, previously healthy Sri Lankan Sinhalese man who d...

  1. Barr humbug: acute cerebellar ataxia due to Epstein-Barr virus.

    Davies, Benjamin; Machin, Nicholas; Lavin, Timothy; Ul Haq, Mian Ayaz

    2016-01-01

    Epstein-Barr virus (EBV) infection is associated with neurological sequellae, but rarely there is acute cerebellar ataxia (ACA) in an adult. We present a novel case of a 26-year-old man, who presented with ACA. He had normal MRI and CSF analysis. Serum testing confirmed active EBV. A course of oral prednisolone 1 mg/kg for 4 weeks, with a subsequent taper was started. He made a full recovery within 3 weeks of presentation. PMID:27558189

  2. Acute heart failure associated with congenital complete atrioventricular block due to neonatal lupus: case series report

    Neonatal lupus (NL) defines a set of clinical syndromes characterized by maternal autoantibodies against the RNA protein complex (Ro/SSA or La/SSB) that cross the placenta and potentially lead to fetal tissue damage. Little is known about other cardiac manifestations of NL different from congenital heart block (CHB), as heart failure (HF). Four cases of LN with BCC and acute HF at the first three days of life on average were reported. No complications or deaths were reported at 4,9 months of follow-up. All infants had anti-Ro high titles at the time of diagnosis.

  3. Pulmonary fibrosis following pneumonia due to acute Legionnaires' disease. Clinical, ultrastructural, and immunofluorescent study.

    Chastre, J; Raghu, G; Soler, P; Brun, P; Basset, F; Gibert, C

    1987-01-01

    During a recent nosocomial outbreak, 20 critically ill patients with acute Legionnaires' disease were admitted to the intensive care unit of Hopital Bichat, Paris. Pulmonary specimens were obtained at surgery or immediately after death in 12 patients and were examined by light, immunofluorescent, and electron microscopy. Five of these 12 patients showed evidence of pulmonary fibrosis. In all of these five patients, infection with Legionella pneumophila was evidenced by bacteriologic methods, and other diseases known to cause fibrosis were excluded. The condition of four patients deteriorated rapidly with respiratory failure, and they died with pulmonary fibrosis. Only one patient finally recovered but was left with pulmonary sequelae. Two distinctive morphologic patterns were observed, one in which interstitial fibrosis was predominant and one in which intra-alveolar organization and fibrosis were also present. The alveolar epithelial lining and the basement membranes were disrupted in all patients, as evidenced by ultrastructural observations and by immunofluorescent studies showing gaps in the distribution of type 4 collagen and laminin. Types 1 and 3 collagen accumulated in areas corresponding to thickened interstitium and intra-alveolar fibrosis. Thus, some patients who survive the acute pneumonia of Legionnaires' disease may develop pulmonary fibrosis, and this process may lead to functional impairment or death despite prompt and appropriate treatment. PMID:3539546

  4. Acute allergic contact dermatitis due to para-phenylenediamine after temporary henna painting.

    Nawaf, Al-Mutairi; Joshi, Arun; Nour-Eldin, Osama

    2003-11-01

    The use of temporary natural henna painting for body adornment and hair dyeing is very common in several countries of the Indian subcontinent, Middle East, and North Africa, and the fad is spreading in other parts of the world. Several cases of para-phenylenediamine (PPD) contaminated, temporary traditional/natural henna induced sensitization and acute allergic reaction have been reported, along with occasional serious long term and rare fatal consequences. We report here a 17-year-old girl with blisters over her hands of five-days duration that appeared within 72 hours of applying a temporary henna paint to her hands during a social occasion. Similar lesions were noted on her face. She had previously applied black henna only once, a year earlier without developing any lesions. Clinical diagnosis of acute allergic contact dermatitis (ACD) was made. After a short course of oral corticosteroids, topical mometasone furaote 1.0% cream, and oral antihistamines, the lesions healed completely over the next four weeks leaving post-inflammatory hypopigmentation. Patch testing done with standard European battery, PPD 1% in petrolatum, and commercially available natural henna powder revealed a 3+ reaction to PPD at 48 hours. No reaction was seen at the natural henna site. Awareness of the condition among physicians and the public and regulation regarding warnings of the risks of using such products is urgently warranted. PMID:14684936

  5. Cerebral blood flow and liver function in patients with encephalopathy due to acute and chronic liver diseases

    Almdal, T; Schroeder, T; Ranek, L

    1989-01-01

    the patients, without any differences between patients with acute or chronic liver diseases or the different degrees of hepatic encephalopathy. In conclusion, a marked reduction of the CBF was seen in hepatic encephalopathy, irrespective of the etiology of the disease.......The purpose of the present investigation was to study changes in cerebral blood flow (CBF) in hepatic encephalopathy, to ascertain whether this was related to the changes in liver function and whether these changes gave any prognostic information. CBF, determined by the intravenous xenon-133 method......, and liver functions, assessed by the prothrombin index, bilirubin concentration, and the galactose elimination capacity, were studied in patients with acute fulminant liver failure and in patients with encephalopathy due to chronic liver diseases--that is, cirrhosis of various etiologies. The CBF...

  6. Sindrome confusional agudo por abstinencia aguda de nicotina Delirium due to acute nicotine withdrawal

    Manuel Klein

    2002-08-01

    Full Text Available El síndrome confusional agudo (SCA o delirium en pacientes hospitalizados es un problema frecuente y grave. Se caracteriza por síntomas de comienzo agudo y curso fluctuante con inatención, pensamiento desorganizado, y con distintos niveles de alteración de la conciencia.En la bibliografía consultada, el SCA como manifestación de un síndrome de abstinencia aguda nicotínica fue descripto en solo ocho casos. Presentamos el caso de un tabaquista grave que, internado por una reagudización de su enfermedad pulmonar obstructiva crónica (EPOC, presentó un cuadro de SCA al tercer día de abstinencia tabacal, cediendo los síntomas tras la administración de un parche de nicotina. Lo descripto sugiere que en pacientes internados que presentan SCA y agitación, con fuertes antecedentes de tabaquismo, un simple ensayo con un parche de nicotina puede ofrecer en pocas horas una notable respuesta terapéutica y a su vez un test confirmatorio. El reconocimiento del SCA como forma de presentación de la abstinencia nicotínica permitirá identificar casos habitualmente complejos en los que se podrá implementar una sencilla y eficaz alternativa terapéutica.Delirium or acute confusional state among hospitalized patients is a frequent and serious problem. It is characterized by acute onset symptoms, fluctuating course, impaired attention, unorganized thinking, and altered level of conciousness. Delirium, as a manifestation of acute nicotine withdrawal syndrome has been reported in the reviewed literature only in eight cases. We report the case of a heavy smoker admitted because of a reagudization of his chronic obstructive pulmonary disease. At the third day of nicotine abstinence, he developed delirium with a rapid improvement of his symptoms after treatment with a transdermal nicotine patch. This description suggests that in hospitalized heavy smokers who develop delirium with agitation, a simple trial with a nicotine patch can offer a dramatic

  7. Acute Myocardial Infarction in a Young Lady due to Vitamin B12 Deficiency Induced Hyperhomocysteinemia

    Shamkani, Warkaa Al; Jafar, Nagham Saeed; Narayanan, Sunil Roy; Rajappan, Anil Kumar

    2015-01-01

    Hyper-homocysteinemia is a risk factor for coronary artery disease in young patients. A 32 years old female without any conventional risk factors except obesity presented with acute anterior wall myocardial infarction (MI). Her echocardiography showed anterior wall hypokinesia with moderate left ventricular dysfunction. Angiography showed tight stenosis of the proximal left anterior descending (LAD) and borderline lesion in left circumflex coronary artery (LCX). She underwent percutaneous coronary intervention (PCI) to LAD with good result. Her blood tests showed low vitamin B12, folate and serum iron levels and elevated serum homocysteine level. She was given folic acid and vitamin B12 and her homocysteine levels normalized. This case demonstrates that hyperhomocysteinemia caused by nutritional deficiency of vitamin co factors may lead to MI. Hyperhomocysteinemia should be considered in the evalauation of young people with MI, especially those without conventional risk factors. PMID:25838876

  8. Intervention analysis of introduction of rotavirus vaccine on hospital admissions rates due to acute diarrhea

    Maria de Lourdes Teixeira Masukawa

    2014-10-01

    Full Text Available The aim of this study is to investigate the impact of rotavirus vaccine on hospitalization rates for acute diarrhea in children younger than 5 years old after the introduction of the vaccine in 2006. A descriptive analytical observational study was carried out of the hospitalization rates occurred between 2000 and 2011 in 22 Regional Health Centers of Paraná State, Brazil. The effect of the vaccine was assessed by applying the SARIMA/Box-Jenkins time series methodology of intervention analysis, which allows verifying the slopes of the series are different after the introduction of the vaccine and estimating the magnitude of these effects for children younger than five years of age, by age group, for each region center. It was verified a statistically significant reduction by center/month on hospitalization rates for children 1 year old and younger, with averages of 47% and 58%, respectively, in December 2011.

  9. Liver transplantation for acute hepatic failure due to chemotherapy-induced HBV reactivation in lymphoma patients

    Timothée Noterdaeme; Luc Longrée; Christian Bataille; Arnaud Deroover; Anne Lamproye; Jean Delwaide; Yves Beguin; Pierre Honoré; Olivier Detry

    2011-01-01

    Hepatitis B (HBV) reactivation induced by chemotherapy is problem encountered recently in the management of malignant diseases. Chemotherapy-induced HBV reactivation may ultimately lead to terminal acute liver failure. Liver transplantation (LT) currently remains the only definitive treatment option for such cases, but is generally denied to patients suffering from malignancy. Here, the authors describe 2 cases of cancer-free and HBV graft re-infection-free survival after LT performed for terminal liver failure arising from HBV reactivation induced by chemotherapy for advanced stage lymphoma. These 2 cases, and some other reports in the literature, may suggest that patients suffering from hematologic malignancies and terminal liver disease can be considered for LT if the prognosis of their hematologic malignancy is good.

  10. Case Report: Pulmonary Alveolar Calcification as a Result of Severe Hypercalcemia due to Acute Lymphoblatic Leukemia.

    Colleti Junior, Jose; Carla Armelin Benites, Eliana; Spadaccia dos Santos Fernandes, Gustavo; Antonio Freddi, Norberto; Koga, Walter; Brunow de Carvalho, Werther

    2015-01-01

    Severe hypercalcemia is a rare metabolic disorder in pediatric medicine. This report describes a rare case of severe hypercalcemia and its clinical manifestations in a 2-year-old toddler. The radiological findings caused by hypercalcemia and osteolysis were emblematic of the osteolytic lesions. Hypercalcemia led to massive pulmonary alveolar calcification. The hypercalcemia was successfully treated with pamidronate, a bisphosphonate drug class. Further investigation resulted in a diagnosis of acute lymphoblastic leukemia (ALL). The patient is currently on chemotherapy and has a favorable prognosis. Although severe hypercalcemia alone is an unusual finding as the first sign for ALL, this should be considered, not to mention the radiological images resulted from calcium deposits. PMID:26213611

  11. Analysis on 29 Cases of Acute Abdomen Disease of Ectopic Pregnancy in Adolescent Females%少女异位妊娠急腹症29例分析

    王树楼; 王微

    2012-01-01

    Objective To accumulate treatment experiences for emergency room doctors through analyzing the clinical data of adolescent ectopic pregnancy patients. Methods Retrospective analysis on the clinical data of 29 adolescent ectopic pregnancy patients were done. Results All of the 29 patients received sur-geries( by abdominal or laparoscopic surgery ), proved to be rapture of ectopic pregnancy, and were cured and discharged. Conclusion Early diagnosis, early treatment and selection of optimal surgery plan are the keys to provide clinical efficacy to acute abdominal disease of ectopic pregnancy.%目的 分析异位妊娠少女患者的临床资料,以积累可供急诊科医师参考的诊治经验.方法 对在我科就诊的29例少女异位妊娠的临床资料进行回顾性分析.结果 29例患者均经手术治疗(经腹或经腹腔镜),术后均证实为异位妊娠破裂,全部康复出院.结论 少女异位妊娠急腹症的早期诊断、早期治疗及最佳治疗方案是提供临床疗效的关键.

  12. How to reduce avoidable admissions due to acute diabetes complications?: Interrelation between primary and specialized attention in a diabetes unit

    N. V. García-Talavera Espín

    2012-12-01

    Full Text Available Introduction: Type 2 Diabetes Mellitus is a serious health problem. In the year 2030 it will affect 366 million people around the world. Objective: Evaluate the effectiveness of a mixed intervention and reducing the amount and seriousness of acute complications in diabetics from our Health Area. Materials and method: Protocols of action as well as information documents were produced. Diabetes Unit coordinated educational activities in the different support levels of the Area VII of Murcia. Information talks were provided for the people in charge of the Diabetes Unit in every Care Center and Service of the Health Area. Personalized training was provided for patients treated in the differet Care levels. The study comprised three stages. Information leaflets were spread and talks offered to the patient regarding in house handling of hypo and hyper glycemia. Results: A reduction of 39% of the emergencies due to acute non complicated diabetes was achieved, as well as a reduction of 47.6% of hospital admissions. There was a reduction of 67.8% of the amount of total hospital stays for the group of patients under 35 years who were admitted into the hospital due to type 1 or 2 diabetes mellitus that didn't show any complications (GRD295. Conclusions: There was a reduction of more than thirty percent in the emergencies due to acute decompensations in the disease and a significant reduction in the avoidable hospital stays in the young adult, thus improving the patients' life quality and reducing the social cost of the diabetic patient.

  13. Acute steatohepatitis, due to extreme metabolic dysregulation, as the first presentation of non-alcoholic fatty liver disease

    Georgios Kranidiotis

    2013-05-01

    Full Text Available Non-alcoholic fatty liver disease (NAFLD is a slowly progressive chronic disease, with a high prevalence among obese, dyslipidemic or diabetic people, commonly presented as an asymptomatic mild elevation of serum aminotransferases. We report a patient who experienced an acute form of non-alcoholic steatohepatitis, as the first manifestation of NAFLD, due to exacerbation of pre-existing metabolic disorders by an extremely unhealthy lifestyle. A 50-year old, obese, diabetic man presented with a one-week history of jaundice and malaise. Analysis revealed elevated liver enzymes, bilirubin, lipids, and glucose. Based on patient’s history, physical examination, laboratory results, and imaging findings, acute non-alcoholic steatohepatitis was established as a diagnosis of exclusion. The patient was started on a low-calorie diet free of carbohydrates and fats, in combination with insulin. A dramatic improvement of clinical and laboratory parameters was observed. In the context of extreme metabolic dysregulation, induced by unhealthy diet, NAFLD may present as an acute steatohepatitis.

  14. A homosexual japanese man with acute hepatitis due to hepatitis B virus genotype ae, concurrent with amebic colitis

    Sakaguchi, Kohsaku; Kobashi, Haruhiko; Takaki, Akinobu; Kato, Jun; Nawa, Toru; Tatsukawa, Masashi; Ishikawa, Shin; Iwasaki, Yoshiaki; Miyake, Yasuhiro; Shiratori, Yasushi

    2007-01-01

    We report herein a case with acute hepatitis due to hepatitis B virus genotype Ae, concurrent with amebic colitis. A 39-year-old homosexual Japanese man was admitted to our hospital with jaundice. Laboratory tests showed an elevation of transaminase and positivity for hepatitis B surface antigen and IgM-type antibody to hepatitis B core antigen. The hepatitis B virus genotype was determined to be Ae. Furthermore, a mud-like stool with blood and mucous had sometimes been noted during the past ...

  15. A homosexual japanese man with acute hepatitis due to hepatitis B virus genotype ae, concurrent with amebic colitis

    Miyake, Yasuhiro; Iwasaki, Yoshiaki; Ishikawa, Shin; Tatsukawa, Masashi; Nawa, Toru; Kato, Jun; Takaki, Akinobu; Kobashi, Haruhiko; Sakaguchi, Kohsaku; Shiratori, Yasushi

    2007-01-01

    We report herein a case with acute hepatitis due to hepatitis B virus genotype Ae, concurrent withamebic colitis. A 39-year-old homosexual Japanese man was admitted to our hospital with jaundice.Laboratory tests showed an elevation of transaminase and positivity for hepatitis B surface antigen and IgM-type antibody to hepatitis B core antigen. The hepatitis B virus genotype was determined to be Ae. Furthermore, a mud-like stool with blood and mucous had sometimes been noted during thepast 3 y...

  16. Acute flaccid paralysis due to West nile virus infection in adults: A paradigm shift entity

    Boby Varkey Maramattom

    2014-01-01

    Full Text Available Three cases of acute flaccid paralysis (AFP with preceding fever are described. One patient had a quadriparesis with a florid meningoencephalitic picture and the other two had asymmetric flaccid paralysis with fasciculations at the onset of illness. Magnetic resonance imaging in two cases showed prominent hyperintensitities in the spinal cord and brainstem with prominent involvement of the grey horn (polio-myelitis. Cerebrospinal fluid (CSF polymerase chain reaction was positive for West Nile virus (WNV in the index patient. All three cases had a positive WNV immunoglobulin M antibody in serum/CSF and significantly high titer of WNV neutralizing antibody in serum, clearly distinguishing the infection from other Flaviviridae such as Japanese encephalitis. WNV has been recognized in India for many decades; however, AFP has not been adequately described. WNV is a flavivirus that is spread by Culex mosquitoes while they take blood meals from humans and lineage 1 is capable of causing a devastating neuro-invasive disease with fatal consequences or severe morbidity. We describe the first three laboratory confirmed cases of WNV induced AFP from Kerala and briefly enumerate the salient features of this emerging threat.

  17. CT in the evaluation of patients on ECMO due to acute respiratory failure

    Heading AbstractBackground. In patients with acute severe respiratory failure (ARF) treated with extracorporeal membrane oxygenation (ECMO) the radiological evaluation has until now almost exclusively relied on bedside radiography and US. At St. Goeran/Karolinska ECMO centre CT has become a routine complement to bedside examinations.Objective. To review retrospectively the frequency, indications and findings on CT of patients with ARF on ECMO and to evaluate the risk of complications associated with transportation for CT examinations.Materials and methods. One hundred twelve neonates, children and adults were treated with ECMO from May 1994 to January 2001. Forty-six per cent of these patients had CT examinations on one or more occasions during ECMO, giving a total number of 238 examination sites on 104 occasions. All CT examinations were performed in the Paediatric Radiology Department and included a 10-min transport using a mobile ECMO system.Results. CT was more often performed in older patients and in patients with long ECMO runs. The main indications were suspected complications of ECMO and/or the underlying disease or a delay in clinical improvement. In 57% of the CT occasions, significant findings affecting treatment were revealed. There were no complications associated with the examinations or transport.Conclusions. CT is safe and useful in evaluation of patients with ARF during ECMO. (orig.)

  18. Mortality due to acute adverse drug reactions in Galicia: 1997-2011.

    Miguel-Arias, Domingo; Pereiro Gómez, César; Bermejo Barrera, Ana M; López de Abajo Rodríguez, Benito; Sobrido Prieto, María

    2016-01-01

    The aim of this research is to study all people who died in the Autonomous Community of Galicia from acute death after drugconsumption (ADR) in which there was judicial intervention during the period from 1997 to 2011, according to inclusion and exclusión criteria established by the National Drug Plan for the entire national territory. Sociodemographic and clinical characteristics of deceased subjects were studied, in order to identify key risk factors and/or vulnerable populations.A total of 805 deaths were recorded. The distribution by provinces and municipalities corresponds to the areas of greatest population, incidence of consumption and proximity to the coast. The average age of these patients was 34.34 years, with a gradual increase over years. Most of them were male (91.2%) and single (47.7). 43.5% of the deceased habitually used the parenteral route of administration and 36.4% had positive HIV serology. The most frequently-detected substances corresponded to opiates (heroin: 61.3%, methadone: 35.6%), followed by cocaine (53.7%), although the most common pattern was that of poly-consumption. ADR mortality figures remain relatively stable throughout the study period. The predominant pattern is that of males, opiates and a long history of consumption. PMID:26990265

  19. MR venography of the abdomen

    Purpose: To evaluate the image quality of magnetic resonance venography (MRV) of pelvic and abdominal veins. Methods: A retrospective analysis of all MRV between 1993 and 1996 was conducted. A 2D-FLASH-TOF without breath hold and with arterial presaturation was used. All venous segments have been assessed for the quality of visualisation and an overall image quality was determined. 43% of our patients h[ malignant disease and phlebothrombosis h[ alre[y been diagnosed in 64%. Results: 126 examinations and 1696 venous segments were analysed. The overall quality of the examinations was good, however one examination was non diagnostic because of motion artefacts. Vessels along the vertical axis were good visualised in over 90%. Most important reasons for insufficient visualisation were breathing, motion and metal artefacts as well as compression and displacement of veins due to tumour disease. Conclusions: Magnetic resonance venography without breath hold TOF-technique is practical and robust for routine clinical applications. (orig.)

  20. Acute Interstitial Nephritis due to Leptospira grippotyphosa in the Absence of Weil’s Disease

    Tanja Schmidhauser; Simona Curioni; Enos Bernasconi

    2013-01-01

    Anicteric leptospirosis is a self-limited flu-like disease, whereas the icteric form is a severe illness characterized by multiple organ involvement or even failure. A case involving a patient with rapidly progressing renal insufficiency requiring intermittent renal replacement therapy due to Leptospira grippotyphosa in the absence of a Weil’s disease is reported.

  1. Expectations about recovery from acute non-specific low back pain predict absence from usual work due to chronic low back pain : a systematic review

    Hallegraeff, J.M.; Krijnen, W.P.; van der Schans, C.P.; de Greef, M.H.G.

    2012-01-01

    Question: Do negative expectations in patients after the onset of acute low back pain increase the odds of absence from usual work due to progression to chronic low back pain? Design: Systematic review with meta-analysis of prospective inception cohort studies. Participants: Adults with acute or sub

  2. Studies of the ionizing radiation effects on the effluents acute toxicity due to anionic surfactants

    Several studies have shown the negative effects of surfactants, as detergents active substance, when discharged on biological sewage wastewater treatment plants. High toxicity may represent a lower efficiency for biological treatment. When surfactants are in aquatic environment they may induce a loss of grease revetment on birds (feather). Depending on the surfactant concentration, several damages to all biotic systems can happen. Looking for an alternative technology for wastewater treatment, efficient for surfactant removal, the present work applied ionizing radiation as an advanced oxidation process for affluents and effluents from Suzano Treatment Station. Such wastewater samples were submitted to radiation using an electron beam from a Dynamic Electron Beam Accelerator from Instituto de Pesquisas Energeticas e Nucleares. In order to assess this proposed treatment efficacy, it was performed acute toxicity evaluation with two test-organisms, the crustacean Daphnia similis and the luminescent bacteria Vibrio fischeri. The studied effluents were: one from a chemical industry (IND), three from sewage plant (affluents - GG, GM and Guaio) and the last biologically treated secondary effluent (EfF), discharged at Tiete river. The applied radiation doses varied from 3 kGy to 50 kGy, being 50 kGy enough for surfactant degradation contained at industrial effluent. For GG, GM and Guaio samples, doses of 6 kGy and 10 kGy were efficient for surfactant and toxicity reduction, representing an average removal that varied from 71.80% to 82.76% and toxicity from 30% to 91% for most the effluents. The final effluent was less toxic than the others and the radiation induced an average 11% removal for anionic surfactant. The industrial effluents were also submitted to an aeration process in order to quantify the contribution of surfactant to the whole sample toxicity, once it was partially removed as foam and several fractions were evaluated for toxicity. (author)

  3. Aggressive treatment of acute limb ischemia due to thrombosed popliteal aneurysms

    Objective: The absence of infra-popliteal runoff in patients with acute limb ischemia and thrombosed popliteal aneurysms carries a high risk of amputation. A combined treatment method involving thrombolysis and surgery is reported. Material and methods: Information regarding six patients was reviewed. Ankle brachial indices and degree of ischemia were recorded. All patients underwent digital subtraction angiography. In five patients thrombus dissolution was achieved using a combination of mechanical and pharmacologic therapy. One patient was judged incapable of withstanding any delay in reperfusion and was treated with isolated limb perfusion using a thrombolytic agent. All patients underwent surgical revascularization. Follow-up (1-3 years) consisted of duplex examinations at 6 months and yearly thereafter. Results: Five patients had no measurable ankle-brachial index (ABI), while one patient had an ABI of 0.4. Initial angiography noted all patients to have no runoff in continuity to the pedal arch. Following thrombolytic therapy, an adequate bypass vessel was noted in all cases, with reconstitution of the plantar arch in five patients. Distal revascularizations included one peroneal, and five below knee popliteal arterial bypasses. Fasciotomies were performed in four of the six patients. There were no amputations. One patient developed a persistent foot drop. Two patients developed bypass grafts occlusions; one of which required therapy. Conclusion: The pre-operative use of thrombolytic therapy is a safe and effective method to achieve limb salvage in this patient population. Patients must be capable of withstanding an additional period of ischemia allowing for reconstitution of distal runoff. Isolated limb perfusion is of use when a delay to reperfusion cannot be tolerated. (Copyright (c) 1998 Elsevier Science B.V., Amsterdam. All rights reserved.)

