- Is positive oral contrast material necessary for computed tomography in patients with suspected acute abdomen? [Journal Article]
- RRadiologia 2018 Nov 26
- The number of computed tomography studies done in emergency departments has increased substantially, and with this increase the controversy about whether positive oral contrast agents are necessary i...
The number of computed tomography studies done in emergency departments has increased substantially, and with this increase the controversy about whether positive oral contrast agents are necessary in all patients has also grown. The great image quality provided by multidetector computed tomography scanners, the increase in intraabdominal fat (as a natural element that provides contrast for separating the bowel loops) related with the increased prevalence of obesity in the population, and the potential drawbacks associated with the use of high-density oral contrast agents argue against the generalized us of these agents. This article aims to evaluate the effects of omitting the use of this type of oral contrast material for computed tomography examinations required in the emergency department for suspicion of acute abdominal pathology through an efficient literature search among recent publications.
- Retroperitoneal extramedullary plasmacytoma: A case report and review of the literature. [Case Reports]
- MMedicine (Baltimore) 2018; 97(46):e13281
- CONCLUSIONS: Retroperitoneal extramedullary plasmacytoma (EMP) is a rare condition that is frequently a diagnostic challenge, mainly due to its unusual location and nonspecific symptoms, especially in the early stages. The diagnosis of EMP is made through a combination of imaging and pathological examination. Presently, the combinations of radiotherapy and surgery or radiotherapy are the primary treatments, usually leading to an acceptable local control rate. The application of chemotherapy, however, should be carefully considered.
- Successful rescue of acute liver failure and hemophagocytic lymphohistiocytosis following varicella infection: A case report and review of literature. [Journal Article]
- WJWorld J Clin Cases 2018 Nov 06; 6(13):659-665
- Herein we report a case of acute liver failure (ALF) and hemophagocytic lymphohistiocytosis (HLH) induced by varicella infection, successfully rescued by a combination therapy of acyclovir, supportiv...
Herein we report a case of acute liver failure (ALF) and hemophagocytic lymphohistiocytosis (HLH) induced by varicella infection, successfully rescued by a combination therapy of acyclovir, supportive care, and immunosuppression with dexamethasone and etoposide. A previously healthy 16-year-old boy presented with generalized rash, fever, severe abdominal pain, and abnormal liver function within 4 d. Chickenpox was suspected, and acyclovir and intravenous immunoglobulin were started on admission. However, the patient's condition deteriorated overnight with soaring transaminases, severe coagulopathy and encephalopathy. On the fourth day of admission, pancytopenia emerged, accompanied by hypofibrinogenemia and hyperferritinemia. The patient was diagnosed with ALF. He also met the diagnostic criteria of HLH according to the HLH-2004 guideline. Polymerase chain reaction (PCR) amplifications of varicella-zoster virus (VZV) were positive, confirming that VZV was a causative trigger for ALF and HLH. In view of the devastating immune activation in HLH, immunosuppression therapy with dexamethasone and etoposide was administered, in addition to high dose acyclovir. The patient's symptoms improved dramatically and he finally made a full recovery. To our knowledge, this is only the second report of a successful rescue of ALF associated with HLH, without resorting to liver transplantation. The first case was reported in a neonate infected by herpes simplex virus-1. However, survival data in older children and adults are lacking, most of whom died or underwent liver transplantation. Our report emphasizes the clinical vigilance for the possible presence of HLH, and the necessity of extensive investigation for underlying etiologies in patients presenting with indeterminate ALF. Early initiation of specific therapy targeting the underlying etiology, and watchful immunosuppression such as dexamethasone and etoposide, together with supportive therapy, are of crucial importance in this life-threatening disorder.
- Intraoperative catheter directed thrombolytic therapy for the treatment of superior mesenteric and portal Vein thrombosis. [Journal Article]
- IJInt J Surg Case Rep 2018 Oct 05; 53:242-245
- CONCLUSIONS: The management of SMV can be divided into medical and surgical therapy. Patients who have clear signs of peritonitis will require emergent surgery. Interventions for life-threatening portal vein thrombosis are limited and poorly described in the literature.We report a case of extensive portal vein thrombosis(PVT) advancing proximally to involve the superior mesenteric vein. Rapid portal vein patency and improved hepatic function was achieved with the direct use of tissue plasminogen activator infusion via operatively placed middle colic vein catheter.