  4. Long term outcome of acute kidney injury due to leptospirosis? A longitudinal study in Sri Lanka

    2014-01-01

    Background Leptospirosis is an important zoonotic disease of variable severity and is a common cause of acute kidney injury (AKI) in tropics. However the knowledge on long term renal outcome in leptospirosis is scarce. This study aims to assess the long-term renal outcome of AKI caused by leptospirosis. Findings Hospital records of patients who had developed AKI following leptospirosis (Serologically confirmed) presented to two Teaching Hospitals in Kandy district over 3 years from 2007 were studied. A total of 44 patients were included and they had been followed up at least for one year in out patient clinics with regular assessment including renal status. Renal histology was studied in two patients. The primary outcome measure was normalization of renal function at one year. Of the 44 patients, 31 were in the risk and injury stage (Group 1), and the rest of them were in the failure stage (Group 2) under RIFLE criteria. Of group 2 patients, 11 had abnormal renal functions on discharge. Their mean serum creatinine and GFR values on discharge were 392 mmol/l and 20 ml/min/1.73 m2. Other two patients had full renal recovery whilst in the hospital. Nine in the group 2 required renal replacement therapy by means of peritoneal dialysis, intermittent haemodialysis or haemofiltration. Seventeen out of the total had persistently abnormal renal functions on discharge. Of them 13 recovered their renal functions to normal. Four patients (9%) who belonged to group 2, had persistently abnormal renal functions after first year compatible with stage 3 chronic kidney disease (CKD). Renal histology of two patients showed tubulointerstitial lymphocyte infiltrate, tubular atrophy and interstitial fibrosis. Conclusion The long term renal outcome of AKI following leptospirosis is satisfactory as only 9% of patients had abnormal renal functions compatible with early stage of CKD. Even among them, advanced CKD or dialysis dependency had not been observed. PMID:24964804

  5. Acute hemolytic transfusion reactions due to multiple alloantibodies including anti-E, anti-c and anti-Jkb.

    Park, Tae Sung; Kim, Ki Uk; Jeong, Woo Jin; Kim, Hyung Hoi; Chang, Chulhun L; Chung, Joo Seop; Cho, Goon Jae; Lee, Eun Yup; Son, Han Chul

    2003-12-01

    We report a case of two consecutive episodes of acute hemolytic transfusion reactions (HTRs) due to multiple alloantibodies in a 34-yr-old man who suffered from avascular necrosis of left femoral head. He received five units of packed red blood cells (RBCs) during surgery. Then the transfusion of packed RBCs was required nine days after the surgery because of the unexplained drop in hemoglobin level. The transfusion of the first two units resulted in fever and brown-colored urine, but he received the transfusion of another packed RBCs the next day. He experienced even more severe symptoms during the transfusion of the first unit. We performed antibody screening test, and it showed positive results. Multiple alloantibodies including anti-E, anti-c and anti-Jkb were detected by antibody identification study. Acute HTRs due to multiple alloantibodies were diagnosed, and the supportive cares were done for 6 days. We suggest the antibody screening test should be included in the panel of pretransfusion tests for safer transfusion, and it is particularly mandatory for the patients with multiple transfusions, pregnant women, and preoperative patients. PMID:14676451

  6. Regional myocardial extraction of a radioiodinated branched chain fatty acid during right ventricular pressure overload due to acute pulmonary hypertension

    To determine whether branched chain fatty acid extraction is reduced during right ventricular (RV) dysfunction due to acute pulmonary artery hypertension, studies were done in 6 anesthetized dogs. Regional branched chain fatty acid extraction was measured by comparing the myocardial uptake of I-125 labeled 15-[p-(iodophenyl)]-3-methylpentadecanoic acid (I-PDA) to myocardial blood flow. Acute pulmonary hypertension was induced by incremental intravenous injection of 100 micron diameter glass beads into six pentobarbital anesthetized, mechanically ventilated dogs. Myocardial blood flow was measured by radiolabeled microspheres both under baseline conditions and during pulmonary hypertension. Mean RV pressure rose from 12 +- 2 (mean +- SEM) to 30 +-3mmHg resulting in a 225 +- 16% increase in RV stroke work. RV ejection fraction, as assessed by gated blood pool scans fell from 39 +- 2 to 18 +- 2%. Left ventricular (LV) pressures, stroke work and ejection fraction were unchanged. Myocardial blood flow increased 132 + 59% in the RV free wall and 67 +- 22% in the RV septum. LV blood flow was unchanged. Despite increased RV work and myocardial blood flow, no differences were noted in the branched chain fatty acid extraction ratios among LV or RV free walls or septum. The authors conclude that early RV dysfunction associated with pulmonary artery hypertension is not due to inadequate myocardial blood flow or branched chain fatty acid extraction

  7. ACUTE PHOSPHATE NEPHROPATHY DUE TO USE OF PHOSPHOROUS ENEMA: CASE REPORT

    Jamshid, Hamdard; Rumeyza, Kazancıoğlu; Işın, Kılıçaslan; YASEMINÖZLÜK; Murat, Alay; Ruhper, Çekin; Reha, Erkoç; Gauhar, Rakhymzhan

    2014-01-01

    The number of colonoscopies is rising worldwide due to national screening programs. In the USA, for example, approximately 14.2 million colonoscopies are performed every year. Adequate cleansing of the bowel before colonoscopy is important in order to obtaingood results, and many preparations are used as purgatives. One such kind of purgative is an enema containing sodium phosphate.Sodium phosphate containing purgatives are widely used Bezmialem Vakif University Faculty of Medicine, Departmen...

  8. Acute Stridor and Respiratory Failure due to Retrosternal Subglottic Stenosis of Unknown Origin

    Linda Smith; Nicola Jane Willis; Tharindu Vithanage; Gerben Keijzers; Tara Cochrane

    2013-01-01

    Respiratory failure due to subglottic stenosis is a rare but serious condition. A 22-year-old male presented to the emergency department (ED) with shortness of breath, stridor, and change in tone of voice. The patient did not complain of B-symptoms (fever, weight loss, and night sweats). In the week before this presentation, he was diagnosed with an upper respiratory tract infection with associated bronchospasm and discharged on oral antibiotics and inhaled salbutamol without effect. He devel...

  9. Roentgenological observation in the disease of biliary tract by plain film study of abdomen

    Kim Byung Soo [Busan National University College of Medicine, Busan (Korea, Republic of)

    1979-06-15

    , the gallbladder shadow was found only at the acute stage, for the reason that, in the two cases of the showing gallbladder shadow, the gall bladder shadow could not be shown on the plain film taken after remission of the clinical symptoms. 8. Consequently, the author concluded that the radiographic findings of showing gallbladder shadow and abnormal meteorism in plain films of abdomen could be considered as a key point to diagnose the cholecystography in patients of acute abdomen.

  10. Roentgenological observation in the disease of biliary tract by plain film study of abdomen

    , the gallbladder shadow was found only at the acute stage, for the reason that, in the two cases of the showing gallbladder shadow, the gall bladder shadow could not be shown on the plain film taken after remission of the clinical symptoms. 8. Consequently, the author concluded that the radiographic findings of showing gallbladder shadow and abnormal meteorism in plain films of abdomen could be considered as a key point to diagnose the cholecystography in patients of acute abdomen.

  11. Adult midgut malrotation presented with acute bowel obstruction and ischemia

    Akile Zengin

    2016-01-01

    Conclusion: Malrotation should be considered in differential diagnosis in patients presented with acute abdomen and intestinal ischemia. Surgical intervention should be prompt to limit morbidity and mortality.

  12. Multislice-CT of the abdomen

    Zech, Christoph Johannes; Reiser, Maximilian F. (eds.) [Univ. Hospitals Munich, Grosshadern (Germany). Dept. of Clinical Radiology; Baron, Richard [Chicago Univ., IL (United States). Dept. of Radiology; Bartolozzi, Carlo [Pisa Univ. (Italy). Dept. of Oncology; Pisa Univ. (Italy). Dept. of Transplants and Advanced Technology

    2012-07-01

    This book provides a lucid summary of modern multislice CT imaging of the abdomen, with a focus on the essential imaging findings. After a concise technical introduction, the most important abdominal diseases are described and illustrated with high-quality images. Sections are devoted to the liver and biliary system, the pancreas and spleen, the kidneys and urogenital system, and the bowel and peritoneal cavity. Throughout, key differential diagnostic features are highlighted. The editorial team is composed of internationally renowned radiologists from Europe and the United States, and all chapters have been written by recognized experts in the topic under consideration. Multislice CT of the Abdomen will serve as an excellent reference for radiologists participating in further professional training and will prove an ideal source of information for all who wish to deepen their personal knowledge of the subject.

  13. Acute Cardiac Failure in a Pregnant Woman due to Thyrotoxic Crisis

    Nao Okuda

    2012-01-01

    Full Text Available Introduction. Cardiac failure during pregnancy is usually related to preeclampsia/eclampsia, rarely to hyperthyroidism. While hyperthyroidism can easily lead to hypertensive cardiac failure and may harm the fetus, it is sometimes difficult to distinguish hyperthyroidism from normal pregnancy. Case Presentation. We encountered a case of 41-year-old pregnant woman with hypertensive cardiac failure. Because we initially diagnosed as pre-eclampsia/eclampsia, Caesarian section was performed. However, her symptoms still persisted after delivery. After thyroid function test results taken on the day of admission were obtained on the fourth day, we could diagnose that her cardiac failure was caused by thyrotoxic crisis. Conclusions. Hypertensive cardiac failure due to hyperthyroidism during pregnancy is rare and difficult to diagnose because of similar presentation of normal pregnancy. However, physicians should be aware of the risks posed by hyperthyroidism during pregnancy.

  14. Trauma imaging in the thorax and abdomen

    This book thoroughly covers the radiologic diagnosis of traumatic injuries of the thorax and abdomen with special consideration given to the physical principles governing blunt, blast, and penetrating trauma and to the pathophysiology which they cause. The clinical experience forming the major data base for this book is drawn from the Ramban Medical Center in Haifa, Israel, the major trauma center for the Middle East wars

  15. Seizure is a rare presentation for acute hemolysis due to G6PD deficiency. We report a previously healthy boy who presented initially with seizure and cyanosis and subsequently acute hemolysis, due to glucose-6-phosphate dehydrogenase deficiency (G6PD) an

    FAYYAZI, Afshin; Ali KHAJEH; Hosein ESFAHANI

    2012-01-01

    Seizure is a rare presentation for acute hemolysis due to G6PD deficiency. We report a previously healthy boy who presented initially with seizure and cyanosis and subsequently acute hemolysis, due to glucose-6-phosphate dehydrogenase deficiency (G6PD) and probably secondary methemoglobinemia, following the ingestion of fava beans.

  16. Seizure is a rare presentation for acute hemolysis due to G6PD deficiency. We report a previously healthy boy who presented initially with seizure and cyanosis and subsequently acute hemolysis, due to glucose-6-phosphate dehydrogenase deficiency (G6PD an

    Afshin FAYYAZI

    2012-06-01

    Full Text Available Seizure is a rare presentation for acute hemolysis due to G6PD deficiency. We report a previously healthy boy who presented initially with seizure and cyanosis and subsequently acute hemolysis, due to glucose-6-phosphate dehydrogenase deficiency (G6PD and probably secondary methemoglobinemia, following the ingestion of fava beans.

  17. The Role of Inspiratory Muscle Training in Sickle Cell Anemia Related Pulmonary Damage due to Recurrent Acute Chest Syndrome Attacks

    Burcu Camcıoğlu

    2015-01-01

    Full Text Available Background. The sickling of red blood cells causes a constellation of musculoskeletal, cardiovascular, and pulmonary manifestations. A 32-year-old gentleman with sickle cell anemia (SCA had been suffering from recurrent acute chest syndrome (ACS. Aim. To examine the effects of inspiratory muscle training (IMT on pulmonary functions, respiratory and peripheral muscle strength, functional exercise capacity, and quality of life in this patient with SCA. Methods. Functional exercise capacity was evaluated using six-minute walk test, respiratory muscle strength using mouth pressure device, hand grip strength using hand-held dynamometer, pain using Visual Analogue Scale, fatigue using Fatigue Severity Scale, dyspnea using Modified Medical Research Council Scale, and health related quality of life using European Organization for Research and Treatment of Cancer QOL measurement. Results. A significant improvement has been demonstrated in respiratory muscle strength, functional exercise capacity, pain, fatigue, dyspnea, and quality of life. There was no admission to emergency department due to acute chest syndrome in the following 12 months after commencing regular erythrocytapheresis. Conclusion. This is the first report demonstrating the beneficial effects of inspiratory muscle training on functional exercise capacity, respiratory muscle strength, pain, fatigue, dyspnea, and quality of life in a patient with recurrent ACS.

  18. The Role of Inspiratory Muscle Training in Sickle Cell Anemia Related Pulmonary Damage due to Recurrent Acute Chest Syndrome Attacks.

    Camcıoğlu, Burcu; Boşnak-Güçlü, Meral; Karadallı, Müşerrefe Nur; Akı, Şahika Zeynep; Türköz-Sucak, Gülsan

    2015-01-01

    Background. The sickling of red blood cells causes a constellation of musculoskeletal, cardiovascular, and pulmonary manifestations. A 32-year-old gentleman with sickle cell anemia (SCA) had been suffering from recurrent acute chest syndrome (ACS). Aim. To examine the effects of inspiratory muscle training (IMT) on pulmonary functions, respiratory and peripheral muscle strength, functional exercise capacity, and quality of life in this patient with SCA. Methods. Functional exercise capacity was evaluated using six-minute walk test, respiratory muscle strength using mouth pressure device, hand grip strength using hand-held dynamometer, pain using Visual Analogue Scale, fatigue using Fatigue Severity Scale, dyspnea using Modified Medical Research Council Scale, and health related quality of life using European Organization for Research and Treatment of Cancer QOL measurement. Results. A significant improvement has been demonstrated in respiratory muscle strength, functional exercise capacity, pain, fatigue, dyspnea, and quality of life. There was no admission to emergency department due to acute chest syndrome in the following 12 months after commencing regular erythrocytapheresis. Conclusion. This is the first report demonstrating the beneficial effects of inspiratory muscle training on functional exercise capacity, respiratory muscle strength, pain, fatigue, dyspnea, and quality of life in a patient with recurrent ACS. PMID:26060589

  19. [Acute brainstem encephalitis and myelitis in a girl with isolated methylmalonic aciduria due to MUT gene defect].

    Liu, Yu-Peng; Ding, Yuan; Li, Xi-Yuan; Wang, Hai-Jun; Song, Jin-Qing; Ye, Jin-Tang; Wu, Tong-Fei; Yang, Yan-Ling

    2015-10-01

    Methylmalonyl CoA mutase deficiency due to MUT gene defect has been known as the main cause of isolated methylmalonic acidemia in Mainland China. This study reported a patient with isolated methylmalonic aciduria (MUT type) characterized as acute brainstem encephalitis and myelitis. The previously healthy girl presented with fever, lethargy and progressive weakness in her extremities at the age of 3 years and 2 months. Three day later, she had respiratory distress and consciousness. Cranial MRI revealed bilateral symmetrical lesion of pallidum, brain stem and spinal cord, indicating acute brainstem encephalitis and myelitis. Her blood propionylcarnitine (6.83 μmol/L vs normal range 1.0 to 5.0 μmol/L) and urinary methylmalonic acid (133.22 mmol/mol creatinine vs normal range 0.2 to 3.6 mmol/mol creatinine) increased significantly. Plasma total homocysteine was normal. On her MUT gene, a reported mutation (c.1630_1631GG>TA) and a novel mutation (c.1663C>T, p.A555T) were identified, which confirmed the diagnosis of methylmalonic aciduria (MUT type). After cobalamin injection, protein-restricted diet with the supplements of special formula and L-carnitine, progressive improvement has been observed. The clinical manifestation of patients with methylmalonic aciduria is complex. Metabolic study and gene analysis are keys for the diagnosis and treatment of the disorder. PMID:26483233

  20. Independent lung ventilation in a newborn with asymmetric acute lung injury due to respiratory syncytial virus: a case report

    Di Nardo Matteo

    2008-06-01

    Full Text Available Abstract Introduction Independent lung ventilation is a form of protective ventilation strategy used in adult asymmetric acute lung injury, where the application of conventional mechanical ventilation can produce ventilator-induced lung injury and ventilation-perfusion mismatch. Only a few experiences have been published on the use of independent lung ventilation in newborn patients. Case presentation We present a case of independent lung ventilation in a 16-day-old infant of 3.5 kg body weight who had an asymmetric lung injury due to respiratory syncytial virus bronchiolitis. We used independent lung ventilation applying conventional protective pressure controlled ventilation to the less-compromised lung, with a respiratory frequency proportional to the age of the patient, and a pressure controlled high-frequency ventilation to the atelectatic lung. This was done because a single tube conventional ventilation protective strategy would have exposed the less-compromised lung to a high mean airways pressure. The target of independent lung ventilation is to provide adequate gas exchange at a safe mean airways pressure level and to expand the atelectatic lung. Independent lung ventilation was accomplished for 24 hours. Daily chest radiograph and gas exchange were used to evaluate the efficacy of independent lung ventilation. Extubation was performed after 48 hours of conventional single-tube mechanical ventilation following independent lung ventilation. Conclusion This case report demonstrates the feasibility of independent lung ventilation with two separate tubes in neonates as a treatment of an asymmetric acute lung injury.

  1. Brachial Plexopathy due to Myeloid Sarcoma in a Patient With Acute Myeloid Leukemia After Allogenic Peripheral Blood Stem Cell Transplantation.

    Ha, Yumi; Sung, Duk Hyun; Park, Yoonhong; Kim, Du Hwan

    2013-04-01

    Myeloid sarcoma is a solid, extramedullary tumor comprising of immature myeloid cells. It may occur in any organ; however, the invasion of peripheral nervous system is rare. Herein, we report the case of myeloid sarcoma on the brachial plexus. A 37-year-old woman with acute myelogenous leukemia achieved complete remission after chemotherapy. One year later, she presented right shoulder pain, progressive weakness in the right upper extremity and hypesthesia. Based on magnetic resonance images (MRI) and electrophysiologic study, a provisional diagnosis of brachial plexus neuritis was done and hence steroid pulse therapy was carried out. Three months later the patient presented epigastric pain. After upper gastrointestinal endoscopy, myeloid sarcoma of gastrointestinal tract was confirmed pathologically. Moreover, 18-fluoride fluorodeoxyglucose positron emission tomography showed a fusiform shaped mass lesion at the brachial plexus overlapping with previous high signal lesion on the MRI. Therefore, we concluded the final diagnosis as brachial plexopathy due to myeloid sarcoma. PMID:23705126

  2. Severe Acute Pancreatitis in Pregnancy

    Bahiyah Abdullah

    2015-01-01

    Full Text Available This is a case of a pregnant lady at 8 weeks of gestation, who presented with acute abdomen. She was initially diagnosed with ruptured ectopic pregnancy and ruptured corpus luteal cyst as the differential diagnosis. However she then, was finally diagnosed as acute hemorrhagic pancreatitis with spontaneous complete miscarriage. This is followed by review of literature on this topic. Acute pancreatitis in pregnancy is not uncommon. The emphasis on high index of suspicion of acute pancreatitis in women who presented with acute abdomen in pregnancy is highlighted. Early diagnosis and good supportive care by multidisciplinary team are crucial to ensure good maternal and fetal outcomes.

  3. Anemia and performance status as prognostic markers in acute hypercapnic respiratory failure due to chronic obstructive pulmonary disease

    Haja Mydin H

    2013-03-01

    Full Text Available Helmy Haja Mydin, Stephen Murphy, Howell Clague, Kishore Sridharan, Ian K TaylorDepartment of Respiratory Medicine, Sunderland Royal Infirmary, Sunderland, United KingdomBackground: In patients with acute hypercapnic respiratory failure (AHRF during exacerbations of COPD, mortality can be high despite noninvasive ventilation (NIV. For some, AHRF is terminal and NIV is inappropriate. However there is no definitive method of identifying patients who are unlikely to survive. The aim of this study was to identify factors associated with inpatient mortality from AHRF with respiratory acidosis due to COPD.Methods: COPD patients presenting with AHRF and who were treated with NIV were studied prospectively. The forced expiratory volume in 1 second (FEV1, World Health Organization performance status (WHO-PS, clinical observations, a composite physiological score (Early Warning Score, routine hematology and biochemistry, and arterial blood gases prior to commencing NIV, were recorded.Results: In total, 65 patients were included for study, 29 males and 36 females, with a mean age of 71 ± 10.5 years. Inpatient mortality in the group was 33.8%. Mortality at 30 days and 12 months after admission were 38.5% and 58.5%, respectively. On univariate analysis, the variables associated with inpatient death were: WHO-PS ≥ 3, long-term oxygen therapy, anemia, diastolic blood pressure < 70 mmHg, Early Warning Score ≥ 3, severe acidosis (pH < 7.20, and serum albumin < 35 g/L. On multivariate analysis, only anemia and WHO-PS ≥ 3 were significant. The presence of both predicted 68% of inpatient deaths, with a specificity of 98%.Conclusion: WHO-PS ≥ 3 and anemia are prognostic factors in AHRF with respiratory acidosis due to COPD. A combination of the two provides a simple method of identifying patients unlikely to benefit from NIV.Keywords: acute exacerbations of COPD, noninvasive ventilation, emphysema, prognostic markers

  4. Hyponatremia in aneurysmal subarachnoid hemorrhage is due to the syndrome of inappropriate antidiuresis and acute glucocorticoid deficiency

    Hannon, M J

    2011-06-01

    Hyponatraemia is the most common electrolyte abnormality following subarachnoid haemorrhage (SAH) and contributes to increased morbidity and mortality. Retrospective data suggests that the syndrome of inappropriate diuresis (SIAD) is the most common cause of hyponatraemia in SAH, though cerebral salt wasting has been postulated by some workers to be the predominant abnormality. Data which has shown acute glucocorticoid deficiency following SAH has suggested that some cases of euvolaemic hyponatraemia may also be caused by this mechanism.We prospectively studied the hormonal and haemodynamic influences involved in the development of hyponatraemia in 100 patients (61% female, median age 53 (range 16-82)) with non-traumatic aneurysmal SAH. Each patient had plasma sodium (pNa), urea, osmolality, glucose and 0900h cortisol (PC), and urinary sodium and osmolality measured on days 1, 2, 3, 4, 6, 8, 10 and 12 following SAH. Fluid balance and haemodynamic parameters were recorded daily. Results were compared with 15 patients admitted to ITU following vascular surgery. A PC<300nmol\\/L in a patient in ITU was regarded clinically as inappropriately low.49% of patients developed hyponatraemia (pNa<135 mmol\\/L), including 14% who developed clinically significantly hyponatraemia (pNa<130 mmol\\/L). 36\\/49 (73.4%) developed hyponatraemia between days 1 and 3 post SAH. The median duration of hyponatraemia was 3 days (range 1–10 days).In 35\\/49 (71.4%), hyponatraemia was due to SIAD as defined by standard diagnostic criteria. 14% of SAH patients had at least one PC<300nmol\\/L; 5 of these (35.7%) developed hyponatraemia. In 4 patients hyponatraemia was preceded by acute cortisol deficiency and responded to hydrocortisone treatment. In contrast, all controls had PC>500 nmol\\/L on day 1, and >300 nmol on days 3–12. There were no cases of cerebral salt wasting. There was no relationship between the incidence of hyponatraemia and the defined anatomical territory or severity of

  5. Perforated jejunal diverticulitis as a rare cause of acute abdomen

    Jejunal diverticula is rare and in most cases without any symptoms. They become clinically relevant when complications, such as diverticulitis, malabsorption caused by bacterial overgrowth, intestinal hemorrhage, or obstruction, occur. In this case report a case of perforated jejunal diverticulitis is presented and the problems in finding the correct diagnosis are discussed. (orig.)

  6. Perforated jejunal diverticulitis as a rare cause of acute abdomen

    Peters, R.; Grust, A.; Fuerst, G. [Department of Radiology, Heinrich-Heine-University, Duesseldorf (Germany); Gerharz, C.D. [Department of Pathology, Heinrich-Heine-University, Duesseldorf (Germany); Dumon, C. [Department of Surgery, Heinrich-Heine-University, Duesseldorf (Germany)

    1999-09-01

    Jejunal diverticula is rare and in most cases without any symptoms. They become clinically relevant when complications, such as diverticulitis, malabsorption caused by bacterial overgrowth, intestinal hemorrhage, or obstruction, occur. In this case report a case of perforated jejunal diverticulitis is presented and the problems in finding the correct diagnosis are discussed. (orig.) With 3 figs., 13 refs.

  7. Acute Abdomen in Interstitial Ectopic Pregnancy, An Emergency Laparoscopic Treatment

    Picardo, E; M. Mitidieri; Salvagno, F; E.M. Canuto; Benedetto, C.; G.L. Marchino; Minniti, E.

    2014-01-01

    The present case report demonstrates a laparoscopic approach to treat interstitial cornual pregnancy in emergency. Interstitial ectopic pregnancy develops in the uterine portion of the fallopian tube which accounts for 2–4% of all ectopic pregnancies and has the potential to cause life-threatening hemorrhage at rupture. The mortality rate for a woman diagnosed with such a pregnancy is 2–2.5%. Diagnosis of interstitial pregnancy is made by ultrasound. In this case a 32 year-old woman, Gravida ...

  8. Spontaneous Uterine Perforation of Pyometra Presenting as Acute Abdomen

    Toshihiro Kitai

    2014-01-01

    Full Text Available Pyometra is the accumulation of pus in the uterine cavity, and spontaneous perforation of pyometra resulting in generalized diffuse peritonitis is extremely uncommon. We report a rare case of diffuse peritonitis caused by spontaneous perforation of pyometra. A 66-year-old postmenopausal woman with diffuse abdominal pain and vomiting was admitted to our institution. She had a history of mixed connective-tissue disease and had been taking steroids for 20 years. Under a diagnosis of generalized peritonitis secondary to perforation of the gastrointestinal tract or uterus, supravaginal hysterectomy and bilateral salpingo-oophorectomy were performed. Unfortunately, wound dehiscence and infection occurred during the postoperative course, which were exacerbated by her immunocompromised state. Despite intensive care and a course of antibiotics, the patient died of multiple organ failure resulting from sepsis on the 36th postoperative day. Although correct diagnosis, early intervention, and proper treatment can reduce morbidity and mortality of spontaneous perforation of pyometra, if severe infection occurs, this disease can be life threatening for immunocompromised hosts.

  9. Spontaneous uterine perforation of pyometra presenting as acute abdomen.

    Kitai, Toshihiro; Okuno, Kentaro; Ugaki, Hiromi; Komoto, Yoshiko; Fujimi, Satoshi; Takemura, Masahiko

    2014-01-01

    Pyometra is the accumulation of pus in the uterine cavity, and spontaneous perforation of pyometra resulting in generalized diffuse peritonitis is extremely uncommon. We report a rare case of diffuse peritonitis caused by spontaneous perforation of pyometra. A 66-year-old postmenopausal woman with diffuse abdominal pain and vomiting was admitted to our institution. She had a history of mixed connective-tissue disease and had been taking steroids for 20 years. Under a diagnosis of generalized peritonitis secondary to perforation of the gastrointestinal tract or uterus, supravaginal hysterectomy and bilateral salpingo-oophorectomy were performed. Unfortunately, wound dehiscence and infection occurred during the postoperative course, which were exacerbated by her immunocompromised state. Despite intensive care and a course of antibiotics, the patient died of multiple organ failure resulting from sepsis on the 36th postoperative day. Although correct diagnosis, early intervention, and proper treatment can reduce morbidity and mortality of spontaneous perforation of pyometra, if severe infection occurs, this disease can be life threatening for immunocompromised hosts. PMID:25057420

  10. Spontaneous Uterine Perforation of Pyometra Presenting as Acute Abdomen

    Toshihiro Kitai; Kentaro Okuno; Hiromi Ugaki; Yoshiko Komoto; Satoshi Fujimi; Masahiko Takemura

    2014-01-01

    Pyometra is the accumulation of pus in the uterine cavity, and spontaneous perforation of pyometra resulting in generalized diffuse peritonitis is extremely uncommon. We report a rare case of diffuse peritonitis caused by spontaneous perforation of pyometra. A 66-year-old postmenopausal woman with diffuse abdominal pain and vomiting was admitted to our institution. She had a history of mixed connective-tissue disease and had been taking steroids for 20 years. Under a diagnosis of generalized ...

  11. MR imaging of upper abdomen following cholecystectomy: normal and abnormal findings

    Haakansson, K. [Kalmar Hospital, (Sweden). Dept. of Radiology; Leander, P.; Ekberg, O. [Malmoe Univ. Hospital (Sweden). Dept. of Radiology; Haakansson, H.O. [Kalmar Hospital, (Sweden). Dept. of Surgery

    2001-03-01

    To describe the normal MR appearance after cholecystectomy and the findings in patients with postoperative complications using fast pulse sequences in abdominal MR imaging. Material and methods: In a prospective study of 119 patients, 64 were examined with MR after cholecystectomy. In total, 56 patients with uncomplicated cholecystectomy were examined with MR 1-5 days (mean 1.6 days) after cholecystectomy. Nine patients had an abdominal postoperative complication and 8 of these were examined with MR after the complication commenced 1-12 days after the cholecystectomy. Results: Oedema in the gallbladder fossa was the only finding in 39 patients (61%), all with uneventful recovery. Small fluid collections in an area consistent with the gallbladder fossa were seen in 9/64 (14%) patients, of which 3 had surgical complications: 1 bleeding and 2 bile duct leakage. Twenty-two (34%) patients had small locally situated fluid collections adjacent to the liver, 14 were uneventful and 8 showed postoperative surgical complications. Seven patients had fluid in the rest of the abdomen of which 5 had surgical complications; 4 due to bile duct leakage and 1 acute pancreatitis. One patient had a postoperative bleeding not seen on MR images. Conclusion: MR is very sensitive in detecting fluid collections. Early MR findings following cholecystectomy are normally only subtle changes, mainly in the gallbladder fossa. Fluid collections diagnosed elsewhere than in the gallbladder fossa usually indicate a surgical complication and a surgical complication is unlikely if MR fails to show a fluid collection.

  12. Reduction of death rate due to acute myocardial infarction in subjects with cancers through systemic restoration of impaired nitric oxide.

    Rajeshwary Ghosh

    Full Text Available INTRODUCTION: Excessive aggregation of platelets at the site of plaque rupture on the coronary artery led to the formation of thrombus which is reported to precipitate acute myocardial infarction (AMI. Nitric oxide (NO has been reported to inhibit platelet aggregation and induce thrombolysis through the in situ formation of plasmin. As the plasma NO level in AMI patients from two different ethnic groups was reduced to 0 µM (median compared to 4.0 µM (median in normal controls, the effect of restoration of the NO level to normal ranges on the rate of death due to AMI was determined. METHODS AND RESULTS: The restoration of plasma NO level was achieved by a sticking small cotton pad (10×25 mm containing 0.28 mmol sodium nitroprusside (SNP in 0.9% NaCl to the abdominal skin of the participants using non-toxic adhesive tape which was reported to normalize the plasma NO level. The participants (8,283 were volunteers in an independent study who had different kinds of cancers and did not wish to use any conventional therapy for their condition but opted to receive SNP "pad" for their condition for 3 years. The use of SNP "pad" which normalized (≈4.0 µM the plasma NO level that in consequence reduced the death rate due to AMI, among the participants, was found to be significantly reduced compared to the death due to AMI in normal population. CONCLUSION: Our data suggested that the use of SNP "pad" significantly reduced the death due to AMI. TRIAL REGISTRATION: www.ctri.nic.in CTRI/2013/12/004236.

  13. Right Hydronephrosis as a Complication of Acute Appendicitis

    Okur, Selahattin Koray; Koca, Yavuz Savaş; Yıldız, İhsan; Barut, İbrahim

    2016-01-01

    Introduction. Acute appendicitis is the most common cause of acute abdomen, but atypical appendicitis may lead to delayed diagnosis and related complications. In this report, we present a very rare case of acute appendicitis causing right hydronephrosis. Case Report. A 54-year-old male patient who had been receiving antibiotic therapy due to the diagnosis of urinary tract infection for the last one week but had no clinical improvement was admitted to the emergency service. Abdominal computed tomography (CT) showed right hydronephrosis and a pelvic abscess. After appendectomy and abscess drainage had been performed, hydronephrosis was completely recovered. Discussion. The use of appendicitis scoring systems, abdominal ultrasonography (USG), abdominal CT, and diagnostic laparoscopy can be useful for the diagnostic process in patients presenting with acute abdomen. In our patient, we considered that the surgical treatment was delayed since the symptoms of acute appendicitis were suppressed by the antibiotic therapy that was being administered due to the complaints including symptoms of urinary tract infections. Conclusion. Atypical appendicitis may cause a delay in the diagnosis of acute appendicitis and thus may lead to serious complications such as right hydronephrosis, prolonged hospital stay, increased morbidity and mortality, and increased antibiotic resistance. PMID:27069699

  14. Right Hydronephrosis as a Complication of Acute Appendicitis.

    Okur, Selahattin Koray; Koca, Yavuz Savaş; Yıldız, İhsan; Barut, İbrahim

    2016-01-01

    Introduction. Acute appendicitis is the most common cause of acute abdomen, but atypical appendicitis may lead to delayed diagnosis and related complications. In this report, we present a very rare case of acute appendicitis causing right hydronephrosis. Case Report. A 54-year-old male patient who had been receiving antibiotic therapy due to the diagnosis of urinary tract infection for the last one week but had no clinical improvement was admitted to the emergency service. Abdominal computed tomography (CT) showed right hydronephrosis and a pelvic abscess. After appendectomy and abscess drainage had been performed, hydronephrosis was completely recovered. Discussion. The use of appendicitis scoring systems, abdominal ultrasonography (USG), abdominal CT, and diagnostic laparoscopy can be useful for the diagnostic process in patients presenting with acute abdomen. In our patient, we considered that the surgical treatment was delayed since the symptoms of acute appendicitis were suppressed by the antibiotic therapy that was being administered due to the complaints including symptoms of urinary tract infections. Conclusion. Atypical appendicitis may cause a delay in the diagnosis of acute appendicitis and thus may lead to serious complications such as right hydronephrosis, prolonged hospital stay, increased morbidity and mortality, and increased antibiotic resistance. PMID:27069699

  15. Multidetector computed tomography angiography of the abdomen

    Multidetector computed tomography (MDCT) angiography has provided excellent opportunities for advancement of computed tomography (CT) technology and clinical applications. It has a wide range of applications in the abdomen including vascular pathologies either occlusive or aneurysmal; enables the radiologist to produce vascular mapping that clearly show tumor invasion of vasculature and the relationship of vessels to mass lesions. MDCTA can be used in preoperative planning for hepatic resection, preoperative evaluation and planning for liver transplantation. MDCTA can also provide extremely valuable information in the evaluation of ischemic bowel disease, active Crohn disease, the extent and location of collateral vessels in cirrhosis

  16. [A case of acute chronic respiratory failure due to fat embolism syndrome after the left femoral neck fracture].

    Oda, Keishi; Kawanami, Toshinori; Yatera, Kazuhiro; Ogoshi, Takaaki; Kozaki, Minako; Nagata, Shuya; Nishida, Chinatsu; Yamasaki, Kei; Ishimoto, Hiroshi; Mukae, Hiroshi

    2011-09-01

    A 78 year old Japanese woman was transferred to our hospital for the treatment of a fracture of the left femoral neck in April, 2010. She had been taking oral corticosteroid (prednisolone 5 mg/day) for the treatment of idiopathic interstitial pneumonia since 2003, and had been treated by home oxygen therapy since 2007. She fell in the restroom at home and hurt herself, and was transferred to our hospital for treatment of a left femoral neck fracture in April, 2010. Her respiratory status was stable just after the transfer; however, she was transferred to the intensive care unit and started to receive mechanical ventilation due to rapidly progressive respiratory failure on the fourth day after admission. Chest X-ray and computed tomography revealed rapid progression of bilateral ground-glass attenuations, and acute exacerbation of interstitial pneumonia was clinically suspected. However, the elevation of D-dimer over time and characteristic findings of petechial hemorrhagic lesions on her palpebral conjunctivae and neck with microscopic findings of phagocytized lipid in alveolar macrophages in her endobronchial secretion led to the diagnosis of fat embolism syndrome. She was successfully treated with high-dose corticosteroid and sivelestat sodium, and she was discharged on the 21st day after admission. Although a differential diagnosis of acute exacerbation of interstitial pneumonia and fat embolism syndrome was necessary and difficult in the present case, characteristic findings of petechial hemorrhagic lesions of skin, palpebral conjunctiva and lipid-laden alveolar macrophages in endotracheal aspirate were useful for the accurate and prompt diagnosis of fat embolism syndrome. PMID:21913383

  17. CLINICAL STUDY OF SIGMOID VOLVULUS IN ACUTE INTESTINAL OBSTRUCTION CASES : 3 YEARS E XPERIENCE

    Rambabu

    2015-09-01

    Full Text Available Sigmoid volvulus is abnormal rotation of sigmoid colon along it’s mesenteric axis which may results in effects ranging from partial to complete obstruction of bowel to vascular compromise, culminating in gangrene of bowel. Sigmoid volvulus is responsible for about 4 - 24% of all acute intestinal obstruction. Retrospectiv ely for last 3 years all cases of acute intestinal obstruction admitted to surgery were reviewed and study of sigmoid volvulus cases done. We analysed 247 cases of acute intestinal obstruction retrospectively over a period of 3 years . 50 cases are due to s igmoid volvulus. Most of cases are around 41 - 60 years. Most of cases present with pain abdomen , abdominal distention , constipation. Diagnosis is made by plain x - ray abdomen. Most cases treated with Derotation , resection and anastomosis. Out of 50 cases 6 d eaths occurred.

  18. The high incidence of acute hemolysis due to favism in Ahvaz, Iran-clinical features and laboratory findings

    Seyyed Mohammad Hasan Aletayeb; Bashir Chomeili; Mehri Taheri; Tahereh Ziaei Kajbaf; Mehran Hakimzadeh; Majid Aminzadeh; Morteza Shojaei Moghadam; Susan Maleki

    2010-01-01

    Objective:To collect comprehensive information about the features of favic patients in Ahvaz (Capital of Khouzestan, Iran) and analyze the extent of the differences with their corresponding in other regions. Methods:A total of 103 patients with acute hemolysis admitted to pediatric division of Abouzar Hospital located in the city of Ahvaz, Iran during 21st of June 2008 to 20th of June 2009 were analyzed retrospectively. Results:95.14%of the patients had favism while 4.86%of them underwent hemolysis due to other reasons. These patients were male (68.93%) and female children (31.06%) admitted mostly during the spring season. The three main symptoms were urine discoloration, jaundice and vomiting. At the admission time, the main hematologic findings were as follows:G6PD sufficient status (45.63%), G6PD deficient status (54.36%) and hemoglobin concentration:2.5-11.8 (mean±SD:6.45±2.12) g/dL. Conclusions:In conclusion, Ahvaz was determined as a black zone for favism in which the disease can be considered a life threatening health problem. Moreover, slight differences were observed in the three main symptoms compared with favic patients in other regions.

  19. Treatment of Cough and Dyspnea due to Acute Bronchitis by Plaster for Cough and Dyspnea-A Report of 735 Cases

    陈振甫; 周文秀; 高举先; 孙江桥

    2002-01-01

    @@ In the light of the theory of treating the internal disease externally, an externally used plaster for treating cough and dyspnea due to acute bronchitis (Ke Chuan Yi Tie Kang 咳喘一贴康) was successfully applied to 735 cases of acute bronchitis (the treatment group), with the other 423 cases treated with routine western drugs as controls. The results showed that the cure rate in the treatment group was significantly higher than that in the control group (P<0.01); and that in the treatment group, the cure rate for the wind-cold type of acute bronchitis was significantly higher than that for the wind-heat type of acute bronchitis (P<0.01).

  20. Gastrointestinal stromal tumor: acute liquefaction necrosis

    Stromal tumors, together with leiomyomas and schwannomas, constitute the sol-called mesenchymal tumors of the intestinal wall. Stromal tumors are histologically differentiated from other mesenchymal tumors in that they are derived from the interstitial cell of Cajal. These tumors can be encountered at any point throughout the entire digestive tract, by usually develop in stomach or small bowel. the clinical presentation in anemia secondary to gastrointestinal bleeding. Acute abdomen due to perforation or necrosis is rare. We present a case of jejunal stromal tumors with massive liquefaction necrosis, a circumstance that resulted in the peculiar radiological features observed. (Author) 9 refs,

  1. Accidental foreign bodies in pediatric abdomens: A pictorial essay

    Foreign bodies in pediatric abdomens are caused by accidental ingestion or trauma. The purpose of this article is to review the various findings of accidental foreign bodies in pediatric abdomens. Abdominal radiography, fluoroscopic examination, gastrointestinal contrast studies and CT may be useful in evaluating the location and type of foreign body, and for evaluating complications such as bowel perforation and obstruction

  2. Accidental foreign bodies in pediatric abdomens: A pictorial essay

    Park, Chan Ho; Kim, Young Tong [Soonchunhyang Univ. Cheonan Hospital/Soonchunhyang Univ. College of Medicine, Cheonan (Korea, Republic of)

    2012-08-15

    Foreign bodies in pediatric abdomens are caused by accidental ingestion or trauma. The purpose of this article is to review the various findings of accidental foreign bodies in pediatric abdomens. Abdominal radiography, fluoroscopic examination, gastrointestinal contrast studies and CT may be useful in evaluating the location and type of foreign body, and for evaluating complications such as bowel perforation and obstruction.

  3. Non-invasive mechanical ventilation in acute respiratory failure due to chronic obstructive pulmonary disease: correlates for success.

    Ambrosino, N; Foglio, K; Rubini, F.; Clini, E.; Nava, S.; M. Vitacca

    1995-01-01

    BACKGROUND--Non-invasive mechanical ventilation is increasingly used in the treatment of acute respiratory failure in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to identify simple parameters to predict the success of this technique. METHODS--Fifty nine episodes of acute respiratory failure in 47 patients with COPD treated with non-invasive mechanical ventilation were analysed, considering each one as successful (78%) or unsuccessful (22%) according t...

  4. Does dragonfly's abdomen flexion help with fast turning maneuvers?

    Liu, Geng; Li, Chengyu; Dong, Haibo; Flow Simulation Research Group Team

    2013-11-01

    Dragonflies are able to achieve fast turning maneuvers during take-off flights. Both asymmetric wing flapping and abdomen flexion have been observed during the fast turning. It's widely thought that the asymmetric wing beats are responsible of producing the aerodynamic moment needed for the body rotation. However, the dynamic effect of the abdomen flexion is not clear yet. In this study, an integrated experimental and computational approach is used to study the underlying dynamic effect of dragonfly abdomen flexion. It's found that dragonfly abdomen tended to bend towards the same side as the body reorienting to. Quantitative analysis have shown that during take-off turning maneuver the abdomen flexion can modulate the arm of force by changing the position of the center of mass relative to the thorax. As a result, roll and yaw moments produced by the wing flapping can be enhanced. This work is supported by NSF CBET-1313217. This work is supported by NSF CBET-1313217.

  5. Abdominal Wall Abscess due to Acute Perforated Sigmoid Diverticulitis: A Case Report with MDCT and US Findings

    Rafailidis Vasileios

    2013-01-01

    Full Text Available Perforation of the inflamed diverticula is a common diverticulitis complication. It usually leads to the formation of a local abscess. In some rare cases, the inflammatory process may spread towards extra-abdominal sites like the anterior or posterior abdominal wall or the thigh and form an abscess in these sites. We present the case of a 73-year-old man with a history of pain at the lower left quadrant of the abdomen for 20 days and a visible mass in this site. Ultrasonography and computed tomography revealed this mass to be an abscess of the abdominal wall which had been formed by the spread of ruptured sigmoid diverticulitis by continuity of tissue through the lower left abdominal wall. Local drainage of the abscess was performed and the patient was discharged after alleviation of symptoms and an uneventful course. We also discuss causes of abdominal wall abscesses along with the possible pathways by which an intra-abdominal abscess could spread outside the abdominal cavity.

  6. Disseminated fusariosis and endogenous fungal endophthalmitis in acute lymphoblastic leukemia following platelet transfusion possibly due to transfusion-related immunomodulation

    Yong Ku

    2011-11-01

    Full Text Available Abstract Background To report a case of disseminated fusariosis with endogenous endophthalmitis in a patient with acute lymphoblastic leukemia. Transfusion-associated immune modulation secondary to platelet transfusion could play an important role in the pathophysiology of this case. Case Presentation A 9 year-old male with acute lymphoblastic leukemia complicated by pancytopenia and disseminated Intravascular coagulation was given platelet transfusion. He developed disseminated fusariosis and was referred to the ophthalmology team for right endogenous endophthalmitis. The infection was controlled with aggressive systemic and intravitreal antifungals. Conclusion Patients with acute lymphoblastic leukemia are predisposed to endogenous fungal endophthalmitis. Transfusion-associated immune modulation may further increase host susceptibility to such opportunistic infections.

  7. Obstructive Jaundice Due to a Pancreatic Mass: A Rare Presentation of Acute Lymphoblastic Leukaemia in an Adult

    Sudin Varghese Daniel

    2010-01-01

    Full Text Available Context To highlight a rare presentation of acute lymphoblastic leukaemia. Case report A 39-year-old man presented with a 4 month history of weight loss and a 6 week history of upper abdominal pain radiating to the back with nausea and vomiting. Liver function tests showed an obstructive picture, full blood count was normal and on computerised tomography there was diffuse enlargement of the pancreas, with dilatation of the common bile duct and intra hepatic biliary radicles. Four weeks after presenting, the white cell count became elevated with blasts on the blood film and bone marrow biopsy revealed a precursor B cell acute lymphoblastic leukaemia. After induction chemotherapy his jaundice resolved, the pancreatic mass reduced in size and he is now in a complete remission. Conclusion Acute lymphoblastic leukaemia may mimic common causes of a pancreatic mass such as adenocarcinoma and should be considered as part of the differential diagnosis when atypical features are present.

  8. Simultaneous acute appendicitis and ectopic pregnancy

    Ankouz Amal; Ousadden Abdelmalek; Majdoub Karim; Chouaib Ali; Maazaz Khalid; Taleb Khalid

    2009-01-01

    The acute abdomen in pregnancy is a surgical emergency. Ectopic pregnancy and appendicitis are two causes of acute abdomen in pregnancy. Difficulties in correctly identifying the cause of the pain can be hazardous to the patient and care needs to be taken in obtaining a prompt and accurate diagnosis enabling the most appropriate management. The case presented here underlies the pathogenesis of the simultaneous existence of these two conditions in a patient.

  9. 盐酸丙帕他莫致急性肝损伤%Acute liver injury due to propacetamol hydrochloride

    杨思芸; 潘昭平; 胡玉兰; 柳华; 王龙飞; 胡晓燕

    2015-01-01

    1例45岁男性患者行左侧颌面部和颈部肿物切除术,术前丙氨酸转氨酶( ALT)19 U/L,天冬氨酸转氨酶(AST)32 U/L,γ-谷氨酰转移酶(GGT)146 U/L。术后给予盐酸丙帕他莫2.0 g入0.9%氯化钠注射液100 ml静脉滴注,1次/12 h。术后第8天复查肝功能示ALT 642 U/L,AST 692 U/L, GGT 368 U/L。患者无恶心、呕吐、腹胀、纳差等不适症状,皮肤、巩膜无黄染,肝区无压痛。考虑为盐酸丙帕他莫所致急性肝损伤。当日停用盐酸丙帕他莫,给予多烯磷脂酰胆碱、还原型谷胱甘肽、N-乙酰半胱氨酸等保肝治疗。停用盐酸丙帕他莫第8天,ALT 87 U/L,AST 341 U/L,GGT 354 U/L;第18天,ALT 84 U/L,AST 36 U/L,GGT 276 U/L;第32天,ALT 24 U/L,AST 17 U/L,GGT 36 U/L。%A 45-year-old male received a lump resection on left maxillofacial and cervical region. Before treatment,the laboratory test results were as follows:alanine aminotransferase( ALT)19 U/L, aspartate aminotransferase( AST)32 U/L,gamma glutamyltransferase( GGT)146 U/L. He was given an intravenous infusion of propacetamol hydrochloride 2. 0 g in 0. 9% sodium chloride 100 ml twice daily. The laboratory tests were as follows:alanine aminotransferase 642 U/L,aspartate aminotransferase 692 U/L, gamma glutamyltransferase 368 U/L on day 8 after operation. The patient had no symptoms of nausea, vomiting,abdominal distention,and poor appetite. There was no tenderness in his hepatic zones. He was considered as acute liver injury due to propacetamol hydrochloride. Propacetamol hydrochloride was discontinued immediately and liver-protective drugs such as polyene phosphatidylcholine, reduced glutathione,and N-acetyl cysteine were given. On day 8 of drug withdrawal,the results of laboratory tests were as follows:ALT 87 U/L,AST 341 U/L,GGT 354 U/L. On day 32 of drug withdrawal,the laboratory tests results were as follows:ALT 24 U/L,AST 17 U/L,GGT 36 U/L.

  10. Production of DNA Double Strand Breaks in Human Cells due to Acute Exposure to Tritiated Water (HTO)

    The average and maximum energies of the beta emission from 3H are 5.69 keV and 18.6 keV respectively. The average range in water (or soft tissues), around 0.5 1/4m (500 nm), is considerably less than the typical diameter of a cell (10-30 1/4m), and even of a cell nucleus (5-10 1/4m), thus the micro-location of the tritium atom may well be crucial in determining its biochemical consequences. Due to the high ionization density of the beta particles emitted by tritium (about 400 ion pairs/1/4m) possible interaction of tritium beta radiation with DNA may play a significant role. Tritiated water (HTO) is the main chemical form in which tritium is found in the environment. In the body it may be retained as organically bound tritium (OBT), binding to biological molecules or remaining as OBT with various degrees of solubility. OBT can be retained in the human body much longer than HTO and therefore the dose arising from OBT can reach 50% of the total tritium dose . Histones are major protein components of chromatin. They function as spools around which DNA winds and play an important role in the regulation of gene expression. In the absence of histones, the DNA in chromosomes would be unmanageably long, as human cells each have about 1.8 m of DNA. During mitosis, DNA is duplicated and condensed, resulting in about 120 1/4m of chromosomes. It was recently reported that the phosphorylation of histone H2AX on serine residue 139 (D3-H2AX) is associated with Double Strand Breaks (DSB) sites in DNA), which indicates the possibility of research based on the detection of DSBs in DNA. The phosphorylated megabase chromatin domain surrounding the DSB can be immunostained and visualized as discrete foci by fluorescence microscopy, as each DNA DSB formed produces a visible D3-H2AX focus. Since 1 Gy of radiation produces approximately 60 DSBs/cell, doses of a few mGy should be distinguishable from the background, and it was recently shown that the exposure to 1 mGy of X-rays induces a

  11. Acute Effects of Outdoor Air Pollution on Emergency Department Visits Due to Five Clinical Subtypes of Coronary Heart Diseases in Shanghai, China

    Xie, Juan; He, Mingzhen; Zhu, Weiying

    2014-01-01

    Background Air pollution can be a contributing cause to the development and exacerbation of coronary heart disease (CHD), but there is little knowledge about the acute effects of air pollution on different clinical subtypes of CHD. Methods We conducted a time-series study to investigate the association of air pollution (particulate matter with an aerodynamic diameter < 10 µm [PM10], sulfur dioxide [SO2], and nitrogen dioxide [NO2]) on emergency department (ED) visits due to five different sub...

  12. Norovirus infections in children under 5 years of age hospitalized due to the acute viral gastroenteritis in northeastern Poland

    Oldak, E.; Sulik, A.; Rozkiewicz, D.; Liwoch-Nienartowicz, N.

    2011-01-01

    The primary aim of this study was to evaluate the frequency and seasonality of norovirus infection in hospitalized Polish children under 5 years of age, and a secondary aim was to compare the clinical severity of norovirus and rotavirus disease. The prospective surveillance study was carried out from July 2009 through June 2010. Stool samples from 242 children hospitalized due to acute viral gastroenteritis were tested for rotavirus group A and adenovirus with commercial immunochromatographic...

  13. Posttraumatic stress due to an acute coronary syndrome increases risk of 42-month major adverse cardiac events and all-cause mortality

    Edmondson, Donald; Rieckmann, Nina; Shaffer, Jonathan A.; Joseph E Schwartz; Burg, Matthew M.; Davidson, Karina W.; Clemow, Lynn; Shimbo, Daichi; Kronish, Ian M.

    2011-01-01

    Approximately 15% of patients with acute coronary syndromes (ACS) develop posttraumatic stress disorder (PTSD) due to their ACS event. We assessed whether ACS-induced PTSD symptoms increase risk for major adverse cardiac events (MACE) and all-cause mortality (ACM) in an observational cohort study of 247 patients (aged 25–93 years; 45% women) hospitalized for an ACS at one of 3 academic medical centers in New York and Connecticut between November 2003 and June 2005. Within 1 week of admission,...

  14. Hemolytic anemia due to acute cytomegalovirus infection in an immunocompetent adult: a case report and review of the literature

    Noto Pasquale

    2010-10-01

    Full Text Available Abstract Introduction Cytomegalovirus is a common virus responsible for a wide range of clinical manifestations. Hemolysis is a rare but potentially life-threatening complication of cytomegalovirus infection, described mostly in immunocompromised patients, the pathogenesis of which is still unclear. We performed a review of the literature regarding cases of hemolytic anemia during acute cytomegalovirus infection in apparently immunocompetent individuals. We searched for relevant articles in PubMed for the period of 1980 through 2008. Case presentation We describe a case of Coombs-negative hemolytic anemia in a 44-year-old Caucasian immunocompetent man with acute cytomegalovirus infection. Conclusion Clinicians should consider cytomegalovirus infection in the differential diagnosis of hemolytic anemia in immunocompetent adults. Possible therapeutic options include antiviral therapy and steroids, although the best treatment strategy is still controversial.

  15. [Investigation of vectors and reservoirs in an acute Chagas outbreak due to possible oral transmission in Aguachica, Cesar, Colombia].

    Soto, Hugo; Tibaduiza, Tania; Montilla, Marleny; Triana, Omar; Suárez, Diana Carolina; Torres Torres, Mariela; Arias, María Teresa; Lugo, Ligia

    2014-04-01

    Colombia recorded 11 cases of acute Chagas disease and 80 cases of oral contamination with Trypanosoma cruzi. The current study analyzes the entomological and parasitological characteristics of the outbreak in Aguachica, Cesar Department, in 2010. An interdisciplinary group of health professionals and regional university personnel conducted the laboratory tests in the patients and the investigation of the transmission focus. Eleven cases of acute Chagas diseases were detected in a single family in a dwelling with domiciliated triatomines and Rhodnius pallescens, Pantrongylus geniculatus, Eratyrus cuspidatus, and two Didelphis marsupialis opossums infected with T. cruzi in Attalea butyracea and Elaeis oleifera palm trees in the urban area of Aguachica. The study analyzes the role of R. pallescens and palm trees in the wild cycle of T. cruzi and in oral transmission of Chagas disease. Sporadic incursions by wild R. pallescens, P. geniculatus, and E. cuspidatus from the nearby palm trees into human dwellings may cause increasingly frequent outbreaks of oral Chagas disease. PMID:24896050

  16. Acute Kidney Injury due to Menstruation-related Disseminated Intravascular Coagulation in an Adenomyosis Patient: A Case Report

    Son, Jungmin; Lee, Dong Won; Seong, Eun Young; Song, Sang Heon; Lee, Soo Bong; Kang, Jin; Yang, Byeong Yun; Lee, Su Jin; Choi, Jong-Ryeol; Lee, Kyu-Sup; Kwak, Ihm Soo

    2010-01-01

    The authors report a case of acute kidney injury (AKI) resulting from menstruation-related disseminated intravascular coagulation (DIC) in an adenomyosis patient. A 40-yr-old woman who had received gonadotropin for ovulation induction therapy presented with anuria and an elevated serum creatinine level. Her medical history showed primary infertility with diffuse adenomyosis. On admission, her pregnancy test was negative and her menstrual cycle had started 1 day previously. Laboratory data wer...

  17. Biochemical indices of blood serum of cows with acute radiation sickness due to nuclear fission products. [/sup 235/U

    Yakovleva, V.P.; Burov, N.I

    1977-01-01

    Fission products of /sup 235/U were given to cows daily for 4 days. The animals developed the intestinal form of acute radiation sickness and did not survive longer than 20 days. Blood samples were taken at intervals and determinations were made on activity of transaminases and alkaline phosphatase, serum carbohydrates, cholesterol, lecithin, total lipids, K, Na, and Fe. Results showed an increase in enzyme activity, increase in carbohydrate levels, decrease in lipids and electrolytes, and weight loss. (HLW)

  18. Independent lung ventilation in a newborn with asymmetric acute lung injury due to respiratory syncytial virus: a case report

    Di Nardo Matteo; Perrotta Daniela; Stoppa Francesca; Cecchetti Corrado; Marano Marco; Pirozzi Nicola

    2008-01-01

    Abstract Introduction Independent lung ventilation is a form of protective ventilation strategy used in adult asymmetric acute lung injury, where the application of conventional mechanical ventilation can produce ventilator-induced lung injury and ventilation-perfusion mismatch. Only a few experiences have been published on the use of independent lung ventilation in newborn patients. Case presentation We present a case of independent lung ventilation in a 16-day-old infant of 3.5 kg body weig...

  19. Obstructive Jaundice Due to a Pancreatic Mass: A Rare Presentation of Acute Lymphoblastic Leukaemia in an Adult

    Sudin Varghese Daniel; Andrew Melvin Smith; Quentin Antony Hill; Krishna Viswanath Menon; Deven Harshad Vani

    2010-01-01

    Context To highlight a rare presentation of acute lymphoblastic leukaemia. Case report A 39-year-old man presented with a 4 month history of weight loss and a 6 week history of upper abdominal pain radiating to the back with nausea and vomiting. Liver function tests showed an obstructive picture, full blood count was normal and on computerised tomography there was diffuse enlargement of the pancreas, with dilatation of the common bile duct and intra hepatic biliary radicles. Four weeks after ...

  20. Clinical analysis of patients with acute radiation syndrome due to total body irradiation or total lymphatic irradiation

    Objective: To study the severity of iatrogenic acute radiation syndrome, treatment, hematopoietic recovery and related complications in patients subjected to total body irradiation (TBI) or total lymphatic irradiation (TLI) prior to hematopoietic stem cell transplantation. Methods: 100 tumor patients (91 with leukemia and 9 with other tumors), after receiving 500∼1000 cGy (in an average of 738.6 cGy) of TBI or TLI with super high dose chemotherapy as conditioning regimen during the process of hemopoietic stem cell transplantation, developed severe or even extremely severe, mainly bone marrow form acute radiation syndrome. Results: The patients' white blood cell count once dropped to (0∼0.15) x 109/L, platelet count fell to (1∼17) x 109/L, bone marrow was depleted with only a few non-hemopoietic cells and rare hemopoietic cells, and a high risk of complicating with infection and hemorrhage was observed. Treated with a variety of measures including protective isolation, supportive care, administration of growth factors such as GM-CSF or G-CSF, blood component transfusion and effective antibiotics, 92 cases restored their normal hemopoiesis, while 8 cases died of infection or hemorrhage. The clinical course of these patients indicated that a majority of the patients with severe and extremely severe, iatrogenic acute radiation syndrome involving bone marrow could restore their normal hemopoiesis, and hemopoietic stem cell transplantation played an important role in the treatment. Conclusion: Hemopoietic stem cell transplantation and administration of growth factors are very useful for the treatment of acute radiation syndrome

  1. Brachial Plexopathy due to Myeloid Sarcoma in a Patient With Acute Myeloid Leukemia After Allogenic Peripheral Blood Stem Cell Transplantation

    Ha, Yumi; Sung, Duk Hyun; Park, Yoonhong; Kim, Du Hwan

    2013-01-01

    Myeloid sarcoma is a solid, extramedullary tumor comprising of immature myeloid cells. It may occur in any organ; however, the invasion of peripheral nervous system is rare. Herein, we report the case of myeloid sarcoma on the brachial plexus. A 37-year-old woman with acute myelogenous leukemia achieved complete remission after chemotherapy. One year later, she presented right shoulder pain, progressive weakness in the right upper extremity and hypesthesia. Based on magnetic resonance images ...

  2. Morbidity due to acute lower respiratory infection in children with birth defects: a total population-based linked data study

    Jama-Alol, Khadra A; Moore, Hannah C.; Jacoby, Peter; Bower, Carol; Lehmann, Deborah

    2014-01-01

    Background Acute lower respiratory infections (ALRIs) are leading causes of hospitalisation in children. Birth defects occur in 5% of live births in Western Australia (WA). The association between birth defects and ALRI hospitalisation is unknown. Methods We conducted a retrospective cohort study of 245,249 singleton births in WA (1996-2005). Population-based hospitalisation data were linked to the WA Register of Developmental Anomalies to investigate ALRI hospitalisations in children with an...

  3. Psoriasis May Raise Risk for Aneurysms in Abdomen

    ... nlm.nih.gov/medlineplus/news/fullstory_158314.html Psoriasis May Raise Risk for Aneurysms in Abdomen: Study ... 14, 2016 THURSDAY, April 14, 2016 (HealthDay News) -- Psoriasis patients may face a higher risk of an ...

  4. Acute abdominal pain in patients with lassa fever: Radiological assessment and diagnostic challenges

    Kenneth C Eze

    2014-01-01

    Full Text Available Background: To highlight the problems of diagnosis and management of acute abdomen in patients with lassa fever. And to also highlight the need for high index of suspicion of lassa fever in patients presenting with acute abdominal pain in order to avoid surgical intervention with unfavourable prognosis and nosocomial transmission of infections, especially in Lassa fever-endemic regions. Materials and Methods: A review of experiences of the authors in the management of lassa fever over a 4-year period (2004-2008. Literature on lassa fever, available in the internet and other local sources, was studied in November 2010 and reviewed. Results: Normal plain chest radiographic picture can change rapidly due to pulmonary oedema, pulmonary haemorrhage and acute respiratory distress syndrome. Plain abdominal radiograph may show dilated bowels with signs of paralytic ileus or dynamic intestinal obstruction due to bowel wall haemorrhage or inflamed and enlarged Peyer′s patches. Ultrasound may show free intra-peritoneal fluid due to peritonitis and intra-peritoneal haemorrhage. Bleeding into the gall bladder wall may erroneously suggest infective cholecystitis. Pericardial effusion with or without pericarditis causing abdominal pain may be seen using echocardiography. High index of suspicion, antibody testing for lassa fever and viral isolation in a reference laboratory are critical for accurate diagnosis. Conclusion: Patients from lassa fever-endemic regions may present with features that suggest acute abdomen. Radiological studies may show findings that suggest acute abdomen but these should be interpreted in the light of the general clinical condition of the patient. It is necessary to know that acute abdominal pain and vomiting in lassa fever-endemic areas could be caused by lassa fever, which is a medical condition. Surgical option should be undertaken with restraint as it increases the morbidity, may worsen the prognosis and increase the risk of

  5. Acute abdominal pain in patients with lassa fever: Radiological assessment and diagnostic challenges

    Eze, Kenneth C.; Salami, Taofeek A.; Kpolugbo, James U.

    2014-01-01

    Background: To highlight the problems of diagnosis and management of acute abdomen in patients with lassa fever. And to also highlight the need for high index of suspicion of lassa fever in patients presenting with acute abdominal pain in order to avoid surgical intervention with unfavourable prognosis and nosocomial transmission of infections, especially in Lassa fever-endemic regions. Materials and Methods: A review of experiences of the authors in the management of lassa fever over a 4-year period (2004-2008). Literature on lassa fever, available in the internet and other local sources, was studied in November 2010 and reviewed. Results: Normal plain chest radiographic picture can change rapidly due to pulmonary oedema, pulmonary haemorrhage and acute respiratory distress syndrome. Plain abdominal radiograph may show dilated bowels with signs of paralytic ileus or dynamic intestinal obstruction due to bowel wall haemorrhage or inflamed and enlarged Peyer's patches. Ultrasound may show free intra-peritoneal fluid due to peritonitis and intra-peritoneal haemorrhage. Bleeding into the gall bladder wall may erroneously suggest infective cholecystitis. Pericardial effusion with or without pericarditis causing abdominal pain may be seen using echocardiography. High index of suspicion, antibody testing for lassa fever and viral isolation in a reference laboratory are critical for accurate diagnosis. Conclusion: Patients from lassa fever-endemic regions may present with features that suggest acute abdomen. Radiological studies may show findings that suggest acute abdomen but these should be interpreted in the light of the general clinical condition of the patient. It is necessary to know that acute abdominal pain and vomiting in lassa fever-endemic areas could be caused by lassa fever, which is a medical condition. Surgical option should be undertaken with restraint as it increases the morbidity, may worsen the prognosis and increase the risk of nosocomial transmission

  6. Parenteral nutrition including polyamine under experimental irradiation of the abdomen

    White rats-males were used in experiments. Irradiation dose of abdomen area is 13.5 Gy (1400 R). Parenteral nutrition using aminoacid preparation of polyamine affects favourably during radiation damage resulted from local irradiation of abdomen area. This was manifested in weakening of gastroenteric syndrom, reduction of 3.5 day death of animals and increase of their 30 day survival rate, intensification of recovery processes in small intestine, decrease of cell devastation in bone marrow

  7. Acute pancreatitis complicated with splenic rupture: A case report

    Hernani, Bruno L; Silva, Pedro C; Nishio, Ricardo T; Mateus, Henrique C; Assef, José C; De Campos, Tercio

    2015-01-01

    Atraumatic splenic rupture is an uncommon complication of acute pancreatitis. This report describes the case of a 30-year-old man with acute pancreatitis and splenic vein thrombosis complicated by splenic rupture. The patient was admitted to the emergency department with pain in the upper abdomen that had been present for six hours and was associated with vomiting and sweating. He was diagnosed with acute pancreatitis of alcoholic etiology. Upon computed tomography (CT) of the abdomen, the pa...

  8. Factors Associated with Death Due to 2009 Influenza A (H1N1) Virus Infection and Acute Respiratory Distress Syndrome in Beijing, 2009-2011

    Jin-qian; Zhang; Li-cheng; Zhang; Na; Ren; Ming; Zhang; Li-min; Guo; Xing-wang; Li; Jun; Cheng

    2012-01-01

    Objective Patients with H1N1 virus infection were hospitalized and quarantined, and some of them developed into acute respiratory failure, and were transfered to the medical intensive care unit of Beijing Ditan Hospital, Capital Medical University in Beijing, China. Methods The clinical features and preliminary epidemiologic findings among 30 patients with confirmed H1N1 virus infection who developed into acute respiratory failure for ventilatory support were investigated. Results A total of 30 patients(37.43 ± 18.80 years old) with 2009 influenza A(H1N1) related acute respiratory distress syndrome(ARDS) received treatment with mechanical ventilation, 15 cases of whom were male and 17 cases died of ARDS. Fatal cases were significantly associated with an APACHE Ⅱ score(P = 0.016), but not with PaO 2 /FIO 2(P = 0.912) and chest radiograph(P = 0.333). The most common complication was acute renal failure(n = 9). Five patients received extracorporeal membrane oxygenation(ECMO), 3 of whom died and the others survived. The major causes of death were multiple organ dysfunction syndrome(MODS)(39%), intractable respiratory failure(27%) and sepsis(20%). Conclusions Most patients with respiratory failure due to influenza A(H1N1) virus infection were young, with a high mortality, particularly associated with APACHE Ⅱ score, secondary infection of lung or type 2 diabetes mellitus.

  9. Perforation of the bowel due to cytomegalovirus infection in a man with AIDS: surgery is not always necessary!

    Yoganathan, Katie Tharshana; Morgan, Andrew Roger; Yoganathan, Kathir G

    2016-01-01

    Cytomegalovirus (CMV) infection is the most common viral opportunistic infection in immunocompromised patients and is a rare cause of bowel perforation. It invariably requires surgical intervention and is often fatal. We report a 50-year-old Caucasian man with AIDS, presented 3 weeks after developing abdominal pain and distension. He was treated for CMV retinitis in the past. His adherence to antiretroviral therapy was poor. Examination revealed a recurrence of active CMV retinitis. His abdomen was tender and distended. The plain X-ray of the abdomen revealed a double wall sign (Rigler's sign), indicating pneumoperitoneum due to the bowel perforation. The upper endoscopy was normal. His CD4 count was 30 cells/mm(3) He was treated with cidofovir infusion. He made a full recovery, without requiring any form of surgery. However, he died of adult respiratory distress syndrome 14 months later, due to iatrogenic acute pancreatitis. PMID:27440845

  10. Low cost continuous femoral nerve block for relief of acute severe cancer related pain due to pathological fracture femur

    Rachel Cherian Koshy

    2010-01-01

    Full Text Available Pathological fractures in cancer patient cause severe pain that is difficult to control pharmacologically. Even with good pain relief at rest, breakthrough and incident pain can be unmanageable. Continuous regional nerve blocks have a definite role in controlling such intractable pain. We describe two such cases where severe pain was adequately relieved in the acute phase. Continuous femoral nerve block was used as an efficient, cheap and safe method of pain relief for two of our patients with pathological fracture femur. This method was proved to be quite efficient in decreasing the fracture-related pain and improving the level of well being.

  11. Growth Inhibition and Apoptosis Due to Restoration of E2A Activity in T Cell Acute Lymphoblastic Leukemia Cells

    Park, Steven T.; Nolan, Garry P.; Sun, Xiao-Hong

    1999-01-01

    Two models have been proposed for the molecular mechanism by which the Tal1 oncogene causes T cell acute lymphoblastic leukemia (T-ALL). The activation model suggests that Tal1 as heterodimers with the E2A transcription factor activates the expression of oncogenes. The inhibition model postulates that Tal1 interferes with the tumor-suppressing function of E2A. In the Jurkat T cell line, originally derived from a patient with T-ALL, Tal1 is complexed with E2A proteins and the transcriptional a...

  12. Acute renal failure and arterial hypertension due to sub capsular hematoma: is percutaneous drainage a feasible treatment?

    Kobel, Marie Cæcilie; Nielsen, Tommy Kjærgaard; Graumann, Ole

    Percutaneous drainage proved to be successful in managing a renal subcapsular haematoma that was causing acute renal failure and hypertension in a 74-year-old woman. The patient presented with oliguria, nausea and malaise 2 days after a ureteronephroscopic procedure with biopsies of a suspected...... did not respond to antihypertensive treatment, Page kidney was suspected. A pigtail catheter was placed in the haematoma and, shortly after drainage, the diuresis resumed and plasma creatinine together with blood pressure decreased. This condition had previously been managed by open surgery, but...... recent case reports have described successful management by laparoscopy-assisted and radiology-assisted drainage, as described in this case report....

  13. Definitive identification of magnetite nanoparticles in the abdomen of the honeybee Apis mellifera

    Desoil, M.; Gillis, P.; Gossuin, Y.; Pankhurst, Q. A.; Hautot, D.

    2005-01-01

    The biogenic magnetic properties of the honeybee Apis mellifera were investigated with a view to understanding the bee's physiological response to magnetic fields. The magnetisations of bee abdomens on one hand, and heads and thoraxes on the other hand, were measured separately as functions of temperature and field. Both the antiferromagnetic responses of the ferrihydrite cores of the iron storage protein ferritin, and the ferrimagnetic responses of nanoscale magnetite (Fe3O4) particles, were observed. Relatively large magnetite particles (ca. 30 nm or more), capable of retaining a remanent magnetisation at room temperature, were found in the abdomens, but were absent in the heads and thoraxes. In both samples, more than 98% of the iron atoms were due to ferritin.

  14. Definitive identification of magnetite nanoparticles in the abdomen of the honeybee Apis mellifera

    The biogenic magnetic properties of the honeybee Apis mellifera were investigated with a view to understanding the bee's physiological response to magnetic fields. The magnetisations of bee abdomens on one hand, and heads and thoraxes on the other hand, were measured separately as functions of temperature and field. Both the antiferromagnetic responses of the ferrihydrite cores of the iron storage protein ferritin, and the ferrimagnetic responses of nanoscale magnetite (Fe3O4) particles, were observed. Relatively large magnetite particles (ca. 30 nm or more), capable of retaining a remanent magnetisation at room temperature, were found in the abdomens, but were absent in the heads and thoraxes. In both samples, more than 98% of the iron atoms were due to ferritin

  15. Definitive identification of magnetite nanoparticles in the abdomen of the honeybee Apis mellifera

    Desoil, M [Biological Physics Department, University of Mons-Hainaut (Belgium); Gillis, P [Biological Physics Department, University of Mons-Hainaut (Belgium); Gossuin, Y [Biological Physics Department, University of Mons-Hainaut (Belgium); Pankhurst, Q A [London Centre for Nanotechnology, University College London, London WC1E 7HN (United Kingdom); Hautot, D [London Centre for Nanotechnology, University College London, London WC1E 7HN (United Kingdom); Institute for Science and Technology in Medicine, Keele University, Thornburrow Drive, Hartshill, Stoke-en-Trent, ST4 7QB (United Kingdom)

    2005-01-01

    The biogenic magnetic properties of the honeybee Apis mellifera were investigated with a view to understanding the bee's physiological response to magnetic fields. The magnetisations of bee abdomens on one hand, and heads and thoraxes on the other hand, were measured separately as functions of temperature and field. Both the antiferromagnetic responses of the ferrihydrite cores of the iron storage protein ferritin, and the ferrimagnetic responses of nanoscale magnetite (Fe{sub 3}O{sub 4}) particles, were observed. Relatively large magnetite particles (ca. 30 nm or more), capable of retaining a remanent magnetisation at room temperature, were found in the abdomens, but were absent in the heads and thoraxes. In both samples, more than 98% of the iron atoms were due to ferritin.

  16. Urgent stenting for patients with acute stroke due to atherosclerotic occlusive lesions of the cervical internal carotid artery

    Acute symptomatic occlusion of the cervical internal carotid artery (ICA) can be treated by intravenous administration of tissue plasminogen activator, percutaneous transluminal angioplasty, and carotid endarterectomy. Carotid artery stenting (CAS) is now indicated for cervical ICA stenosis, but the safety and the efficacy of urgent CAS have not been established. We retrospectively reviewed 10 patients treated by urgent CAS for atherosclerotic occlusive lesions of cervical ICA with acute stroke. Five patients had complete occlusions and five had near total occlusions. Five of the 10 patients had intracranial tandem occlusions. Indication for urgent CAS was determined by mismatch of diffusion-weighted and perfusion-weighted magnetic resonance imaging findings. Stents were successfully deployed in all lesions. Three of five patients with concomitant intracranial tandem occlusions were treated by additional intraarterial fibrinolysis after the CAS. Intracranial artery occlusions were completely recanalized in one patient, and partially recanalized in two by fibrinolysis. Hyperperfusion syndrome did not occur in any of the patients. A favorable outcome (modified Rankin Scale ≤1) was obtained in all of the five patients with isolated cervical ICA occlusion and one of the five patients with intracranial tandem occlusions. Urgent CAS is a safe and effective treatment in patients with isolated cervical ICA occlusion. Treatment of intracranial tandem occlusions is an issue that must be resolved. (author)

  17. Whole-abdomen radiotherapy for non-Hodgkin's lymphoma using twice-daily fractionation

    Purpose: To report the tolerability and efficacy of twice-daily whole-abdomen irradiation (WAI) for non-Hodgkin's lymphoma (NHL). Methods and Materials: Of 123 patients treated for NHL with WAI, 37% received previous chemotherapy, 28% received WAI as part of comprehensive lymphatic irradiation (CLI), and 32% received WAI for palliation. The median dose to the whole abdomen was 25.0 Gy, followed by a median tumor boost of 9.8 Gy in 58 patients. Fractionation was 1.0 Gy once daily (54%) or 0.8 Gy twice daily (46%). Blood counts were measured weekly. Results: At a median follow-up of 4.3 years, local control was 72% and overall survival was 55% at 5 years. Median time of WAI was 42 days for once-daily treatment and 32 days for twice-daily treatment. Patients receiving twice-daily WAI did not have a significantly higher rate of acute side effects (e.g., nausea, diarrhea, platelet or red blood cell toxicity). Overall, acute thrombocytopenia was the most frequent side effect of treatment; 24 of 96 patients (25%) with available hematologic data had Grade 3+ toxicity. There was no acute Grade 3 gastrointestinal toxicity and no late small bowel obstruction. Multiple regression indicated that patients with four or less involved sites and disease size ≤6 cm had improved local control and overall survival. Conclusions: Twice-daily WAI using 0.8 Gy/fraction does not appear to have any greater toxicity compared with once-daily treatment using 1 Gy/fraction. Small doses per fraction (0.8-1 Gy/fx) are effective, tolerated well in the acute setting, and associated with a low rate of late toxicity

  18. Acute intermittent porphyria caused by novel mutation in HMBS gene, misdiagnosed as cholecystitis

    Alfadhel M

    2014-11-01

    Full Text Available Majid Alfadhel,1,3 Neam Saleh,2 Helal Alenazi,2 Henry Baffoe-Bonnie21Division of Genetics, Department of Pediatrics, 2Division of General Medicine, Department of Medicine, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia; 3College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi ArabiaBackground: Acute intermittent porphyria (AIP is an autosomal dominant neurovisceral inherited disorder due to a defect in the heme biosynthesis pathway. Misdiagnosis of the porphyrias is not uncommon.Case report: We present a case of a 26-year-old female with suspected acute cholecystitis, mental status changes, and seizures. Biochemical and molecular investigations confirmed the diagnosis of AIP by findings of elevated urinary porphobilinogen, 5-aminolevulinic acid, and total porphyrins. DNA molecular testing showed a novel heterozygous mutation (c. 760delC p.L254X in the exon11 of the HMBS gene. To the best of our knowledge, this is the first report of a misdiagnosis of AIP presenting with acute cholecystitis.Conclusion: Clinicians are alerted to consider the possibility of AIP in an adult presenting with an acute abdomen, features of cholecystitis, and neuropsychiatric manifestations.Keywords: porphyria, cholecystitis, acute abdomen, acute intermittent porphyria, HMBS gene, hydroxymethylbilane synthase

  19. An unusual case of acute kidney injury due to vancomycin lessons learnt from reliance on eGFR.

    Barraclough, Katherine; Harris, Marianne; Montessori, Val; Levin, Adeera

    2007-08-01

    We present a case of renal impairment in an emaciated HIV-infected male that initially went unrecognized because of reliance on serum creatinine and estimated glomerular filtration rate (eGFR). Inaccurate vancomycin dosing led to toxic drug levels (66 mg/l), associated with acute and severe worsening of kidney function. This occurred in the context of escalating doses of vancomycin given in the presence of changing kidney function, albeit kidney function that always remained well within the normal range (serum creatinine 29 - 42 mumol/l). In the absence of other plausible explanations, a presumptive diagnosis of vancomycin nephrotoxicity was made. Given the rarity of this diagnosis in the current era, we discuss the pathophysiology of vancomycin nephrotoxicity. We also explore the potential reasons for inaccuracy of GFR prediction equations in the HIV population, and discuss the potential pitfalls associated with application of eGFR or even serum creatinine without appropriate understanding of their limitations. We believe our case highlights a number of important teaching points: Vancomycin nephrotoxitiy is rare but can occur in the setting of kidney dysfunction. Current assessment of kidney function using creatinine and eGFR requires awareness of the clinical caveats in which these measures may be misleading. Acute changes in kidney function, irrespective of the test used, should be contextualized to the individual situation. Persons with HIV and low muscle mass constitute a specific subgroup in whom assessment of kidney function may be problematic using creatinine. We support ongoing efforts to develop or refine equations for specific unique and easily identifiable populations. PMID:17470454

  20. Acute Gastric Volvulus Secondary to Malrotation of Gut in a Child with Cerebral Palsy

    Kanchan Kayastha

    2011-08-01

    Full Text Available Acute gastric volvulus secondary to malrotation of gut is a rare surgical emergency. We report a case of an eight years old cerebral palsy (CP child who presented to us with sudden upper abdominal distension and non productive retching. X-ray abdomen revealed a huge gas shadow on left side of abdomen with paucity of distal gas shadows. On exploration organoaxial gastric volvulus with gastric ischemia, secondary to malrotation of gut, was found. Volvulus derotated and Ladd’s procedure was done. Gastropexy and fundoplication was not done due to gastric ischemia. Early diagnosis and surgical management can save the patient from fatal complications of gastric perforation due to gastric ischemia.

  1. Acute liver failure due to natural killer-like T-cell leukemia/lymphoma: A case report and review of the Literature

    Evan S Dellon; Shannon R Morris; Wozhan Tang; Cherie H Dunphy; Mark W Russo

    2006-01-01

    Acute liver failure (ALF) is a medical emergency requiring immediate evaluation for liver transplantation. We describe an unusual case of a patient who presented with ascites, jaundice, and encephalopathy and was found to have ALF due to natural killer (NK)-like T cell leukemia/lymphoma. The key immunophenotype was CD2+, CD3+, CD7+, CD56+. This diagnosis, which was based on findings in the peripheral blood and ascitic fluid, was confirmed with liver biopsy, and was a contraindication to liver transplantation. A review of the literature shows that hematologic malignancies are an uncommon cause of fulminant hepatic failure, and that NK-like T-cell leukemia/lymphoma is a relatively recently recognized entity which is characteristically CD3+ and CD56+. This case demonstrates that liver biopsy is essential in diagnosing unusual causes of acute liver failure, and that infiltration of the liver with NK-like T-cell lymphoma/leukemia can cause acute liver failure.

  2. Determination of behavioral reactions of a child of 3-6 ages group to be hospitalized due to an acute illness

    Zümrüt Başbakkal; Sibel Sönmez; Nesrin Şen Celasin; Figen Esenay

    2010-01-01

    The study is executed with mothers of children aged 3-6 (n=170) whose children were hospitalized for the first time between the dates of 15.07.2003 and 15.06.2006, who were reachable by phone and accepted to participate in the study aiming determination of behavioral reactions of a child of 3-6 ages group to be hospitalized due to an acute illness.In this study, for data gathering "Personal Information Form" including 15 questions and "Inquiry Form of Behavior Changes of  3-6 Ages Group Child...

  3. Dose estimation in CT exams of the abdomen based on values of DLP

    One of the challenges of multidetector computerized tomography is to minimize the risk of ionizing radiation using optimized protocols since higher doses are necessary to obtain high image quality. It was also noted that, due to the geometry in image acquisition using MDCT becomes necessary to estimate dose values consistent with the hypothesis clinically and with the specificities of the tomographic equipment. The aim of this study was to estimate the doses in abdomen exams from the data recorded on the MDCT console and dimensions obtained from DICOM images of patients undergoing different clinical protocols. Were collected, from the image DICOM of 101 exams, values of the dose length product (DLP) provided by Philips Health Care - Brilliance 64 equipment console, in order to relate them with the dose values obtained by means of thermoluminescent dosimeters ( TLD ) of CasSo4:Mn placed on the surface of a cylindrical simulator abdomen acrylic manufactured under the technical - operational conditions for a typical abdomen exam. From the data obtained, it was possible to find a factor of 1.16 ( 5 % ) indicating that the DLP values Brilliance 64 console underestimate the doses and this should be used with correction factor to estimate the total dose of the patient. (author)

  4. Blunt liver injury with intact ribs under impacts on the abdomen: a biomechanical investigation.

    Yu Shao

    Full Text Available Abdominal trauma accounts for nearly 20% of all severe traffic injuries and can often result from intentional physical violence, from which blunt liver injury is regarded as the most common result and is associated with a high mortality rate. Liver injury may be caused by a direct impact with a certain velocity and energy on the abdomen, which may result in a lacerated liver by penetration of fractured ribs. However, liver ruptures without rib cage fractures were found in autopsies in a series of cases. All the victims sustained punches on the abdomen by fist. Many studies have been dedicated to determining the mechanism underlying hepatic injury following abdominal trauma, but most have been empirical. The actual process and biomechanism of liver injury induced by blunt impact on the abdomen, especially with intact ribs remained, are still inexhaustive. In order to investigate this, finite element methods and numerical simulation technology were used. A finite element human torso model was developed from high resolution CT data. The model consists of geometrically-detailed liver and rib cage models and simplified models of soft tissues, thoracic and abdominal organs. Then, the torso model was used in simulations in which the right hypochondrium was punched by a fist from the frontal, lateral, and rear directions, and in each direction with several impact velocities. Overall, the results showed that liver rupture was primarily caused by a direct strike of the ribs induced by blunt impact to the abdomen. Among three impact directions, a lateral impact was most likely to cause liver injury with a minimum punch speed of 5 m/s (the momentum was about 2.447 kg.m/s. Liver injuries could occur in isolation and were not accompanied by rib fractures due to different material characteristics and injury tolerance.

  5. Anterior ST depression with acute transmural inferior infarction due to posterior infarction. A vectorcardiographic and scintigraphic study

    The hypothesis that anterior ST segment depression represents concomitant posterior infarction was tested in 49 patients admitted with a first transmural inferior myocardial infarction. Anterior ST depression was defined as 0.1 mV or more ST depression in leads V1, V2 or V3 on an electrocardiogram recorded within 18 hours of infarction. Serial vectorcardiograms and technetium pyrophosphate scans were obtained. Eighty percent of the patients (39 of 49) had anterior ST depression. Of these 39 patients, 34% fulfilled vectorcardiographic criteria for posterior infarction, and 60% had pyrophosphate scanning evidence of posterior infarction. Early anterior ST depression was neither highly sensitive (84%) nor specific (20%) for the detection of posterior infarction as defined by pyrophosphate imaging. Of patients with persistent anterior ST depression (greater than 72 hours), 87% had posterior infarction detected by pyrophosphate scan. In patients with inferior myocardial infarction, vectorcardiographic evidence of posterior infarction correlated poorly with pyrophosphate imaging data. Right ventricular infarction was present on pyrophosphate imaging in 40% of patients with pyrophosphate changes of posterior infarction but without vectorcardiographic evidence of posterior infarction. It is concluded that: 1) the majority of patients with acute inferior myocardial infarction have anterior ST segment depression; 2) early anterior ST segment depression in such patients is not a specific marker for posterior infarction; and 3) standard vectorcardiographic criteria for transmural posterior infarction may be inaccurate in patients with concomitant transmural inferior myocardial infarction or right ventricular infarction, or both

  6. Acute psychosis due to non-paraneoplastic anti-NMDA-receptor encephalitis in a teenage girl: Case report.

    Kramina, Sandra; Kevere, Laura; Bezborodovs, Nikita; Purvina, Santa; Rozentals, Guntis; Strautmanis, Jurgis; Viksna, Zane

    2015-12-01

    Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis is a disease occurring when antibodies produced by the body's own immune system attack NMDA-type glutamate receptors in the brain. Most anti-NMDAR encephalitis cases are associated with paraneoplastic syndrome. We analyze the case of a 15-year-old girl who was hospitalized in a child psychiatry clinic in Riga, Latvia, with de novo acute polymorphic psychotic disorder gradually progressing to a catatonic state. The patient received antipsychotic and electroconvulsive therapy with no beneficial effect. The council of doctors discussed differential diagnoses of schizophrenia-induced catatonia and the autoimmune limbic encephalitis-induced catatonic condition. When the diagnosis of anti-NMDAR autoimmune encephalitis was finally confirmed by repeated immunological assays (specific immunoglobulin [Ig] G and IgM in her blood serum and cerebrospinal fluid), and a paraneoplastic process was ruled out, she was started on immunomodulating therapy (methylprednisolone, Ig, plasmapheresis, rituximab), which changed the course of her disease. On immunomodulating treatment, her physical and mental health have gradually improved to almost complete reconvalescence. Psychiatrists should consider anti-NMDAR encephalitis as a differential diagnosis in first-episode psychosis patients presenting with disorientation, disturbed consciousness, pronounced cognitive deficits, movement disorder, dysautonomia, or rapid deterioration, and test for specific IgG NR1 autoantibodies, even if there are no specific findings on routine neuroimaging, electroencephalography (EEG), or cerebrospinal fluid tests. PMID:26663628

  7. The Comparison of Apotel plus Low Dose of Morphine and Full Dose of Morphine in Pain Relief in Patients with Acute Renal Colic

    Morteza-Bagi, Hamid Reza; Amjadi, Mohsen; Mirzaii-Sousefidi, Reyhaneh

    2015-01-01

    Background Renal colic is an acute flank pain which may radiate to the groin, lower abdomen, or external genitalia due to the passage of a urinary stones. Pain management is the most important task in emergency wards when a patient with renal colic attends. This study aims to compare intravenous acetaminophen plus a low dose of morphine with a full dose of morphine in renal colic. Methods In present randomized clinical trial, 100 patients with confirmed renal colic were recruited from the Eme...

  8. Imaging diagnosis of acute appendicitis

    The nontraumatic acute abdomen is one of the most common presentation to the emergency room, with appendicitis being one of the most common causes of the acute abdomen. Up to 30 % of patients suspected of having acute appendicitis will present with atypical signs and symptoms. There are many conditions that imitate acute appendicitis. The percentage of unnecessary appendectomies that result from a clinical false-positive diagnosis of appendicitis. The use of computed tomography (CT) before planned surgery has decreased the negative appendicectomy rate for patients with suspected acute appendicitis. Recognition of the typical and atypical CT signs of appendicitis is important to optimize the diagnosis yield of the examination. Visualization of an appendix with normal characteristics is the most important finding to exclude appendicitis. (author)

  9. PO02 - Clinical profile of children admitted to a paediatric intensive care unit due to acute clinical deterioration

    Jensen, Claus Sixtus; Aagaard, Hanne; Olesen, Hanne Vebert;

    2016-01-01

    Theme: Intensive care Background: There has been an increased number of critically ill patients admitted to paediatric departments. Only a few studies have described the various causes of unplanned admission to paediatric intensive care units (PICU) due to clinical deterioration. However, an...... critical ill children in paediatric wards....

  10. Diffusion-weighted magnetic resonance imaging of the abdomen; Diffusionsgewichtete Magnetresonanztomographie des Abdomens

    Schmid-Tannwald, C.; Reiser, M.F.; Zech, C.J. [Klinikum der Ludwig-Maximilians-Universitaet Muenchen, Campus Grosshadern, Institut fuer Klinische Radiologie, Muenchen (Germany)

    2011-03-15

    Diffusion-weighted magnetic resonance imaging (DW-MRI) provides qualitative and quantitative information of tissue cellularity and the integrity of cellular membranes. Since DW-MRI can be performed without ionizing radiation exposure and contrast media application, DW-MRI is a particularly attractive tool for patients with allergies for gadolinium-based contrast agents or renal failure. Recent technical developments have made DW-MRI a robust and feasible technique for abdominal imaging. DW-MRI provides information on the detection and characterization of focal liver lesions and can also visualize treatment effects and early changes in chronic liver disease. In addition DW-MRI is a promising tool for the detection of inflammatory changes in patients with Crohn's disease. (orig.) [German] Die diffusionsgewichtete (DW-)MRT ermoeglicht die Erfassung qualitativer und quantitativer Informationen bzgl. der Gewebezellularitaet und Membranintegritaet. Die DW-MRT ist insbesondere bei Patienten mit einer Allergie gegen gadoliniumhaltige Kontrastmittel oder eingeschraenkter Nierenfunktion attraktiv, da ihr Einsatz nicht mit Strahlenexposition oder Kontrastmittelgabe verbunden ist. Durch technische Weiterentwicklungen ist die robuste Anwendung der DW-MRI in der Bildgebung des Abdomens seit einiger Zeit moeglich geworden. In der Leberdiagnostik lassen sich Zusatzinformationen zur Detektion und Charakterisierung von Leberlaesionen gewinnen, aber auch Therapieerfolge dokumentieren und fruehe chronische Leberveraenderungen visualisieren. Neben ihrer Rolle bei hepatologischen und onkologischen Fragestellungen erscheint der Einsatz der DW-MRT zudem bei entzuendlichen Fragestellungen wie dem Morbus Crohn sehr viel versprechend. (orig.)

  11. 心肌桥引起急性心肌梗死一例报道%Acute Myocardial Infarction Due to Myocardial Bridge:One Case Report

    刘娟娟; 李慧; 彭明辉; 周敬; 傅士杰; 陈晓泓; 江孙芳

    2014-01-01

    A portion of the artery or artery tree runs under the superficial myocardial fibers for a short distance,and we define the myocardial fibers as " myocardial bridge",and we regard the coronary artery as " intramural coronary artery". The clinical performance of myocardial bridge are varied,and most of myocardial bridge are asymptomatic,and there are very few cases of acute myocardial infarction due to myocardial bridge. In this article,we reported a patient with acute myocardial infarc-tion due to myocardial bridge,in order to strengthen the understanding of the disease for physicians.%冠状动脉的某一段或其分支的某一段走行于室壁心肌纤维之间,该部分的心肌纤维束即为冠状动脉心肌桥,而这段冠状动脉则称为壁冠状动脉。心肌桥临床表现变异较大,多数无临床症状,而由其引起的急性心肌梗死更不多见。本文报道1例由孤立性心肌桥引起急性心肌梗死患者的临床特征及治疗过程,以使临床医师对该病的认识进一步加强。

  12. Clinical characteristics of acute lower respiratory tract infections due to 13 respiratory viruses detected by multiplex PCR in children

    Jeong-Sook Lim

    2010-03-01

    Full Text Available Purpose : This study was performed to investigate the epidemiologic and clinical features of 13 respiratory viruses in children with acute lower respiratory tract infections (ALRIs. Methods : Nasopharyngeal aspirates were prospectively obtained from 325 children aged 15 years or less from May 2008 to April 2009 and were tested for the presence of 13 respiratory viruses by multiplex real-time-polymerase chain reaction (RT-PCR. Results : Viruses were identified in 270 children (83.1%. Co-infections with ?#242; viruses were observed in 71 patients (26.3 %. Respiratory syncytial virus (RSV was the most common virus detected (33.2%, followed by human rhinovirus (hRV (19.1%, influenza virus (Flu A (16.9%, human metapneumovirus (hMPV (15.4%, parainfluenza viruses (PIVs (8.3%, human bocavirus (hBoV (8.0%, adenovirus (ADV (5.8%, and human coronavirus (hCoV (2.2%. Clinical diagnoses of viral ALRIs were bronchiolitis (37.5%, pneumonia (34.5%, asthma exacerbation (20.9%, and croup (7.1%. Clinical diagnoses of viral bronchiolitis and pneumonia were frequently demonstrated in patients who tested positive for RSV, hRV, hMPV, or Flu A. Flu A and hRV were most commonly identified in children older than 3 years and were the 2 leading causes of asthma exacerbation. hRV C was detected in 14 (4.3% children, who were significantly older than those infected with hRV A (mean±SD, 4.1±3.5 years vs. 1.7±2.3 years; P=0.009. hBoV was usually detected in young children (2.3±3.4 years with bronchiolitis and pneumonia. Conclusion : This study described the features of ALRI associated with 13 respiratory viruses in Korean children. Additional investigations are required to define the roles of newly identified viruses in children with ALRIs.

  13. Tube thoracostomy complications in patients with acute blunt thoracic trauma due to road traffic accidents - a comparative study

    Objective: To determine the differences in the frequency and types of Tube thoracostomy complications (TICs) between two groups of patients (A and B)With blunt thoracic trauma (BIT), as a result of road traffic accidents (RTA). Study Design: Prospective, comparative study. Place and duration of Study: Dawadrrii General Hospital (DGH), a level II trauma center, Riyadh, from December 4, 2011 to December 3, 2012. Methodology: The problem of a high number and variety of TICs' resulting due to various technical aspects of tube thoracostomy (IT) are highlighted in this study. This is a prospective comparative study enrolling a total of 140 patients with BTT due to RTA, referred to this hospital with indwelling Tube thoracostomies (TIs) (group A) or undergoing TTs at this hospital (group B) by a single thoracic surgeon within 10-15 minutes of arrival. Patients' demographic and clinical details were recorded and confirmed with the referring physicians, if necessary. The two groups were matched for age, gender, indications for ITs and the number and types of accompanying injuries. Informed consent was obtained before the procedure. Results were analyzed using SPSS v 19. Statistical significance achieved was translated into p values at 95% confidence interval. Results: Of the J 19 patients, who satisfied the inclusion criteria, group A had 49 (41.2%) and group B, 70 (58.8%) patients. Males were in he majority in both groups. A total of 130 chest tubes were placed in 119 patients. Contralateral chest tubes were indicated in 3 patients in group A and 8 patients in group B (table I). The overall TTCs rate was 61.5% (80/130), with the majority in group A (88.7%; p= 0.0001). The number of technical, infective and miscellaneous TTC in group A and B were 47 (92.2%), 6 (85.7%), 18 (81.8%), and 4 (7.8%), 1(14.3%), and 4 (18.2%), respectively (table II). The majority of the chest tubes in group A were smaller than 28 Fr (p=0.0001; RR=2.98; 95% CI=2.17-4.10). Mortality due to TT in

  14. Acute pancreatitis complicated with splenic rupture: A case report

    Bruno; L; Hernani; Pedro; C; Silva; Ricardo; T; Nishio; Henrique; C; Mateus; José; C; Assef; Tercio; De; Campos

    2015-01-01

    Atraumatic splenic rupture is an uncommon complication of acute pancreatitis. This report describes the case of a 30-year-old man with acute pancreatitis and splenic vein thrombosis complicated by splenic rupture. The patient was admitted to the emergency department with pain in the upper abdomen that had been present for six hours and was associated with vomiting and sweating. He was diagnosed with acute pancreatitis of alcoholic etiology. Upon computed tomography(CT) of the abdomen, the pancreatitis was scored as Balthazar C grade, and a suspicious area of necrosis affecting 30% of the pancreas with splenic vein thrombosis was revealed. Seventytwo hours after admission, the patient had significant improvement in symptoms. However, he showed clinical worsening on the sixth day of hospitalization, with increasing abdominal distension and reduced hemoglobin levels. A CT angiography showed a large amount of free fluid in the abdominal cavity, along with a large splenic hematoma and contrast extravasation along the spleen artery. The patient subsequently underwent laparotomy, which showed hemoperitoneum due to rupture of the splenic parenchyma. A splenectomy was then performed, followed by ultrasound-guided percutaneous drainage.

  15. Intra-arterial thrombolysis using rt-PA in patients with acute stroke due to vessel occlusion of anterior and/or posterior cerebral circulation

    The aim of our study was to evaluate the safety and efficacy of intra-arterial (IA) thrombolysis using recombinant tissue plasminogen activator (rt-PA) in patients with acute stroke due to occlusion in the anterior or posterior circulation. We retrospectively analyzed the clinical and radiological data of 88 consecutive patients with acute ischemic stroke who underwent emergency cerebral angiography for the purpose of subsequent IA thrombolysis. The neurological deficit on admission and discharge was graded using the National Institutes of Health Stroke Scale (NIHSS) score. Baseline computer tomography (CT) scans were examined for any signs indicative of cerebral ischemia. The angiographic findings were classified according to the Thrombolysis in Myocardial Infarction (TIMI) score for myocardial infarction. Follow-up CT scans were examined for hemorrhagic complication. Of the 88 patients who underwent IA thrombolysis, 63 presented with complete or partial arterial occlusion in the suspected perfusion area. In these 63 patients, the median NIHSS score dropped from 15 points on admission to 10 points at discharge. The recanalization rate was 52.6% for partial and complete reperfusion. In-hospital mortality was 20.6% (9.1% for carotid, 44.4% for basilar territory occlusion). Intracerebral bleeding (ICB) occurred in 38.6% of the patients with occlusion in the anterior circulation, resulting in these patients presenting a worse clinical outcome than those without ICB. Only minor extracranial bleedings occurred in 20.6% of patients. Patients with ICB had a significantly higher frequency of ischemic signs on the baseline CT scan. Occlusion of a cerebral artery is present in about 75% of the patients eligible for thrombolytic therapy. Intra-arterial thrombolysis using rt-PA in patients with acute ischemic stroke can achieve re-vascularization, although ICB remains the major risk factor affecting its efficacy. (orig.)

  16. Intra-arterial thrombolysis using rt-PA in patients with acute stroke due to vessel occlusion of anterior and/or posterior cerebral circulation

    Tountopoulou, Argyro; Ahl, Bjoern; Weissenborn, Karin [Hannover Medical School, Department of Neurology and Clinical Neurophysiology, Hannover (Germany); Becker, Hartmut; Goetz, Friedrich [Hannover Medical School, Department of Neuroradiology, Hannover (Germany)

    2008-01-15

    The aim of our study was to evaluate the safety and efficacy of intra-arterial (IA) thrombolysis using recombinant tissue plasminogen activator (rt-PA) in patients with acute stroke due to occlusion in the anterior or posterior circulation. We retrospectively analyzed the clinical and radiological data of 88 consecutive patients with acute ischemic stroke who underwent emergency cerebral angiography for the purpose of subsequent IA thrombolysis. The neurological deficit on admission and discharge was graded using the National Institutes of Health Stroke Scale (NIHSS) score. Baseline computer tomography (CT) scans were examined for any signs indicative of cerebral ischemia. The angiographic findings were classified according to the Thrombolysis in Myocardial Infarction (TIMI) score for myocardial infarction. Follow-up CT scans were examined for hemorrhagic complication. Of the 88 patients who underwent IA thrombolysis, 63 presented with complete or partial arterial occlusion in the suspected perfusion area. In these 63 patients, the median NIHSS score dropped from 15 points on admission to 10 points at discharge. The recanalization rate was 52.6% for partial and complete reperfusion. In-hospital mortality was 20.6% (9.1% for carotid, 44.4% for basilar territory occlusion). Intracerebral bleeding (ICB) occurred in 38.6% of the patients with occlusion in the anterior circulation, resulting in these patients presenting a worse clinical outcome than those without ICB. Only minor extracranial bleedings occurred in 20.6% of patients. Patients with ICB had a significantly higher frequency of ischemic signs on the baseline CT scan. Occlusion of a cerebral artery is present in about 75% of the patients eligible for thrombolytic therapy. Intra-arterial thrombolysis using rt-PA in patients with acute ischemic stroke can achieve re-vascularization, although ICB remains the major risk factor affecting its efficacy. (orig.)

  17. Contrast Enhanced US in the Abdomen

    Chung, Yong Eun; Kim, Ki Whang [Dept. of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2012-08-15

    Contrast enhanced ultrasound, which was introduced in 1996, has been widely used in Europe and Eastern Asia. Ultrasound contrast agent can be classified as first generation and second generation, depending on the gas within the microbubble. With the first generation contrast agent, the high MI technique was used, and only intermittent scanning was possible due to destruction of the microbubble during scanning. Use of the second generation contrast agent with the low MI technique makes continuous scanning possible. Contrast enhanced US can be used in detection and differentiation of focal liver lesions. It is also helpful for monitoring of radiofrequency ablation and for targeting of US guided biopsy. Currently, because morphologic criteria alone may not reflect the response of the tumor to treatment, new criteria are needed for treatment evaluation after administration of anti-angiogenic agents. Contrast enhanced US could provide quantitative markers for evaluation of the response to treatment via use of dynamic contrast enhanced US. Due to cost-effectiveness, contrast enhanced US is not yet widely used in Korea; however, considering recent issues regarding contrast agent related adverse reaction, such as contrast induced nephropathy and nephrogenic systemic fibrosis, and radiation exposure, contrast enhanced US might be more widely used in Korea, as an alternative imaging modality in the future.

  18. Pressure transduction and fluid evacuation during conventional negative pressure wound therapy of the open abdomen and NPWT using a protective disc over the intestines

    Lindstedt Sandra

    2012-03-01

    Full Text Available Abstract Background Negative pressure wound therapy (NPWT has gained acceptance among surgeons, for the treatment of open abdomen, since very high closure rates have been reported with this method, compared to other kinds of wound management for the open abdomen. However, the method has occasionally been associated with increased development of fistulae. We have previously shown that NPWT induces ischemia in the underlying small intestines close to the vacuum source, and that a protective disc placed between the intestines and the vacuum source prevents the induction of ischemia. In this study we compare pressure transduction and fluid evacuation of the open abdomen with conventional NPWT and NPWT with a protective disc. Methods Six pigs underwent midline incision and the application of conventional NPWT and NPWT with a protective disc between the intestines and the vacuum source. The pressure transduction was measured centrally beneath the dressing, and at the anterior abdominal wall, before and after the application of topical negative pressures of -50, -70 and -120 mmHg. The drainage of fluid from the abdomen was measured, with and without the protective disc. Results Abdominal drainage was significantly better (p Conclusions The drainage of the open abdomen was significantly more effective when using NWPT with the protective disc than with conventional NWPT. This is believed to be due to the more even and effective pressure transduction in the open abdomen using a protective disc in combination with NPWT.

  19. Acute pulmonary emboli due to internal jugular vein thrombosis in papillary thyroid carcinoma, a case report and literature review

    Masoud Ataiekhorasgani

    2014-01-01

    Full Text Available Upper extremity deep vein thrombosis (UEDVT is a life threatening rare condition. Among the patients with UEDVT, internal jugular vein is accepted as uncommon thrombosis. Since internal jugular vein thrombosis (IJVT is mostly underdiagnosed, a great attention is needed to diagnose the disease. A 75-year-old woman with history of dyspnea on exertion (DOE, weight loss and anorexia with the stable vital sign and right-sided cervical adenopathy with suspected thyroid nodule was admitted. One day after admission, sudden dyspnea was occurring with unstable vital sign and hypotension. Chest X-ray showed a bilateral pleural effusion. Pleural tap was exudative, CT scan showed bilateral pulmonary emboli. CT scan of the neck showed right-sided cervical adenopathy, heterogeneous thyroid and internal jugular vein thrombosis concomitant with superior thyroid vein thrombosis. The patient was treated with thrombolytic agent and enoxaparin followed by warfarin. Thyroid FNA revealed papillary thyroid carcinoma that followed by total thyroidectomy, histopathological examination verified papillary thyroid carcinoma. Although lower extremity DVT is the main cause of pulmonary emboli, but IJVT may be proceed by pulmonary embolism. Due to fatal outcome of pulmonary emboli in IJVT, color duplex sonography, is recommended in documented tumors or suspected history of malignancy.

  20. Difficulties with neurological prognostication in a young woman with delayed-onset generalised status myoclonus after cardiac arrest due to acute severe asthma

    Arvind Rajamani

    2011-01-01

    Full Text Available Neurological prognostication in cardiac arrest survivors is difficult, especially when the primary etiology is respiratory arrest. Prognostic factors designed to have zero false-positive rates to robustly confirm poor outcome are usually inadequate to rule out poor outcomes (i.e., high specificity and low sensitivity. One of the least understood prognosticators is generalised status myoclonus (GSM, with case reports confusing GSM, isolated myoclonic jerks and post-hypoxic intention myoclonus (Lance Adams syndrome [LAS]. With several prognostic indicators (including status myoclonus having been validated in the pre-hypothermia era, their current relevance is debatable. New modalities such as brain magnetic resonance imaging (MRI and continuous electroencephalography are being evaluated. We describe here a pregnant woman resuscitated from a cardiac arrest due to acute severe asthma, and an inability to reach a consensus based on published guidelines, with a brief overview of myoclonus, LAS and the role of MRI brain in assisting prognostication.

  1. A RETROSPECTIVE STUDY OF BLUNT TRAUMA ABDOMEN

    Kumawat

    2015-07-01

    Full Text Available BACKGROUND: Blunt abdominal trauma is one of the important components of poly - trauma. It requires suspicion, investigation and proper management in time, to avoid morbidity & mortality. AIM: The aim of this retrospective study spanning 5 years w.e.f. Jan, 2010 to December, 2014 in this tertiary care institute of Geetanjali Medical College & Hospital, Udaipur was to find out BTA patients in RTA, fall from height, and assault like injuries. We studied type of injuries, male - female ratio, age group, urban & rural population involvement & their operative & non - operative management. MATERIAL & METHOD S : The study is based on 273 cases of BTA; managed in this institute from admission, investigation, management & possible follow up. Observations are depicted in different tables. RESULT: Liver is most commonly involved organ followed by spleen, kidney & pancreas respectively. Initially solid organ injuries cases where treated by surgery, but than non - operative management are tried in haemostatically stable patients. Hollow visceral injuries were always managed by laparotomy & repair or resection as and when needed . Mortality occurred in 35 patients out 273 patients because of delay to reach hospital or septicemia, renal failure and shock due to multi organ failure. CONCLUSION: Close supervision with sophisticated infrastructure and quick action significantly reduces mortality.

  2. Acute oesophageal necrosis syndrome

    Garas, George; Wou, Constance; Sawyer, Joseph; Amygdalos, Iakovos; Gould, Stuart

    2011-01-01

    An 89-year-old woman with a known hiatus hernia presented to the accident and emergency department with acute onset epigastric pain. CT of the thorax and abdomen revealed a large hiatus hernia with mesentero-axial volvulus but no evidence of strangulation. A large aneurysmal aortic arch and descending aorta were visible with associated mural thrombus. As the pain was worsening, following discussion with the patient, the decision to operate was taken. The hiatus hernia was successfully reduced...

  3. An unusual case of haemoperitonium and bladder invasion due to placenta percreta in the third trimester mimicking threatened uterine rupture

    Shama Khan

    2016-02-01

    Full Text Available Placenta praevia percreta is a rare but potentially lethal complication of pregnancy. It has an increasing clinical significance due to its association with previous caesarian section and uterine curettage. Herein we report a patient with placenta percreta, presenting in the emergency as 33 weeks of gestation with acute pain in abdomen and haemorrhagic shock, mimicking silent spontaneous uterine rupture, managed by emergency caesarian section followed by cesarian hysterectomy and bladder repair. [Int J Reprod Contracept Obstet Gynecol 2016; 5(2.000: 556-558

  4. Magnetic Sensing through the Abdomen of the Honey bee.

    Liang, Chao-Hung; Chuang, Cheng-Long; Jiang, Joe-Air; Yang, En-Cheng

    2016-01-01

    Honey bees have the ability to detect the Earth's magnetic field, and the suspected magnetoreceptors are the iron granules in the abdomens of the bees. To identify the sensing route of honey bee magnetoreception, we conducted a classical conditioning experiment in which the responses of the proboscis extension reflex (PER) were monitored. Honey bees were successfully trained to associate the magnetic stimulus with a sucrose reward after two days of training. When the neural connection of the ventral nerve cord (VNC) between the abdomen and the thorax was cut, the honey bees no longer associated the magnetic stimulus with the sucrose reward but still responded to an olfactory PER task. The neural responses elicited in response to the change of magnetic field were also recorded at the VNC. Our results suggest that the honey bee is a new model animal for the investigation of magnetite-based magnetoreception. PMID:27005398

  5. Radiological diagnostics of abdomen and thorax. Image interpretation considering anatomical landmarks and clinical symptoms; Radiologische Diagnostik Abdomen und Thorax. Bildinterpretation unter Beruecksichtigung anatomischer Landmarken und klinischer Symptome

    Krombach, Gabriele A. [Universitaetsklinikum Giessen (Germany). Klinik fuer Diagnostische und Interventionelle Radiologie; Mahnken, Andreas H. (ed.) [Universitaetsklinikum Marburg (Germany). Diagnostische und Interventionelle Radiologie

    2015-07-01

    The book on radiological diagnostics of abdomen and thorax - image interpretation considering anatomical landmarks and clinical symptoms - includes three chapters: (1) imaging of different parts of the body: thorax and abdomen. (II) Thorax: head and neck; mediastinum; heard and pericardium; large vessels; lungs and pleura; mamma. (III) Abdomen: liver; gall bladder and biliary tract; pancreas; gastrointestinal tract; spleen and lymphatic system; adrenal glands; kidneys and urinary tract; female pelvis; male pelvis.

  6. Open abdomen in trauma patients: a double-edged sword

    Huang, Yu-Hua; Li, You-sheng

    2016-01-01

    The use of open abdomen (OA) as a technique in the treatment of exsanguinating trauma patients was first described in the mid-19th century. Since the 1980s, OA has become a relatively new and increasingly common strategy to manage massive trauma and abdominal catastrophes. OA has been proven to help reduce the mortality of trauma. Nevertheless, the OA method may be associated with terrible and devastating complications such as enteroatmospheric fistula (EAF). As a result, OA should not be ove...

  7. Advantages and disadvantages of using non-coplanar techniques in radiotherapy of the abdomen formed 3D; Ventajas e inconvenientes del uso de tecnicas con coplanares en radiaoterpia 3D conformada de abdomen

    Urena Llinares, A.; Castro Ramirez, I.; Iborra Oquendo, M. A; Quinones Rodriguez, L. A.; Angulo Pain, E.

    2011-07-01

    3D Radiotherapy locations abdomen, especially in pancreas and stomach cancers is often extremely difficult if we are to meet the dose constraints to organs at risk due to proximity and many of these (liver, kidneys, intestines, lungs, bone. ..). Of these, the most critical are the kidneys, which also present values of tolerance, in most cases difficult to meet. This is done in our hospital are using non-coplanar techniques performing well both as coating PTV dose to both kidneys.

  8. Determination of behavioral reactions of a child of 3-6 ages group to be hospitalized due to an acute illness

    Zümrüt Başbakkal

    2010-02-01

    Full Text Available The study is executed with mothers of children aged 3-6 (n=170 whose children were hospitalized for the first time between the dates of 15.07.2003 and 15.06.2006, who were reachable by phone and accepted to participate in the study aiming determination of behavioral reactions of a child of 3-6 ages group to be hospitalized due to an acute illness.In this study, for data gathering "Personal Information Form" including 15 questions and "Inquiry Form of Behavior Changes of  3-6 Ages Group Children After Being Hospitalized" with 30 questions were used. Date gathering forms were carried out as pre-test by using face-to-face interview method with mothers of 3-6 aged children who were hospitalized for the first time and were in first 12 hours of hospitalization. "Inquiry Form of Behavior Changes of 3-6 Ages Group Children After Being Hospitalized" was re-carried out with mothers by phone 1 month after children being discharged from hospital.In analyzing of datas statistical programme of SPSS 13.0 for Windows was used. In statistical evaluation;  number-percent dispersion, Wilcoxon Sing Rank test and Paired Sample-t test were used.According to the results obtained from the study, 57.6% of children are male with age average of 4,46±1,18 and 52.3% of them were hospitalized due to Gastroentestinal System Illnesses. A significant difference was determined between average points of behavior changes of 3-6 ages group children hospitalized due to an acute illness before hospitalized (10,735±4,882 and after being discharged from hospital (15,0476±4,306. In the study, it is observed that there are some behavioral changes in children after being hospitalized such as being cranky before going to bed and during eating, disquiet, bed-wetting, seperation anxiety, excessive attachment to a parent, to need help even for the things he/she could accomplish, to have fear from new environments, people or objects, bad temper attacks, fear of doctor/nurse and hospital

  9. Acute Respiratory Distress due to Thymoma in a Patient Treated with TK Inhibitor: A Case Report and Review of the Current Treatment Options

    P. Zarogoulidis

    2011-03-01

    Full Text Available Thymic malignancies are rare intrathoracic tumors that may be aggressive and difficult to treat in advanced stage. Surgery is the cornerstone of the management of thymomas: it is significant for the definite histopathological diagnosis and staging, and in most cases, it constitutes the first step of the treatment strategy. For patients with primary unresectable thymomas, the multimodal treatment schedule nowadays includes neoadjuvant chemotherapy, extensive surgery, adjuvant radiotherapy, and in some cases, adjuvant chemotherapy. A patient with a history of stage III COPD and an undiagnosed thoracic mass was admitted to the intensive care unit with acute respiratory distress. A radiologic evaluation by CT scan revealed a mass of 13 cm in diameter at the mediastinum. Fine needle aspiration was performed and revealed a thymoma. Due to poor performance status, the patient was not able to undergo surgery. He refused to be treated with neither chemotherapy nor radiotherapy, but due to EGFR overexpression, treatment with TK inhibitor was suggested. Fine needle aspiration biopsy is commonly used to identify metastasis to the mediastinum. However, it is less often employed as a primary diagnostic tool for tumors, particularly thymic neoplasms. The use of targeted therapies for the treatment of thymic malignancies has been described in the literature. Over the past years, significant efforts have been made to dissect the molecular pathways involved in the carcinogenesis of these tumors. Insights have been obtained following anecdotal clinical responses to targeted therapies, and large-scale genomic analyses have been conducted.

  10. Determination of behavioral reactions of a child of 3-6 ages group to be hospitalized due to an acute illnessDetermination of behavioral reactions of a child of 3-6 ages group to be hospitalized due to an acute illness

    Nesrin Şen Celasin; Sibel Sönmez; Zümrüt Başbakkal; Figen Esenay

    2010-01-01

    The study is executed with mothers of children aged 3-6 (n=170) whose children were hospitalized for the first time between the dates of 15.07.2003 and 15.06.2006, who were reachable by phone and accepted to participate in the study aiming determination of behavioral reactions of a child of 3-6 ages group to be hospitalized due to an acute illness.In this study, for data gathering "Personal Information Form" including 15 questions and "Inquiry Form of Behavior Changes of 3-6 Ages Group Child...

  11. CLINICAL STUDY AND MANAGEMENT OF BLUNT INJURY ABDOMEN PERTAINING TO SOLID ORGANS

    Katta Srinivasa

    2015-09-01

    Full Text Available Blunt Abdominal trauma is one of the most common causes among injuries caused mainly due to road traffic accidents. 1 The rapid increase in number of motor vehicles and its aftermath has caused rapid increase in number of victims to blunt abdominal trauma. Motor vehicle accidents account for 75 to 80% of blunt abdominal trauma. 2 Blunt injury of abdomen is also a result of fall from height, assault with blunt objects, industrial mishaps, sport injuries, bomb blast and fall from riding bicycle. 2 In view of increasing number of vehicles and consequently road traffic accidents, this topic is chosen to study the cases of blunt abdominal trauma with reference to the patients presenting at Govt. General Hospital, attached to Guntur Medical College, Guntur. OBJECTIVES: The objectives of the study are: 1. To evaluate the impact of blunt abdominal trauma on solid viscera. 2. To evaluate etiology and various modes of presentation. 3. To evaluate various available investigations for the detection of solid organ injuries. 4. To evaluate various modalities of treatment available with aim to reduce the mortality and morbidity. 5. To evaluate common complications of solid organ injury in blunt trauma abdomen. MATERIALS AND METHODS: Patients admitted in Government General Hospital, Guntur, from November 2012 to October 2014 and studied 50 cases. This is a prospective study conducted over 2 years. RESULTS: Male patients were commonly affected (80%, Peak age group being 21 – 30 years (48%. The commonest mode of injury was road traffic accident (58%. The common organ injured was spleen (54% followed by liver. 70% of the patients were treated by surgery, 30% conservatively. The mortality in this study was 14%. CONCLUSIONS : Blunt injury abdomen forms considerable load and health care system, most common age group is youngsters in road traffic accidents , so efforts should be made to formulate and execute road traffic regulations. Well established trauma care

  12. ROD PENETRATES MAN: ARM TO THORACO-ABDOMEN – SURVI VES

    Sitaram

    2013-03-01

    Full Text Available ABSTRACT : Penetrating chest and abdominal injuries are potenti al life threatening due to the associated haemorrhagic shock and visceral injury 1 ,2. Through and through penetrating injury with poly trauma is rarely encountered 8. We report a case presenting with situ projecting heavy iron- metallic rod in a through and through pe netrating into left arm and thoraco- abdomen in a road traffic accident. Management was difficult due to inability to positio n in supine, rapidly progressive haemorrhagic shock and hypoxia due to haemo pneumotho rax. Two operative tables were used with adequate intervening space to accommodate the pr ojecting rod during intubation in supine position. Delayed development of thrombosis in brach ial artery after removal of iron rod, which was removed and brachial artery was repaired. Intens ive monitoring and resuscitation resulted in uneventful outcome.

  13. [Acute pancreatitis caused by varicella-zoster virus after liver transplantation].

    Coelho, J C; Wiederkehr, J C; Campos, A C; Zeni Neto, C; Oliva, V

    1994-02-01

    Twenty-six days after liver transplantation for primary biliary cirrhosis, a 52 year-old patient was rehospitalized for viral infection. The clinical features were fatigue, anorexia and vomiting. On physical examination, vesicular skin lesions involving the left 8 th intercostal space were suggestive of herpes-zoster infection. The following day the patient was extremely tired and dyspnoeic. The abdomen was distended with moderate abdominal epigastric pain. The clinical picture worsened rapidly and the patient died a few hours later. Autopsy revealed acute haemorrhagic necrosis of the pancreas due to herpes-zoster virus. PMID:8207103

  14. Miocarditis fulminante y enfermedad diarreica aguda por Coxsackie virus B6 Fulminant myocarditis and acute gastroenteritis due to Coxsackie virus B6

    Germán Málaga

    2011-03-01

    Full Text Available Presentamos el caso de una paciente joven que presentó choque cardiogénico por virus Coxsakie B6. La paciente acudió a una clínica particular con un cuadro clínico compatible con gastroenterocolitis aguda a la que después de una hora de estar recibiendo hidratación y manejo del cuadro diagnosticado, se agregó hipotensión que llegó al estado de choque, hipoxemia severa y compromiso pulmonar bilateral intersticial por lo que ingresó a Unidad de Cuidados Intensivos, donde recibió manejo de soporte. Debido al cuadro clínico y elevación de enzimas cardiacas se sospechó de compromiso cardiaco, la ecocardiografía evidenció cambios sugerentes de miocarditis. La evolución fue favorable y se le pudo dar de alta después de una semana. El diagnóstico etiológico del cuadro se hizo en el seguimiento, presentando serología con elevación de títulos para virus Coxsakie B6.We present the case of a young woman who suffered cardiogenic due to by Coxsackie virus B6. The patient attended a private clinic with an acute gastroenteritis and after one hour of receiving hydratation,she developed hypotension and shock, severe hypoxemia and bilateral lung infiltrate. The patient entered the Intensive Care Unit, where she received hemodynamic support. Due to the clinical picture and cardiac enzymes increase, a cardiac failure was suspected and the echocardiographic findings suggested "myocarditis". The evolution was successful and Coxsackie B6 virus infection diagnosis was made during the follow up by increase of the levels of antibodies for virus Coxsackie B6.

  15. Follicular Dendritic Cell Sarcoma of the Abdomen: the Imaging Findings

    Kang, Tae Wook; Lee, Soon Jin; Song, Hye Jong [Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2010-04-15

    Follicular dendritic cell sarcoma is a rare neoplasm that originates from follicular dendritic cells in lymphoid follicles. This disease usually involves the lymph nodes, and especially the head and neck area. Rarely, extranodal sites may be affected, including tonsil, the oral cavity, liver, spleen and the gastrointestinal tract. We report here on the imaging findings of follicular dendritic cell sarcoma of the abdomen that involved the retroperitoneal lymph nodes and colon. It shows as a well-defined, enhancing homogenous mass with internal necrosis and regional lymphadenopathy.

  16. Hernia interna de Quain como causa de abdomen agudo

    M. García-Oria; A. Muñoz de la Fuente; J.M. Peraza Casajús; I. Bodega Quiroga; A. Martínez Pozuelo; A Serrano Muñoz

    2012-01-01

    Presentamos el caso de una paciente de 47 años de edad que consulta en urgencias por un cuadro de 8 horas de evolución, de dolor abdominal continuo y difuso, acompañado de vómitos alimentarios al inicio y biliosos después. La paciente presenta estabilidad hemodinámica permaneciendo afebril. El hemiabdomen inferior presenta signos de irritación peritoneal. En los análisis destaca la presencia de neutrofilia y leucocitosis, la radiología simple de abdomen es compatible con suboclusión de intest...

  17. Small Cell Carcinoma of the Lung Presented as Acute Pancreatitis. Case Report and Review of the Literature

    Abdulzahra Hussain; Shamsi El-Hasani; Ali Adnan

    2012-01-01

    Context Small cell carcinoma of the lung is an aggressive cancer with gloomy prognosis. Links to acute pancreatitis is extremely rare. Case report We are reporting a 53-year-old patient who was admitted because of acute pancreatitis. She had no history of gallstones, alcohol abuse, medications or any other predisposition for acute pancreatitis. Further investigations of blood, CT of chest abdomen and neck and ultrasound scan of abdomen, bone marrow and neck lymph node biopsies confirmed advan...

  18. Mesenteric infarction due to iatrogenic polycythemia

    Skoog, Katrina; Carmelle-Elie, Marie; Ferguson, Kevin

    2013-01-01

    BACKGROUND: Polycythemia vera is defined as a chronic myeloproliferative disorder characterized by increased red blood cell count. There have been no reports on mesenteric thrombosis resulting from iatrogenic polycythemia. METHODS: We present a patient with a history of non-small cell lung cancer undergoing maintenance oral chemotherapy on tarceva and adjunctive use of procrit. The patient presented to our emergency department with an acute abdomen and was found to have ischemic bowel from un...

  19. Radiological observation of acute pancreatitis

    The radiologic study of the pancreas oriented in the upper retroperitoneal space is difficult because the specific density of this viscus is the same as that of its surrounding tissue. so that it cannot be visualized directly. Furthermore, it is one of the few viscera in the abdomen which cannot be outlined by a contrast medium. In the abdomen, the diagnosis of acute pancreatitis is very important since the present treatment of this disease is conservative, which emergency laparatomy is indicated in most other abdominal crisaes. However, the diagnosis of acute pancreatitis cannot be made by roentgen studies alone, yet such studies can at times confirm an uncertain clinical diagnosis when evaluated with clinical findings and can occasionally alert the unsuspecting clinician to the possible presence of this disease. Because a radiologic examination plays such an important role in the differential diagnosis of the acute abdomen and at present augmenting interest for pancreatic disease, we present this discussion in order to focus attention on the radiologic features of acute pancreatitis.1. From Nov. 1968 to June 1978, roentgenologic studies of 275 patients diagnosed as acute pancreatitis were reviewed. 2. In this series, the important findings on the chest roentgenograms of 275 cases were as follows. 1) Fifty-five cases (20.0%) of these represented pleural effusion. 2) Platelike atelectasis at the lung bases was noted in 44 cases (16.0%). 3) There was elevation of the diaphragm in 33 cases (12.0%). 3. The significant findings on the simple abdomen of 247 cases were as follows. 1) The presence of a sentinel loop occurred in 168 cases (68.0%). 2) Colon 'cut-off' sign was noted in 106 cases (42.9%). 3) Obliteration of psoas shadows in 8 cases (3.2%). 4) Gastrocolic separation in 4 cases (1.6%). 4. One hundred and seventy-five barium meal studies of the stomach and duodenum were available for review.

  20. Cholestatic hepatitis due to Salmonella typhi

    Ayse Albayrak

    2011-04-01

    Full Text Available Salmonella infection occurs worldwide and is still an important public health problem in many developing countries. The infection can affect almost all major organs including the liver. Severe hepatic involvement with a clinical feature of acute hepatitis is a rare complication. In this paper, a 39-year-old male with acute cholestatic typhoid hepatitis is presented. The case had a tender hepatomegaly and elevated serum alanine and aspartate transaminase, alkaline phosphatase, and gamma glutamyl transferase levels; these features cannot been distinguished from those of acute viral hepatitis. Serological and viral markers of acute viral hepatitis were negative. No pathology could be determined in abdomen Ultrasonography (USG or Magnetic Reso - nance (MR Cholangiography. As enteric fever is a common infection, the recognition of salmonella hepatitis is of clinical importance. When patients from an endemic or outbreak area present acute febrile hepatitis, typhoid fever should be a consideration.

  1. A RARE CASE OF ILEAL CARCINOID PRESENTING WITH ACUT E INTESTINAL OBSTRUCTION

    Abinash

    2013-04-01

    Full Text Available A 55 year old male presented to casualty with featur es of acute intestinal obstruction - Patient was treated one year back for subacute inte stinal obstruction which was suspected to be ileo-caecal tuberculosis treated with Cat II ATT. - On examination abdomen uniform distention, tenderne ss present all over the abdomen. - Bowel sounds were sluggish - Per rectal examination shows empty rectum - Clinical diagnosis is – acute intestinal obstructio n.

  2. Combined PET-MRI of the abdomen; Kombinierte PET-MRT des Abdomens

    Vag, Tibor; Eiber, M.; Schwaiger, M. [Technische Universitaet Muenchen, Klinik fuer Nuklearmedizin, Klinikum Rechts der Isar, Muenchen (Germany)

    2015-12-15

    The first fully integrated combined positron emission tomography-magnetic resonance imaging (PET-MRI) scanners have been clinically available since 2010. Large prospective studies regarding indications and diagnostic accuracy of this new modality are not yet available; however, preliminary studies have shown a higher diagnostic accuracy and confidence compared to PET-computed tomography (PET-CT) in regions where MRI is known to be superior to CT, such as the liver. The benefit of MRI in accurate lesion characterization and the additional value of diffusion-weighted imaging (DWI) as a complementary functional modality by means of the apparent diffusion coefficient (ADC) is apparent in entities with low tracer uptake (e. g. due to small size) and a decreased or absent accumulation pattern on PET. (orig.) [German] Seit 2010 sind die ersten voll integrierten Positronenemissionstomographie(PET)-MR-Scanner im klinischen Gebrauch. Obwohl es derzeit noch an empirischen Daten im Sinne groesserer und prospektiver Studien fehlt, implizieren erste Studien einen diagnostischen Mehrwert gegenueber der PET-CT in Regionen, in denen die MRT bekanntermassen der CT ueberlegen ist. Diese ist in der besseren morphologischen Charakterisierung begruendet, die insbesondere bei Laesionen mit geringer Tracerspeicherung (z. B. aufgrund der geringen Groesse) oder unbekanntem Speicherverhalten in der PET ausschlaggebend ist. Zudem steht der MRT eine komplementaere funktionelle Modalitaet in Form der Diffusionsbildgebung zur Verfuegung, die ueber die Berechnung des Apparent-diffusion-coefficient(ADC)-Werts eine weitere Einschaetzung des Gewebes geben kann. (orig.)

  3. CLINICAL STUDY ON ACUTE PANCREATITIS

    Suhaib Rehaman

    2015-07-01

    Full Text Available INTRODUCTION : Early diagnosis and severity evaluation on patients with acute pancreatitis are very important due to its potential morbidity and mortality. Given the wide spectrum of disease seen, the care of patients with pancreatitis must be highly individualized. Sev eral clinical, laboratory and radiologic factors and many scoring systems have been proposed for outcome prediction. AIMS AND OBJECTIVES: To study the symptomatology, clinical presentation and management in pancreatitis . To study the severity of acute panc reatitis according to Glasgow Scale . METHODS: Present study includes consecutive 38 patients hospitalized in CSI Holdsworth Memorial Hospital over the period of 2 years. All patients were thoroughly investigated and were stratified according to the Glasgow criteria. Data was collected on complications, investigations and interventions undertaken, outcome, duration of stay in hospital and ICU. STATISTICAL ANALYSIS USED: Descriptive, Chi square tests, Crosstabs (Contingency coefficient analysis . RESULTS : Mean age of presentation in our study was 43.1 years. There was a male predominance accounting for 68.4% compared to 31.6% females. Alcohol was the main etiological factor in about 50% of the patients. Sensitivity to S. amylase was about 100%. Accuracy of USG abdomen in diagnosing pancreatitis was about 88.5%. Ascitis was the commonest complication seen in 13.2%. Mean duration of hospital stay was 6.2 days. The patient were stratified according to Glasgow scoring system into mild (0 - 3 and severe (>3 panc reatitis. In our study 32 people were graded with mild pancreatitis, all improved and in 6 people who were graded with severe pancreatitis, 83.3 % improved and 2.6% expired because of complications. Test statistics showed Contingency coefficient 0.355 and P 0.019 (NS. CONCLUSION : Glasgow scoring system remains a valid predicting system for the outcome in patients with acute pancreatitis. It is simple easy to apply with

  4. Imaging findings of Castleman disease of the abdomen and pelvis

    Objective: The purpose of this work was to analysis the most suggestive imaging findings of Castleman disease in the abdomen and pelvis and to improve the recognition of this rare disease. Methods: Ten patients with pathologically proved Castleman disease in the abdomen (n=9) and pelvis (n=1) were included in this study. Patients were 18-56 yeas old (mean=40); 7 were men and 3 women. Imaging findings (CT and MRI, n=4; only CT, n=4; only MRI, n=2) were retrospectively reviewed and correlated with clinical and pathologic findings. Results: The lesions were divided into localized (n=9) and disseminated (n=1) group. The pathologic subtypes of all 9 cases of localized disease were hyaline vascular type. Imaging findings showed a single large mass in six and a single dominant mass with small satellite nodules in three. On plain CT images, the lesions manifested as homogeneous soft masses, which is isoattenuating to muscle. After intravenous injection of contrast media, most of the masses enhanced sharply (5/7) with the attenuation similar to large arteries at arterial phase and delay scans. On MR imaging, the lesions also were homogenous and had isointense or slightly low signal intensity compared with that of muscle on T1 weighted images and high signal intensity on T2 weighted images, and showed contrast enhancement in a similar pattern to contrast enhanced CT. After intravenous injection of contrast media, areas of central lower radial attenuation in the mass were noted in 4 cases of large masses ( > 5 cm) and proved to be fibrotic component pathologically. The pathologic subtypes of 1 cases of disseminated disease was plasma cell type. Imaging findings showed several well-defined nodules lied in the retroperitoneal zone that enhanced sharply with the attenuation similar to large arteries after intravenous injection of contrast media. Conclusion: Imaging findings of Castleman disease in the abdomen and pelvis are closely associated with its pathology. The most

  5. Evaluation of the Appendix Base Location in Acute Appendicitis Using Sonography and its Clinical Significance

    The purpose of this study is to investigate the location of appendiceal base using sonography in acute appendicitis and the usefulness of the appendiceal base marking in deciding the incision site of appendectomy. We performed appendix sonography in 813 patients and 381 patients were diagnosed as acute appendicitis. During sonography, we marked the base of the appendix on the skin of the patients' abdomen. After appendiceal base marking, we measured the distance from McBurney's point to the appendiceal base. The marking was used as the guide for incision site for appendectomy by the surgeon. Among 381 patients, we excluded 78 patients due to non visualization of the cecoappendiceal junction (n = 6), pregnancy appendicitis (n = 2), false positive appendicitis (n = 3) and no reply from the surgeon (n = 67). So we investigated 303 patients prospectively. After operation, we asked the surgeon whether the appendiceal base marking was helpful for appendectomy or not. The base of the appendix at McBurney's point were 31%, lying within 2 cm from McBurney's point were 20%, within 5 cm were 28%, more than 5 cm were 21%. For the usefulness of appendiceal base marking, 95% showed good correlation with marking and surgical incision, and 5% revealed poor correlation. The base of the appendix was located in diverse areas of the abdomen, although most frequent in the McBurney's point and within 2 cm from the McBurney's point. Appendiceal base marking on the skin of the abdomen after diagnosis of acute appendicitis could be an useful method to guide the surgeon for decision of surgical incision site

  6. Evaluation of the Appendix Base Location in Acute Appendicitis Using Sonography and its Clinical Significance

    Lee, Kwan Seop; Kim, Min Jeong; Ko, Eun Young; Hong, Myung Sun; Jeon, Eui Yong; Hwang, Hee Sung; Lee, In Jae; Yang, Ik; Lee, Eil Seong; Lee, Bong Hwa [Hallym University College of Medicine, Chuncheon (Korea, Republic of)

    2005-12-15

    The purpose of this study is to investigate the location of appendiceal base using sonography in acute appendicitis and the usefulness of the appendiceal base marking in deciding the incision site of appendectomy. We performed appendix sonography in 813 patients and 381 patients were diagnosed as acute appendicitis. During sonography, we marked the base of the appendix on the skin of the patients' abdomen. After appendiceal base marking, we measured the distance from McBurney's point to the appendiceal base. The marking was used as the guide for incision site for appendectomy by the surgeon. Among 381 patients, we excluded 78 patients due to non visualization of the cecoappendiceal junction (n = 6), pregnancy appendicitis (n = 2), false positive appendicitis (n = 3) and no reply from the surgeon (n = 67). So we investigated 303 patients prospectively. After operation, we asked the surgeon whether the appendiceal base marking was helpful for appendectomy or not. The base of the appendix at McBurney's point were 31%, lying within 2 cm from McBurney's point were 20%, within 5 cm were 28%, more than 5 cm were 21%. For the usefulness of appendiceal base marking, 95% showed good correlation with marking and surgical incision, and 5% revealed poor correlation. The base of the appendix was located in diverse areas of the abdomen, although most frequent in the McBurney's point and within 2 cm from the McBurney's point. Appendiceal base marking on the skin of the abdomen after diagnosis of acute appendicitis could be an useful method to guide the surgeon for decision of surgical incision site

  7. Open abdomen in trauma patients: a double-edged sword.

    Huang, Yu-Hua; Li, You-Sheng

    2016-01-01

    The use of open abdomen (OA) as a technique in the treatment of exsanguinating trauma patients was first described in the mid-19(th) century. Since the 1980s, OA has become a relatively new and increasingly common strategy to manage massive trauma and abdominal catastrophes. OA has been proven to help reduce the mortality of trauma. Nevertheless, the OA method may be associated with terrible and devastating complications such as enteroatmospheric fistula (EAF). As a result, OA should not be overused, and attention should be given to critical care as well as special management. The temporary abdominal closure (TAC) technique after abbreviated laparotomy was used to improve wound healing and facilitate final fascial closure of OA. Negative pressure therapy (NPT) is the most commonly used TAC method. PMID:27042329

  8. Pancreatite aguda devida a hematoma intramural do duodeno por uso de anticoagulante Acute pancreatitis due to intramural hematoma of the duodenum by use of anticoagulant therapy

    Samer FARHOUD

    2001-01-01

    Full Text Available Racional - A hemorragia intramural espontânea do duodeno causada por complicações da terapêutica anticoagulante é rara e seu tratamento controverso. Objetivo -- Apresentar a experiência advinda do tratamento de doente com essa condição clínica. Relato do caso - Expõe-se o caso de uma mulher de 71 anos de idade, que há 3 meses fazia uso de anticoagulante oral para tratamento de trombose venosa profunda dos membros inferiores. Apresentou-se com cefaléia e dores abdominais intensas no andar superior do abdome, associadas a náuseas e vômitos. Os exames laboratoriais e de imagem comprovaram o diagnóstico de surto agudo de pancreatite, decorrente de hematoma intramural de duodeno. Os valores de protrombina (49,7 s e o sangramento de tecidos moles cervicais e urinário, sugeriam complicação da terapêutica anticoagulante. Resultados - A terapêutica conservadora foi efetiva, tendo a doente recebido alta, assintomática, no 10º dia de internação. Conclusão - É recomendado o emprego do anticoagulante em doses menores nos doentes de risco e adequado controle dos parâmetros da coagulação. Acredita-se ser ideal a conduta conservadora e recomenda-se a cirurgia somente nos casos que evoluem com complicações.Background - Spontaneous intramural hemorrhage of the duodenum due to anticoagulant therapy is rare and the treatment is controversial. Objective - To present the acquired knowledge with the treatment of these disease. Case report - A 71-year-old women receiving for a 3 month period an anticoagulant therapy presented cervical bleeding of soft tissues and symptoms of acute pancreatitis and high small bowel obstruction. Early noninvasive diagnosis by computed tomographic scan was possible and conservative therapy proved successful in complete resolution of the pancreatitis and obstructive symptoms, with resumption of oral intake in the fourth day of treatment. The frequency of bleeding in high risk patients during warfarin therapy

  9. Estimating the burden of acute gastrointestinal illness due to Giardia, Cryptosporidium, Campylobacter, E. coli O157 and norovirus associated with private wells and small water systems in Canada.

    Murphy, H M; Thomas, M K; Schmidt, P J; Medeiros, D T; McFADYEN, S; Pintar, K D M

    2016-05-01

    Waterborne illness related to the consumption of contaminated or inadequately treated water is a global public health concern. Although the magnitude of drinking water-related illnesses in developed countries is lower than that observed in developing regions of the world, drinking water is still responsible for a proportion of all cases of acute gastrointestinal illness (AGI) in Canada. The estimated burden of endemic AGI in Canada is 20·5 million cases annually - this estimate accounts for under-reporting and under-diagnosis. About 4 million of these cases are domestically acquired and foodborne, yet the proportion of waterborne cases is unknown. There is evidence that individuals served by private systems and small community systems may be more at risk of waterborne illness than those served by municipal drinking water systems in Canada. However, little is known regarding the contribution of these systems to the overall drinking water-related AGI burden in Canada. Private water supplies serve an estimated 12% of the Canadian population, or ~4·1 million people. An estimated 1·4 million (4·1%) people in Canada are served by small groundwater (2·6%) and surface water (1·5%) supplies. The objective of this research is to estimate the number of AGI cases attributable to water consumption from these supplies in Canada using a quantitative microbial risk assessment (QMRA) approach. This provides a framework for others to develop burden of waterborne illness estimates for small water supplies. A multi-pathogen QMRA of Giardia, Cryptosporidium, Campylobacter, E. coli O157 and norovirus, chosen as index waterborne pathogens, for various source water and treatment combinations was performed. It is estimated that 103 230 AGI cases per year are due to the presence of these five pathogens in drinking water from private and small community water systems in Canada. In addition to providing a mechanism to assess the potential burden of AGI attributed to small systems and

  10. Determination of behavioral reactions of a child of 3-6 ages group to be hospitalized due to an acute illnessDetermination of behavioral reactions of a child of 3-6 ages group to be hospitalized due to an acute illness

    Nesrin Şen Celasin

    2010-02-01

    Full Text Available The study is executed with mothers of children aged 3-6 (n=170 whose children were hospitalized for the first time between the dates of 15.07.2003 and 15.06.2006, who were reachable by phone and accepted to participate in the study aiming determination of behavioral reactions of a child of 3-6 ages group to be hospitalized due to an acute illness.In this study, for data gathering "Personal Information Form" including 15 questions and "Inquiry Form of Behavior Changes of 3-6 Ages Group Children After Being Hospitalized" with 30 questions were used. Date gathering forms were carried out as pre-test by using face-to-face interview method with mothers of 3-6 aged children who were hospitalized for the first time and were in first 12 hours of hospitalization. "Inquiry Form of Behavior Changes of 3-6 Ages Group Children After Being Hospitalized" was re-carried out with mothers by phone 1 month after children being discharged from hospital.In analyzing of datas statistical programme of SPSS 13.0 for Windows was used. In statistical evaluation; number-percent dispersion, Wilcoxon Sing Rank test and Paired Sample-t test were used.According to the results obtained from the study, 57.6% of children are male with age average of 4,46±1,18 and 52.3% of them were hospitalized due to Gastroentestinal System Illnesses. A significant difference was determined between average points of behavior changes of 3-6 ages group children hospitalized due to an acute illness before hospitalized (10,735±4,882 and after being discharged from hospital (15,0476±4,306. In the study, it is observed that there are some behavioral changes in children after being hospitalized such as being cranky before going to bed and during eating, disquiet, bed-wetting, seperation anxiety, excessive attachment to a parent, to need help even for the things he/she could accomplish, to have fear from new environments, people or objects, bad temper attacks, fear of doctor/nurse and hospital, fear

  11. ACUTE APENDICITIS – GUIDELINES OF DIAGNOSIS AND TREATMENT ON CLINICAL EVIDENCE (II)

    E. Maloman; N. Gladun; Ungureanu, S.; C. Lepadatu

    2006-01-01

    Acute appendicitis is the most frequent cause of acute abdomen. In this paper we present the treatment according to our experience in acute apendicitis. We made a exposure of the surgical methods and the approach techniques. We also performed a review of the literature.

  12. Anatomical study of superficial fascia and localized fat deposits of abdomen

    Pramod Kumar

    2011-01-01

    Full Text Available Background: The development of liposuction and abdominoplasty has renewed interest in the anatomy of the localized fat deposits (LFD areas of the abdomen. This study aims at ascertaining the gross anatomy of superficial fascia and the localized fat deposits of abdomen. Materials and Methods: Eight adult cadavers (four males and four females were dissected. Attachments, number of layers of fascia and colour, shape and maximum size of the fat lobules in loin, and upper and lower abdomen were noted. Thickness of deep membranous layer of superficial fascia of upper abdomen and lower abdomen were measured by metal casing electronic digital calipers, with resolution being 10 μm. The independent sample t-test, ANOVA for comparison and Pearson coefficient for correlation were used. Results: Superficial fascia of the abdomen was multilayered in the midline and number of layers reduced laterally. The shape, size, color, and arrangement of fat lobules were different in different locations. The thickness of the fascia of the lower abdomen in males (mean 528.336 ± SE38.48 was significantly (P < 0.041 more than that in females. (Mean 390.822 ± SE36.24. Pearson correlation between thickness of the membranous layer of the upper and lower abdomen revealed moderately positive correlation (r=0.718; P<0.045. Conclusions: The LFD in the central region of the abdomen corresponds to the area of multilayered fascia with smaller fat lobules. The relatively thinner supporting fascia of the lower abdomen in females may be responsible for excessive bulges of the lower abdomen. The fat lobule anatomy at different sites under study was different.

  13. Episode of Familial Mediterranean Fever-Related Peritonitis in the Second Trimester of Pregnancy Followed by Acute Cholecystitis: Dilemmas and Pitfalls

    Kosmidis, Christophoros; Anthimidis, Georgios; Varsamis, Nikolaos; Makedou, Fotini; Georgakoudi, Eleni; Efthimiadis, Christophoros

    2016-01-01

    Patient: Female, 33 Final Diagnosis: Acute cholecystitis after Familial Mediterranean Fever-related peritonitis Symptoms: Acute abdomen • fever Medication: Colchicine Clinical Procedure: Laparoscopic cholecystectomy and adhesiolysis in the second trimester of pregnancy Specialty: Surgery Objective: Rare co-existance of disease or pathology Background: Differential diagnosis of acute abdomen in pregnant patients is one of the greatest challenges for the clinician. Occurrence of Familial Medite...

  14. Diagnostic evaluation of acute pancreatitis in two patients with hypertriglyceridemia

    Yoshifumi Okura; Kozo Hayashi; Tetsuji Shingu; Goro Kajiyama; Yoshiyuki Nakashima; Keijiro Saku

    2004-01-01

    We present two diagnostically challenging cases of acute pancreatitis with hypertriglyceridemia accompanied with chylomicronemia caused with a deficiency of lipoprotein lipase and with the presence of type V hyperlipidemia.Both cases suffered from acute abdomen following the ingestion of fatty food and revealed the increase in parameters of inflammation without significant elevation of serum amylase levels. The imaging examination of ultrasonography could not detect significant findings of acute pancreatitis and a computer tomography scan eventually confirmed the findings of acute pancreatitis. Both cases responded to a low fat diet and administration of a cholecystokinin receptor antagonist, exhibiting a relief of abdominal symptoms. As in the present cases with acute abdomen following the ingestion of fatty food, the identification of serum hypertriglyceridemia and an abdominal computer tomography scan might be useful in establishing the diagnosis of acute pancreatitis and in developing the therapeutic regimen, when hypertriglyceridemia interferes with the evaluation of pancreatic enzyme activities and ultrasound examination provides poor pancreatic visualization.

  15. Acute lower respiratory tract infection due to respiratory syncytial virus in a group of Egyptian children under 5 years of age

    El-kholy Amany A; El-anany Mervat G; Mansi Yasmeen A; Fattouh Aya M; El-karaksy Hanaa M

    2011-01-01

    Abstract Background and aim Respiratory syncytial virus (RSV) is one of the most important causes of acute lower respiratory tract infections (ALRTI) in infants and young children. This study was conducted to describe the epidemiology of ALRTI associated with RSV among children ≤ 5 years old in Egypt. Patients and Methods We enrolled 427 children ≤ 5 years old diagnosed with ALRTI attending the outpatient clinic or Emergency Department (ED) of Children Hospital, Cairo University during a one-...

  16. Rapid parenteral rehydration in children with dehydration due to acute diarrheal disease Hidratación parenteral rápida en pacientes deshidratados por enfermedad diarreica aguda

    Myriam Bastidas; Valencia, Marta L; Gustavo Gómez; Carlos A. Bernal Parra

    1989-01-01

    Between May and July 1987, we studied 36 children with second or third degree dehydration secondary to acute diarrheal disease of less than one week duration; they had no serious associated problems. Parenteral rehydration was carried out with a solution similar in composition to the one recommended by the World Health Organization for Oral Rehydration Therapy (ORT). Rehydration was achieved in 30 patients withi...

  17. Consolidation whole abdomen irradiation following adjuvant carboplatin-paclitaxel based chemotherapy for advanced uterine epithelial cancer: feasibility, toxicity and outcomes

    To evaluate feasibility and preliminary outcomes associated with sequential whole abdomen irradiation (WAI) as consolidative treatment following comprehensive surgery and systemic chemotherapy for advanced endometrial cancer. We conducted a retrospective analysis of patients treated at our institution from 2000 to 2011. Inclusion criteria were stage III-IV endometrial cancer patients with histological proof of one or more sites of extra-uterine abdomen-confined disease, treated with WAI as part of multimodal therapy. Endpoints were feasibility, acute toxicity, late effects, recurrence-free survival (RFS) and overall survival (OS). Twenty patients were identified. Chemotherapy consisted of 3 to 6 cycles of a platinum-paclitaxel regimen in 18 patients. WAI was delivered using conventional technique to a median total dose of 27.5 Gy. No grade 4 toxicities occurred during chemotherapy or radiotherapy. No radiation dose reduction was necessary. Three patients developed small bowel obstruction, all in the context of recurrent intraperitoneal disease. Kaplan-Meier estimates and 95% confidence intervals for RFS and OS at one year were 63% (38–80%) and 83% (56-94%) and at 3 years 57% (33-76%) and 62% (34-81%), respectively. On univariate Cox analysis, stage IVB and serous papillary (SP) histology were found to be statistically significantly (at the p = 0.05 level) associated with worse RFS and OS. The peritoneal cavity was the most frequent site of initial failure. Consolidative WAI following chemotherapy is feasible and can be performed without interruption with manageable acute and late toxicity. Patients with endometrioid adenocarcinoma, especially stage FIGO III, had favorable outcomes possibly meriting prospective evaluation of the addition of WAI following chemotherapy in selected patients. Patients with SP do poorly and do not routinely benefit from this approach

  18. Binge Eating Leading to Acute Gastric Dilatation, Ischemic Necrosis and Rupture –A Case Report

    Khare, Manish Kumar; Mishra, Sumanta; Marhual, Jogesh Chandra

    2016-01-01

    Acute gastric dilatation is a rarely encountered clinical scenario in our day to day practice. This is very rapidly progressing condition and can lead to ischemic necrosis and perforation/rupture of the stomach. It could be fatal if not timely intervened. We report such a case of a 17-year-old, otherwise healthy boy, who presented with pain and distension of abdomen following binge eating episode after 24 hours of prolonged fasting. On exploration, stomach was dilated with necrosis and perforation at fundus near greater curvature. He was managed with excision of all the devitalized area and primary repair with feeding jejunostomy. The case is presented due to its rarity. Acute gastric dilatation (AGD) leading to ischemic necrosis and perforation because of binge eating episode in an otherwise healthy person is an exceptional occurrence with only few cases reported in literature. The clinician should be aware of this condition for prompt and appropriate management. PMID:27134932

  19. Evaluation of amylase and lipase levels in blunt trauma abdomen patients

    Subodh Kumar

    2012-01-01

    Full Text Available Background: There are studies to prove the role of amylase and lipase estimation as a screening diagnostic tool to detect diseases apart from acute pancreatitis. However, there is sparse literature on the role of serum and urine amylase, lipase levels, etc to help predict the specific intra-abdominal injury after blunt trauma abdomen (BTA. Aim: To elucidate the significance of elevation in the levels of amylase and lipase in serum and urine samples as reliable parameters for accurate diagnosis and management of blunt trauma to the abdomen. Materials and Methods: A prospective analysis was done on the trauma patients admitted in Jai Prakash Narayan Apex Trauma Center, AIIMS, with blunt abdomen trauma injuries over a period of six months. Blood and urine samples were collected on days 1, 3, and 5 of admission for the estimation of amylase and lipase, liver function tests, serum bicarbonates, urine routine microscopy for red blood cells, and complete hemogram. Clinical details such as time elapsed from injury to admission, type of injury, trauma score, and hypotension were noted. Patients were divided into groups according to the single or multiple organs injured and according to their hospital outcome (dead/discharged. Wilcoxon′s Rank sum or Kruskal-Wallis tests were used to compare median values in two/three groups. Data analysis was performed using STATA 11.0 statistical software. Results: A total of 55 patients with median age 26 (range, 6-80 years, were enrolled in the study. Of these, 80% were males. Surgery was required for 20% of the patients. Out of 55 patients, 42 had isolated single organ injury [liver or spleen or gastrointestinal tract (GIT or kidney]. Patients with pancreatic injury were excluded. In patients who suffered liver injuries, urine lipase levels on day 1, urine lipase/amylase ratio along with aspartate aminotransferase (AST, alanine aminotransferase (ALT, and alkaline phosphatase (ALP on days 1, 3, and 5, were found to

  20. Abdomen and spinal cord segmentation with augmented active shape models.

    Xu, Zhoubing; Conrad, Benjamin N; Baucom, Rebeccah B; Smith, Seth A; Poulose, Benjamin K; Landman, Bennett A

    2016-07-01

    Active shape models (ASMs) have been widely used for extracting human anatomies in medical images given their capability for shape regularization of topology preservation. However, sensitivity to model initialization and local correspondence search often undermines their performances, especially around highly variable contexts in computed-tomography (CT) and magnetic resonance (MR) images. In this study, we propose an augmented ASM (AASM) by integrating the multiatlas label fusion (MALF) and level set (LS) techniques into the traditional ASM framework. Using AASM, landmark updates are optimized globally via a region-based LS evolution applied on the probability map generated from MALF. This augmentation effectively extends the searching range of correspondent landmarks while reducing sensitivity to the image contexts and improves the segmentation robustness. We propose the AASM framework as a two-dimensional segmentation technique targeting structures with one axis of regularity. We apply AASM approach to abdomen CT and spinal cord (SC) MR segmentation challenges. On 20 CT scans, the AASM segmentation of the whole abdominal wall enables the subcutaneous/visceral fat measurement, with high correlation to the measurement derived from manual segmentation. On 28 3T MR scans, AASM yields better performances than other state-of-the-art approaches in segmenting white/gray matter in SC. PMID:27610400

  1. Endoluminal contrast for abdomen and pelvis magnetic resonance imaging.

    Gupta, Mohit K; Khatri, Gaurav; Bailey, April; Pinho, Daniella F; Costa, Daniel; Pedrosa, Ivan

    2016-07-01

    Magnetic resonance (MR) imaging of the abdomen and pelvis can be limited for assessment of different conditions when imaging inadequately distended hollow organs. Endoluminal contrast agents may provide improved anatomic definition and detection of subtle pathology in such scenarios. The available routes of administration for endoluminal contrast agents include oral, endorectal, endovaginal, intravesicular, and through non-physiologic accesses. Appropriate use of endoluminal contrast agents requires a thorough understanding of the clinical indications, available contrast agents, patient preparation, and interaction of the contrast agent with the desired MR imaging protocol. For example, biphasic oral enteric contrast agents are preferred in MR enterography as their signal properties on T1- and T2-weighted imaging allow for evaluation of both intraluminal and bowel wall pathology. In specific situations such as with MR enterography, MR defecography, and accurate local staging of certain pelvic tumors, the use of an endoluminal contrast agent is imperative in providing adequate diagnostic imaging. In other clinical scenarios, the use of an endoluminal contrast agent may serve as an indispensable problem-solving tool. PMID:26907710

  2. Hernia interna de Quain como causa de abdomen agudo

    M. García-Oria

    2012-12-01

    Full Text Available Presentamos el caso de una paciente de 47 años de edad que consulta en urgencias por un cuadro de 8 horas de evolución, de dolor abdominal continuo y difuso, acompañado de vómitos alimentarios al inicio y biliosos después. La paciente presenta estabilidad hemodinámica permaneciendo afebril. El hemiabdomen inferior presenta signos de irritación peritoneal. En los análisis destaca la presencia de neutrofilia y leucocitosis, la radiología simple de abdomen es compatible con suboclusión de intestino delgado, y la TAC de urgencia sugiere la posibilidad de torsión intestinal. La cirugía urgente realizada aprecia una hernia interna de un segmento de ileon de unos 25cm, a través de un orificio patológico en el lado derecho del ligamento ancho del útero. Se realiza resección del asa herniada que sufre necrosis isquémica y se cierra el orificio herniario para evitar la recidiva. El día 11 tras el ingreso, es dada de alta sin complicaciones.

  3. Abdome agudo por apendicite com apresentação atípica levando a choque em paciente obeso e hepatopata crônico = Acute abdomen due appendicitis with atypical presentation leading to shock in an obese patient and with chronic liver disease

    Todescatto, Alexandra Damasio

    2014-01-01

    Conclusões: O quadro de abdome agudo tem grande incidência nas unidades de pronto atendimento e, uma vez que compreende inúmeras situações clínicas, faz-se imprescindível conhecer e suspeitar de suas principais causas e de suas apresentações atípicas, de difícil diagnóstico.

  4. Abdome agudo por apendicite com apresentação atípica levando a choque em paciente obeso e hepatopata crônico =Acute abdomen due appendicitis with atypical presentation leading to shock in an obese patient and with chronic liver disease

    Todescatto, Alexandra Damasio

    2014-01-01

    Objetivos: Expor um caso de abdome agudo por apendicite cujo diagnóstico apresentou-se difícil e complicado devido ao perfil do paciente e suas comorbidades. Descrição do Caso: Paciente masculino, 52 anos, superobeso, tabagista e hepatopata crônico, com queixa de dor abdominal aguda em hipocôndrio direito, vômitos e baixa diurese. Inicialmente sem sinais de irritação peritoneal, foi manejado clinicamente, mas apresentou piora do quadro, evoluindo para choque e parada cardiorrespiratória. E...

  5. Acute intermittent porphyria in the puerperium

    Sparić Radmila

    2010-01-01

    Full Text Available Introduction. Acute intermittent porphyria emerges as a result of partial defect of porphobilinogen deaminase and is manifested by repeated episodes of somatic, psychiatric and neurological disorders. The disease is conducted via the autosomaldominant gene of variable penetration, so most of the carriers never experience seizures. Timely making of diagnosis, screening of blood relatives of the patient and education of patients on avoidance of provoking factors are the key to adequate treatment. Case Outline. A 23-year-old patient having born the third child was hospitalized due to pains in the abdomen and convulsive seizures nine days after the vaginal delivery. At admittance, she suffered a generalized convulsive seizure of clonic-tonic type. The patient immediately underwent a complete clinical, laboratory, bacteriological and ultrasound examination. Bearing in mind the fact that the patient had several convulsive seizures even after the given neurological therapy, haem-arginate was introduced into therapy during four days. The administration of haem-arginate led to the normalization of blood pressure, pulse and bowel function. The administration of haem-arginate led to the normalization of blood pressure, pulse and bowel function. The patient was treated by a team of doctors, in the intensive care ward, with the use of medicaments, which are allowed in the case of acute porphyria. Sixteen days after the admittance, with clean neurological status and gynaecological and ultra-sound findings, she was released for ambulatory treatment. Conclusion. The presented case exhibits the gravity of making a diagnosis of acute intermittent porphyria in puerperium and the necessity of multi-disciplinary approach in treating this disease. Acute intermittent porphyria should be considered in cases of ambiguous abdominal pain, as well as in patients having abdominal pains followed by neuro-psychiatric disorders.

  6. Ethylene evolution from pine seedlings due to acute UV-B exposure as a possible indicator of long-term radio-frequency electromagnetic radiation under natural conditions

    Acute stress treatment in the form of UV-B radiation was used to evaluate possible damage to pine trees caused by radio frequency electromagnetic radiation (RF EMR). While pine seedlings grow from seed material collected in sample plots with different RF EMR intensities had identical in vivo ethylene production rates, the degree of activation of ethylene biosynthesis by UV-B treatment in seedlings was proportional to the EMR intensity in the respective sample plots where the ancestor pine trees has grown. (author)

  7. Rationale behind high-dose amoxicillin therapy for acute otitis media due to penicillin-nonsusceptible pneumococci: support from in vitro pharmacodynamic studies.

    Lister, P D; Pong, A; Chartrand, S A; Sanders, C C

    1997-01-01

    To evaluate whether increased doses of amoxicillin should be used to treat acute pneumococcal otitis media, an in vitro pharmacokinetic model was used to evaluate the killing of pneumococci by amoxicillin when middle ear pharmacokinetics were simulated. Logarithmic-phase cultures were exposed to peak concentrations of 3, 6, and 9 microg of amoxicillin per ml every 12 h, and an elimination half-life of 1.6 h was simulated. Changes in viable bacterial counts were measured over 36 h. All three d...

  8. A successfully thrombolysed acute inferior myocardial infarction due to type A aortic dissection with lethal consequences: the importance of early cardiac echocardiography

    Bousoula Eleni

    2011-08-01

    Full Text Available Abstract Thrombolysis, a standard therapy for ST elevation myocardial infarction (STEMI in non-PCI-capable hospitals, may be catastrophic for patients with aortic dissection leading to further expansion, rupture and uncontrolled bleeding. Stanford type A aortic dissection, rarely may mimic myocardial infarction. We report a case of a patient with an inferior STEMI thrombolysed with tenecteplase and followed by clinical and electrocardiographic evidence of successful reperfusion, which was found later to be a lethal acute aortic dissection. Prognostic implications of early diagnosis applying transthoracic echocardiography (TTE are described.

  9. A Case of Hypopharyngeal Squamous Cell Carcinoma with Peritonead and Liver Metastasis Presenting Acute Abdomen

    Hashem Sharifian

    2009-01-01

    Full Text Available "nIntroduction: Squamous cell carcinoma (SCC of the head and neck is usually confined to local and regional sites but occasionally patients may present with rare manifestation of distant metastasis. We reported a case of hypopharyngeal SCC with liver and peritoneal metastasis. "nClinical picture: A 50-year-old female with advanced hypopharyngeal SCC was treated in this center by laryngoesophagectomy and gastric pull up. "nOne year later she presented with signs of bowel obstruction. CT scan showed an 11×15 centimeter mass with a large necrotic center in the peritoneal cavity which caused bowel obstruction. "n Some other necrotic masses were seen in the liver too. After surgery, histopathologic examination shows these masses are metastatic SCC. Abdominal fluid showed malignant cells. "nConclusion: These rare and aggressive presentations of SCC of the head and neck remind us that they may show atypical manifestations and may need more aggressive search of the distant disease in at least some subgroups of the head and neck carcinoma. "n"n  

  10. Acute and overuse injuries of the abdomen and groin in athletes.

    Atkins, Justin M; Taylor, Jonathan C; Kane, Shawn F

    2010-01-01

    Abdominal and groin injuries are common problems encountered by athletes across a wide variety of sports. They range from benign but annoying, such as exercise-related transient abdominal pain (ETAP), to the activity-limiting and possibly career-ending condition of athletic hernia. This article covers ETAP, rectus abdominus injuries, osteitis pubis, athletic hernia, and abdominal/groin hernias to provide an update on the current pathophysiology and treatment of common abdominal and pelvic conditions in the athlete. PMID:20220355

  11. Acute Abdomen Secondary to Incarcerated Umbilical Hernia after Treatment of Massive Cirrhotic Ascites

    Hiang Keat Tan; Pik Eu Chang

    2013-01-01

    Umbilical herniation is common in patients with liver cirrhosis and ascites. Rarely, they suffer from incarceration and strangulation of the umbilical hernia after treatment of ascites. We report 3 cases of umbilical hernia incarceration following removal of massive ascites with different treatment modalities. Physicians managing this group of patients should be aware of this rare and potentially fatal complication.

  12. Acute Abdomen Secondary to Incarcerated Umbilical Hernia after Treatment of Massive Cirrhotic Ascites

    Hiang Keat Tan

    2013-01-01

    Full Text Available Umbilical herniation is common in patients with liver cirrhosis and ascites. Rarely, they suffer from incarceration and strangulation of the umbilical hernia after treatment of ascites. We report 3 cases of umbilical hernia incarceration following removal of massive ascites with different treatment modalities. Physicians managing this group of patients should be aware of this rare and potentially fatal complication.

  13. Intussusception as an acute abdomen caused by non Hodgkin’s lymphoma: A rare case

    Tandon, Mrinal; Shah, Yunus; Gedam, B. S; Saxena, Divish; Bansode, Prasad

    2015-01-01

    In children, non-Hodgkin’s lymphoma has been found to be the lead point in intussusception involving the terminal ileum. We present here a case of ileal primary non-Hodgkin’s lymphoma which presented as intussusception, highlighting the  presentation of this patient, with a brief review of the literature.

  14. The changes of amylase and trypsin activities in rat after abdomen gamma irradiation

    The changes of amylase and trypsin activities in rat following local abdomen gamma irradiation were studied. The results showed that within a certain dose range, the activities of pancreatic enzymes decreased with the increase of doses and reached half of the normal value five days after local and fractional radiation with 30Gy on the abdomen, and maintained at the level below normal for a long time. The complete recovery of pancreatic enzyme activities occurred 120 days after local abdomen exposure. The mechanism of the decrease and recovery of pancreatic enzyme activity after exposure to radiation is briefly discussed

  15. A bypass case due to an acute inferior myocardial infarction caused by vascular occlusion of the left subclavian artery and left anterior descending artery

    Altas Y

    2016-07-01

    Full Text Available Yakup Altas, Ali Veysel Ulugg Department of Cardiology, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey Abstract: ST segment elevation is the most common electrocardiographic finding in acute myocardial infarction. ST elevation in chest leads generally represents left anterior descending artery occlusion, while elevation in DII and III, and aVF represents right coronary and circumflex artery occlusion. A female patient aged 66 years was admitted to our emergency service with ST elevation in leads DIII and aVF. A diagnosis of acute inferior myocardial infarction was made. The patient’s history included coronary artery bypass graft involving the left internal mammary artery to the left anterior descending coronary artery and aorta to the right coronary artery. The patient was taken to the cardiac catheterization laboratory for primary percutaneous coronary intervention and a lesion in the left anterior descending artery was identified. Additionally, the left subclavian artery was totally occluded. Following intervention to the lesion, the patient was discharged on day 4 of admission. Keywords: electrocardiography, myocardial infarction, coronary circulation

  16. Acute Pancreatitis Complicating Acute Hepatitis E Virus Infection: A Case Report and Review

    Hemanta Kumar Nayak

    2013-01-01

    Full Text Available Acute pancreatitis complicating fulminant viral hepatitis has been well recognized; however, acute pancreatitis occurring in nonfulminant hepatitis is very rare. The case presented describes moderate pancreatitis in a young male, manifesting during the course of nonfulminant acute hepatitis E infection. The diagnosis of acute viral hepatitis E was confirmed by serology and reverse transcriptase polymerase chain reaction (RT-PCR to demonstrate Hepatitis E virus (HEV RNA in both stool and serum. Patients with acute viral hepatitis presenting with severe abdominal pain should have a diagnosis of acute pancreatitis suspected and appropriate investigations including serum amylase, lipase, biliary ultrasonography and/or contrast-enhanced computed tomography of the abdomen should be undertaken. The identification of this unusual complication of Hepatitis E is important; however, the prognosis for patients with Acute Pancreatitis Complicating Acute Hepatitis E Virus Infection is good, and uncomplicated recovery with conservative treatment is expected.

  17. The Reversal of Stoma Following Open Abdomen Management.

    Yetişir, Fahri; Şarer, AkgünEbru; Acar, H Zafer; Çiftciler, Erdinç

    2016-06-01

    Bowel stoma formation is very often required during open abdomen (OA) management; we aim to report our stoma reversal series following OA management retrospectively. A retrospective analysis of 31 patients who underwent the reversal of the stoma created during OA management between January 2008 and September 2014 was performed. Twenty-eight of these 31 patients were included in this study. The stoma-related complications are more common after OA management during waiting time interval for reversal. At this time interval, patients with jejunostomy had more stoma-related complications than patients with ileostomy (p = 0.008) and colostomy. (p = 0.001). Waiting time interval was shorter for reversal of jejunostomy than reversal of ileostomy (p = 0.014) and colostomy (p = 0.001). Operation time for jejunostomy (p = 0.016) and colostomy reversal (p = 0.001) were significantly longer than the ileostomy reversal. There was no difference between early and late reversal of stoma regarding morbidity and mortality. The stoma-related complications are more common following OA management during waiting time interval for stoma reversal. The reversal time is more critical for this kind of patients especially with life-threatening complicated jejunostomy. For loop stoma created during OA management, the reversal may be performed after average 50 days without increasing morbidity and mortality. The reversal of end stoma created during OA management has high morbidity. If it is possible, loop stoma should be preferred during OA management. PMID:27358511

  18. Gross anatomy of superficial fascia and future localised fat deposit areas of the abdomen in foetus

    Pramod Kumar; Arvind Kumar Pandey; Brijesh Kumar; K S Aithal; Antony Sylvan Dsouza

    2013-01-01

    Background: The development and popularity of body contouring procedures such as liposuction and abdominoplasty has renewed interest in the anatomy of the superficial fascia and subcutaneous fat deposits of the abdomen. The study of anatomy of fascia and fetal adipose tissue was proposed as it may be of value in understanding the possible programing of prevention of obesity. Objectives: The present study was undertaken to understand the gross anatomy of superficial fascia of abdomen and to st...

  19. Computed Tomographic Study of Superficial Fascia of the Abdomen: Implication to Localized Fat Deposits (LFD) Areas

    Pandey AK; Kumar P; Radhakrishnan P; Kumar S; Kotian SR; D'Souza A; D'Souza AS

    2015-01-01

    Background: Superficial fascia of the abdomen, being a supportive structure plays a vital role in abdominal localized fat deposits (LFDs) as well as in surgical treatment of obesity. Interest in the anatomy of the superficial fascia is increasing with increasing popularity of surgical procedures for abdominal obesity. The study aims at computed tomographic evaluation and classification of the superficial fascia of abdomen & comparing with the earlier published cadaveric study. Materials and m...

  20. A case of functional non communicating rudimentary horn of unicornuate uterus presenting as persistent lump abdomen

    Sana Amrin

    2016-02-01

    Full Text Available Unicornuate uterus with a functional non communicating rudimentary horn is a rare congenital mullerian duct anomaly. It presents with various complaints like dysmenorrhoea, hematometra, endometriosis, lump in abdomen, infertility and even ectopic pregnancy. Here we present such a case which had undergone exploratory laparotomy in the past for lump in abdomen and now presented to us with persistence of lump even after surgery. [Int J Reprod Contracept Obstet Gynecol 2016; 5(2.000: 530-531

  1. Delayed primary closure in open abdomen with stoma using dynamic closure system

    Suarez-Grau, Juan Manuel; Guadalajara Jurado, Juan Francisco; Gómez Menchero, Julio; Bellido Luque, Juan Antonio

    2015-01-01

    Background The situation of abdominal sepsis secondary to colonic perforation sometimes forces treat the patient with multiple interventions in the open abdomen (OA) context. Correct management of OA is important to restore the patient’s clinical situation and to avoid further complications of the abdominal wall. Delayed primary closure of the abdomen using a dynamic and progressive traction is a relatively new technique for treating the OA. Case presentation We report the case of a 50 year o...

  2. Repair of radiation ulcus of the lower abdomen with groin flap

    Yoshimura, Y.; Harashina, T.; Tajima, S. (Keio Univ., Tokyo (Japan). School of Medicine); Suzuki, S.

    1980-08-01

    Two patients with radiation ulcers of the lower abdomen which had occurred after radiotherapy for cancer of the cervix uteri and was repaired with groin flap were reported. Effects of flaps in plastic and reconstructive surgery were also referred to. Besides defects in the lower abdomen, defects in the vulva, the perineum, and the upper region of the femur were probably reconstructed effectively with groin flaps.

  3. Repair of radiation ulcus of the lower abdomen with groin flap

    Two patients with radiation ulcus of the lower abdomen which had occurred after radiotherapy for cancer of the cervix uteri and was repaired with groin flap were reported. Effects of flaps in plastic and reconstructive surgery were also referred to. Besides defects in the lower abdomen, defects in the vulva, the perineum, and the upper region of the femur were probably reconstructed effectively with groin flaps. (Tsunoda, M.)

  4. Acute appendicitis complicated by mass formation occurring simultaneously with serologically proven dengue fever: a case report

    Senanayake, Manouri P; Samarasinghe, Malik

    2014-01-01

    Introduction Acute abdomen and acute appendicitis are unusual clinical presentations that occur in dengue infection–caused illness. Lymphoid hyperplasia and mesenteric adenitis are possible explanations, although vasculitis in the pathology of dengue infection has not been reported. Authors of previous case reports have described mimicking of acute appendicitis discovered upon surgical treatment. Dengue virus has not been proven to cause acute appendicitis. Case presentation We report a case ...

  5. Utilization of alteplase in trauma victim with an open abdomen

    Martin, Sharolyn L; Tellez, M Geno

    2011-01-01

    Trauma victims with multisystem injuries are at risk for the development of deep vein thrombosis and pulmonary embolus (PE). The use of thrombolytic therapy remains very controversial and not well-documented in both the postsurgical and trauma subset of patients. Major trauma, surgery or head injury have been noted as absolute contraindications to thrombolysis in acute myocardial infarction. The decision to utilize thrombolytic therapy cannot be algorithmic; it must be based on the assessment...

  6. Acute Generalized Exanthematous Pustulosis Induced by Cefepime: A Case Report

    L.F.F. Botelho

    2010-06-01

    Full Text Available Acute generalized exanthematous pustulosis (AGEP is a rare cutaneous rash characterized by widespread sterile nonfollicular pustules. Cefepime is a fourth generation cephalosporin, used to treat severe infections. A 67-year-old man was admitted with acute gastroenterocolitis. On the seventh day, the patient developed a nosocomial pneumonia and cefepime was initiated. On the fourth day of cephalosporin treatment, he presented with a maculopapular, pruritic eruption affecting the face, neck, abdomen and limbs. One day later he developed disseminated pustular lesions and his temperature was 37°C. Laboratory analysis evidenced leukocytosis and skin biopsy showed subcorneal pustule, edema in the papillary dermis, perivascular inflammatory infiltrate consisting of neutrophils, leukocytoclasia and red cell extravasation in the epidermis. Cefepime was suspended and within 4 days the non-follicular pustules cleared following a desquamation. AGEP is a disease attributed to a variety of causes, but in 90% of the cases it is due to an adverse drug reaction. Antibiotics are implicated in 80% of these cases, mostly penicillins and macrolides. There are few cases associated with cephalosporins. It is very important to consider AGEP in cases of acute pustular rashes and drugs should be investigated as causative agents.

  7. Dosimetric assessments multi-slice CT of the chest and abdomen in pediatrics; Evaluaciones dosimetricas en TC multicorte de torax y abdomen en pediatria

    Giner Sala, M.; Roch Gonzalez, M.; Rodriguez Martin, G.; Garcia Castanon, P.; Espana Lopez, M. L.

    2013-07-01

    The objective of this study is the dosimetry evaluation in pediatric MSCT of thorax and abdomen, and the estimation of effective dose in the different ranges of age taking into account the new ICRP recommendations, by variations that may be involved in explorations that affect breast. (Author)

  8. Acute lower respiratory tract infection due to respiratory syncytial virus in a group of Egyptian children under 5 years of age

    El-kholy Amany A

    2011-04-01

    Full Text Available Abstract Background and aim Respiratory syncytial virus (RSV is one of the most important causes of acute lower respiratory tract infections (ALRTI in infants and young children. This study was conducted to describe the epidemiology of ALRTI associated with RSV among children ≤ 5 years old in Egypt. Patients and Methods We enrolled 427 children ≤ 5 years old diagnosed with ALRTI attending the outpatient clinic or Emergency Department (ED of Children Hospital, Cairo University during a one- year period. Nasopharyngeal aspirates were obtained from the patients, kept on ice and processed within 2 hours of collection. Immunoflourescent assay (IFA for RSV was performed. Results 91 cases (21.3% had viral etiology with RSV antigens detected in 70 cases (16.4%. The RSV positive cases were significantly younger than other non-RSV cases (mean age 8.2 months versus 14.2 months, p Conclusion RSV is the most common viral etiology of ALRTI in children below 5 years of age, especially in young infants below 6 months of age. It is more prevalent in winter and tends to cause severe infection.

  9. Effectiveness of a drinking-motive-tailored emergency-room intervention among adolescents admitted to hospital due to acute alcohol intoxication: A randomized controlled trial

    Wurdak, M.; Wolstein, J.; Kuntsche, E.N.

    2016-01-01

    The aim of this study is to develop and test the effectiveness of a drinking-motive-tailored intervention for adolescents hospitalized due to alcohol intoxication in eight cities in Germany between December 2011 and May 2012 against a similar, non-motive-tailored intervention. In a randomized contro

  10. Analgesia en el paciente con abdomen agudo: ¿persiste el peligro? Analgesia in patients with acute abdomen: does danger persist?

    Juan Camilo Correa Gallego; Edward Alexander Blandón Castaño

    2006-01-01

    INTRODUCCIÓN: el dolor abdominal es un motivo de consulta frecuente. Dado que se presenta como el síntoma principal en diversas enfermedades y que existe la posibilidad de que se generen complicaciones si el diagnóstico no se establece oportunamente, ha habido renuencia a brindar analgesia en forma temprana en estos casos. Los cambios en el ejercicio médico actual permiten preguntarse si está aún justificada la conducta de mantener a estos pacientes sin analgesia. MATERIALES Y MÉTODOS: se rea...

  11. Effectiveness and safety of noninvasive positive-pressure ventilation for severe hypercapnic encephalopathy due to acute exacerbation of chronic obstructive pulmonary disease:a prospective case-control study

    ZHU Guang-fa; ZHANG Wei; ZONG Hua; XU Qiu-fen; LIANG Ying

    2007-01-01

    Background Although severe encephalopathy has been proposed as a possible contraindication to the use of noninvasive positive-pressure ventilation(NPPV),increasing clinical reports showed it was effective in patients with impaired consciousness and even coma secondary to acute respiratory failure,especially hypercapnic acute respiratory failure(HARF).To further evaluate the effectiveness and safety of NPPV for severe hypercapnic encephalopathy,a prospective case-control study was conducted at a university respiratory intensive care unit(RICU)in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)during the past 3 years.Methods Forty-three of 68 consecutive AECOPD patients requiring ventilatory support for HARF were divided into 2 groups,which were carefully matched for age,sex,COPD course,tobacco use and previous hospitalization history,according to the severity of encephalopathy,22 patients with Glasgow coma scale(GCS)0.05),but group A needed an average of 7 cmH2O higher of maximal pressure support during NPPV,and 4,4 and 7 days longer of NPPV time,RICU stay and hospital stay respectively than group B(P<0.05 or P<0.01).NPPV therapy failed in 12 patients(6 in each group)because of excessive airway secretions(7 patients),hemodynamic instability(2),worsening of dyspnea and deterioration of gas exchange(2),and gastric content aspiration(1).Conclusions Selected patients with severe hypercapnic encephalopathy secondary to HARF can be treated as effectively and safely with NPPV as awake patients with HARF due to AECOPD;a trial of NPPV should be instituted to reduce the need of endotracheal intubation in patients with severe hypercapnic encephalopathy who are otherwise good candidates for NPPV due to AECOPD.

  12. Topographic Locomotive Analysis of 99mTc-HDP Uptake of Acute Rhabdomyolysis and Musculotendinous Unit Injury due to Excessive Swimming Exercise in Novice: A Case Report

    Rhabdomyolysis (RM), also referred to as myonecrosis, is not an uncommon disorder of skeletal muscle, the incidence of which is on the increase as endurance tests, sports and body build have become popular. RM is divided into diffuse muscle fiber damage and musculotendinous unit (MTU) injury. A recent study by Crenshaw et al. revealed that muscular fiber damage caused by racing was associated with elevated intra-muscular pressure, capillary damage, and ischchemia. It is to be remembered that myocytes are mainly destroyed in RM whereas perimysial connective is predominantly damaged in myositis ossificans. When muscle fibers disrupt myoglobin escapes into extracellular fluid and plasma resulting in myoglobinemia and often acute renal failure. Plasma creatine phosphokinase level becomes elevated. We report a case of strenuous swimming-related RM that occurred in the muscles of the shoulder girdles and chest wall analyzed using magnified 9:9mTc-HDP bone scan. Of interest magnified bone scan of RM in the present case showed not only ordinary muscular injury but also MTU injury. MRI is useful in the study of soft tissue injury and in recent years sonography has also become increasingly used. As mentioned 99mTc-HDP bone scan, especially magnification scan, sensitively depicts metabolic change that occurred in injured muscles and tendons. Unless injury is trivial the bone scan nearly always reveals pathological uptake in a damaged muscle, MTU, and/or tendinous insertion permitting the topographic distinction of injury. Thus, the diagnosis of myolysis, MTU injury, and enthesitis can specifically be made when one uses magnification technique

  13. Prevalence of Acute Respiratory Infections in Women and Children in Western Sierra Leone due to Smoke from Wood and Charcoal Stoves

    Eldred Tunde Taylor

    2012-06-01

    Full Text Available Combustion of biomass fuels (wood and charcoal for cooking releases smoke that contains health damaging pollutants. Women and children are the most affected. Exposure to biomass smoke is associated with acute respiratory infections (ARI. This study investigated the prevalence of ARI potentially caused by smoke from wood and charcoal stoves in Western Sierra Leone, as these two fuels are the predominant fuel types used for cooking. A cross sectional study was conducted for 520 women age 15–45 years; and 520 children under 5 years of age in homes that burn wood and charcoal. A questionnaire assessing demographic, household and exposure characteristics and ARI was administered to every woman who further gave information for the child. Suspended particulate matter (SPM was continuously monitored in fifteen homes. ARI prevalence revealed 32% and 24% for women, 64% and 44% for children in homes with wood and charcoal stoves, respectively. After adjusting for potential confounders for each group, the odds ratio of having suffered from ARI was similar for women, but remained large for children in homes with wood stoves relative to charcoal stoves (OR = 1.14, 95%CI: 0.71–1.82 and (OR = 2.03, 95%CI: 1.31–3.13, respectively. ARI prevalence was higher for children in homes with wood stoves compared with homes with charcoal stoves, but ARI prevalence for both types of fuels is higher compared with reported prevalence elsewhere. To achieve a reduction in ARI would require switching from wood and charcoal to cleaner fuels.

  14. Topographic Locomotive Analysis of {sup 99m}Tc-HDP Uptake of Acute Rhabdomyolysis and Musculotendinous Unit Injury due to Excessive Swimming Exercise in Novice: A Case Report

    Bahk, Yong Whee; Jeon, Ho Seung [SungAe General Hospital, Seoul (Korea, Republic of)

    2008-12-15

    Rhabdomyolysis (RM), also referred to as myonecrosis, is not an uncommon disorder of skeletal muscle, the incidence of which is on the increase as endurance tests, sports and body build have become popular. RM is divided into diffuse muscle fiber damage and musculotendinous unit (MTU) injury. A recent study by Crenshaw et al. revealed that muscular fiber damage caused by racing was associated with elevated intra-muscular pressure, capillary damage, and ischchemia. It is to be remembered that myocytes are mainly destroyed in RM whereas perimysial connective is predominantly damaged in myositis ossificans. When muscle fibers disrupt myoglobin escapes into extracellular fluid and plasma resulting in myoglobinemia and often acute renal failure. Plasma creatine phosphokinase level becomes elevated. We report a case of strenuous swimming-related RM that occurred in the muscles of the shoulder girdles and chest wall analyzed using magnified {sup 9}:9{sup m}Tc-HDP bone scan. Of interest magnified bone scan of RM in the present case showed not only ordinary muscular injury but also MTU injury. MRI is useful in the study of soft tissue injury and in recent years sonography has also become increasingly used. As mentioned {sup 99m}Tc-HDP bone scan, especially magnification scan, sensitively depicts metabolic change that occurred in injured muscles and tendons. Unless injury is trivial the bone scan nearly always reveals pathological uptake in a damaged muscle, MTU, and/or tendinous insertion permitting the topographic distinction of injury. Thus, the diagnosis of myolysis, MTU injury, and enthesitis can specifically be made when one uses magnification technique.

  15. Effectiveness of a drinking-motive-tailored emergency-room intervention among adolescents admitted to hospital due to acute alcohol intoxication — A randomized controlled trial

    Wurdak, M.; Wolstein, J; Kuntsche, E.N.

    2015-01-01

    The aim of this study is to develop and test the effectiveness of a drinking-motive-tailored intervention for adolescents hospitalized due to alcohol intoxication in eight cities in Germany between December 2011 and May 2012 against a similar, non-motive-tailored intervention. In a randomized controlled trial, 254 adolescents received a psychosocial intervention plus motive-tailored (intervention group; IG) or general exercises (control group; CG). Adolescents in the IG received exercises in ...

  16. The Diagnostic Value of D-dimer, Procalcitonin and CRP in Acute Appendicitis

    Bulent Kaya, Baris Sana, Cengiz Eris, Koray Karabulut, Orhan Bat, Riza Kutanis

    2012-01-01

    Full Text Available BACKGROUND: The early diagnosis of acute abdomen is of great importance. To date, several inflammatory markers have been used for the diagnosis of acute abdominal conditions, including acute appendicitis. The aim of this study was to evaluate the diagnostic utility of D-dimer, Procalcitonin (PCT and C-reactive protein (CRP measurements in the acute appendicitis.METHODS: This prospective study was conducted between March 1st, 2010 and July 1st, 2011. In this period, seventy-eight patients were operated with the diagnosis of acute appendicitis, and D-dimer, PCT and CRP levels of the patients were measured. The patients were grouped as phlegmonous appendicitis (Group 1, gangrenous appendicitis (Group 2, perforated appendicitis (Group 3 and negative appendectomy (Group 4 according to the surgical findings and histopathological results.RESULTS: Of 78 patients, 54 (69.2 % were male and 24 (30.8 % were female, and the mean age was 25.4 ± 11.1 years (range, 18 to 69 years. 66 (84.6 % patients had increased leukocyte count (white blood cell count. The PCT values were higher than the upper normal limit in 20 (25.6% patients, followed by D-dimer in 22 (28.2 % patients and CRP in 54 (69.2 % patients. The diagnostic value of leukocyte count and CRP in acute appendicitis was higher than that of the other markers, whereas leukocyte count showed very low specificity. CRP values were higher in perforated appendicitis when compared with the phlegmonous appendicitis (p<0.05. However, PCT and D-dimer showed lower diagnostic values (26% and 31%, respectively.CONCLUSION: An increase in CRP levels alone is not sufficient to make the diagnosis of acute appendicitis. However, CRP levels may differentiate between phlegmonous appendicitis and perforated appendicitis. Due to their low sensitivity and diagnostic value, PCT and D-dimer are not better markers than CRP for the diagnosis of acute appendicitis.

  17. Acidosis láctica por metformina desencadenada por una insuficiencia renal aguda Metformin-induced lactic acidosis due to acute renal failure

    M.D. Macías-Robles

    2011-04-01

    Full Text Available La acidosis láctica es una complicación grave pero infrecuente asociada al empleo de metformina. Se discuten los mecanismos fisiopatológicos implicados en la acidosis láctica, con especial atención al papel potencial del fármaco. Presentamos un caso severo de este efecto secundario de la metformina en una paciente con diabetes tipo 2 que ingresó en el Servicio de Urgencias Hospitalario por un cuadro de insuficiencia renal aguda. El diagnóstico quedó apoyado por unos niveles séricos elevados de la biguanida, procedimiento escasamente utilizado en la práctica clínica. El tratamiento consiste en suspender la administración del fármaco e iniciar de forma inmediata la hemodiálisis con bicarbonato, lo cual proporciona un tratamiento sintomático y etiológico al eliminar del suero tanto el lactato como el antidiabético oral. Los síntomas de la acidosis láctica por metformina son inespecíficos y el comienzo es sutil, lo que hace necesario un alto nivel de sospecha para establecer un diagnostico precoz.Lactic acidosis is a serious but uncommon side effect of metformin use. We discuss the pathophysiological mechanisms of lactic acidosis with particular regard to the role played by the drug as a potential cause of the entity. We report on a severe case of this kind of drug toxicity in a patient with type 2 diabetes mellitus, admitted to the emergency department with acute renal failure symptoms. The diagnosis was supported by elevated serum levels of the biguanide, a procedure scarcely used in clinical practice. The management of this complication consists in drug discontinuation and hemodialysis with bicarbonate that provides symptomatic and ethiological treatment by removing both the lactate and the hypoglycemic agent from the serum. Since the symptoms of metformin-associated lactic acidosis are unspecific and its onset is subtle, a high level of suspicion is needed to establish an early diagnosis.

  18. Rapid parenteral rehydration in children with dehydration due to acute diarrheal disease Hidratación parenteral rápida en pacientes deshidratados por enfermedad diarreica aguda

    Myriam Bastidas

    1989-03-01

    Full Text Available

    Between May and July 1987, we studied 36 children with second or third degree dehydration secondary to acute diarrheal disease of less than one week duration; they had no serious associated problems. Parenteral rehydration was carried out with a solution similar in composition to the one recommended by the World Health Organization for Oral Rehydration Therapy (ORT. Rehydration was achieved in 30 patients within 6 hours and In 3 more within 12 hours; there were no cases of hypernatremia or hyperkalemia. It is concluded that parenteral rehydration with a solution similar to the one employed for ORT is an adequate alternative when oral rehydration is not indicated in children with diarrheal disease.

    Entre mayo y julio de 1987 se estudiaron 36 niños que ingresaron al Hospital Infantil de Medellín con deshidratación de segundo o tercer grado, secundaria a enfermedad diarreica de evolución menor de una semana y sin enfermedad grave asociada. La hidratación se llevó a cabo parenteralmente empleando una mezcla de composición similar a la que recomienda la Organización Mundial de la Salud para la Terapia de Rehidratación Oral (TRO. Se logró la hidratación en un lapso de 6 horas en 30 de los 36 pacientes y en 3 más en las siguientes 6 horas; no se produjeron casos de hipernatremia ni de hiperkalemia. Se concluye que la hidratación parenteral, con una solución de composición similar a la de la TRO, es una alternativa adecuada cuando no está indicada la hidratación oral del niño con enfermedad diarreica.

  19. Dose to organs at risk in the upper abdomen in patients treated with extended fields by helical tomotherapy: a dosimetric and clinical preliminary study

    The aim of this work was to determine the technical feasibility and safety of extended-field radiotherapy (EF), performed by Helical TomoTherapy, in patients with positive pelvic and/or para-aortic nodes. Dosimetric data were collected and acute and sub-acute toxicities of the upper abdominal organs at risk (OAR) were evaluated. Twenty-nine patients suitable for EF irradiation for local disease and/or nodal disease in the pelvic or para-aortic area were treated. The prescription dose was 50.4/54 Gy (1.7-1.8 Gy/fraction) for prophylactic lymph nodes (N-) and 60–70.5 Gy (2–2.35 Gy/fraction) for clinically evident gross disease (N+). Modulation factor (MF), pitch and field width (FW) were chosen to optimize dose distribution and treatment duration. Dose values of PTVs and OAR were analysed. The length of the treatment field, the N + and N- volumes, and treatment duration were reported. To evaluate the safety of treatment, haematological, hepatic, renal and pancreatic functions were assessed before, during and after treatment. The median follow-up time was 17.6 months (range: 6–22 months). The treatment was well tolerated and all patients but one completed treatment without interruption. Four of the 29 patients experienced G3 haematological acute toxicity (13.8%), but no patient experienced sub-acute grade G3 toxicity. Ten patients experienced G1 and three G2 acute gastrointestinal toxicity (nausea). No sub-acute gastrointestinal or renal toxicity was observed. Only one (3.7%) patient had a persistent slight increase of pancreatic enzymes and two (7.4%) patients a slight increase of hepatic enzymes six months after radiotherapy (G1 toxicity). With our treatment design and dose regimen, we found that EF treatment by TomoTherapy could be safely and effectively delivered with minimal acute and sub-acute toxicities in the upper abdomen area

  20. Surgical treatment of acute pancreatitis

    Klose, K.J.; Neher, M.; Kuhn, F.P.; Kuemmerle, F.; Thelen, M.

    1983-03-31

    The diagnosis of acute pancreatitis is based on anamnestic, clinical and chemical data. Ultrasound and computed tomography permit direct visualisation of the pancreas and establish the diagnosis. In cases of haemorrhagic-necrotising pancreatitis they demonstrate the extent of morphological changes and permit exclusion of other causes of an acute abdomen. The imaging methods support indications for operation in cases of subtotal or total parenchymatous necrosis and in pancreatic abscesses. Conservative expectant approaches in patients with severe clinical course and slight morphological changes as well as in agreement of clinical and morphological findings are facilitated. Complete demonstration of parenchymatous and peripancreatic necroses furnishes useful additional information for total extirpation. Gallstone disease can be demonstrated or excluded preoperatively. Since introduction of ultrasound and computed tomography for the diagnosis of acute pancreatitis a marked diminution of early surgical intervention and delayed operation has been achieved.