- A Challenging Diagnosis of Ascites: A Case Report of Peritoneal Tuberculosis. [Journal Article]
- CRCase Rep Infect Dis 2018; 2018:8136476
- Approximately 2 billion people, which is about one third of the world's population, are infected with tuberculosis (TB). Around 10% of infected people will develop active TB at one point in their lif...
Approximately 2 billion people, which is about one third of the world's population, are infected with tuberculosis (TB). Around 10% of infected people will develop active TB at one point in their lifetime. We present a rare case of a 68-year-old male who presented to the emergency department with a 2-week progressive dyspnea. In addition, the patient complained of generalized weakness, subjective fevers, and abdominal pain in the right upper quadrant. Ascites was noted on physical exam, and the patient underwent a diagnostic paracentesis with initial workup that was unrevealing for underlying etiology. Abdominal computed tomography was done, which revealed peritoneal carcinomatosis. He underwent omental biopsy which showed necrotizing granulomatous inflammation with rare acid-fast bacilli. Repeat biopsy was culture positive for mycobacterium tuberculosis complex. The patient was started on rifampin, isoniazid, pyrazinamide, and ethambutol with improvement of his symptoms days after treatment was started. This case demonstrates how the diagnosis of peritoneal tuberculosis can be elusive. Physicians must be aware of this disease and its behavior in high risk patients, also of the current diagnostic limitations.
- Case report: dual primary AIDS-defining cancers in an HIV-infected patient receiving antiretroviral therapy: Burkitt's lymphoma and Kaposi's sarcoma. [Journal Article]
- BCBMC Cancer 2018 Nov 08; 18(1):1080
- CONCLUSIONS: These findings suggest that multiple ADCs can occur in PWHA who are receiving HAART and have successful virologic suppression. Healthcare providers caring for PWHA should maintain vigilance for the development of a broad spectrum of cancers.
- Development and validation of a diagnostic prediction model distinguishing complicated from uncomplicated diverticulitis. [Journal Article]
- SJScand J Gastroenterol 2018 Nov 05; :1-7
- CONCLUSIONS: This proposed prediction model can safely rule out complicated diverticulitis. Clinical practitioners could cautiously use this model to aid them in the decision whether or not to subject patients to further secondary care diagnostics or treatment.
- [Application of purse string suture with Harmonious Clips and Olympus endoloop in single channel endoscopy for large gastric antrum mucosa defect]. [Journal Article]
- ZYZhonghua Yi Xue Za Zhi 2018 Oct 16; 98(38):3074-3078
- Objective: To evaluate the feasibility and safety of purse string suture with Harmonious Clips and Olympus endoloop in single channel endoscopy for large gastric antrum mucosa defect. Methods: A to...
Objective: To evaluate the feasibility and safety of purse string suture with Harmonious Clips and Olympus endoloop in single channel endoscopy for large gastric antrum mucosa defect. Methods: A total of 33 patients who underwent ESD of gastric antrum in single channel endoscopy at the First people's Hospital of Wujiang District from January 2015 to April 2018 were retrospectively analyzed. Everyone had one lesion, and the diameters were all more than 3 cm. After the resection and hemostasis, purse string suture with Harmonious Clips and Olympus endoloop or no suture in study group (n=16) and the control group (n=17). The degree of abdominal pain, postoperative gastrointestinal decompression time, incidence of delayed hemorrhage, postoperative hospital stay and the healing rate were observed and compared. Results: All patients successfully completed resection, no perforation occurred, and all the lesions were resected completely in one time. All patients in the study group were sutured successfully. The abdominal pain score on the first day after operation was (2.7±0.7) in the study group, and (3.6±0.8) in the control group(t=3.686, P=0.001). The mean time of postoperative gastrointestinal decompression was (1.6±0.5) days in the study group, while (2.4±0.7) days in the control group(t=3.675, P=0.001). No delayed bleeding occurred in the study group, while 5 cases in the control group had delayed bleeding. The rate of delayed hemorrhage was 29.4% in control group, 4 cases successfully achieved hemostasis through endoscopy therapy, 1 case was given surgical intervention after ineffective endoscopic hemostasis(P=0.044). The average postoperative hospital stay were (6.2±1.1) days and (5.9±2.0) days respectively (t=0.423, P=0.675). Two months after the operation, the two groups of patients reviewed the gastroscopy, the results showed that, all wounds in the study group were healed completely, the healing rate was 100%. There were 6 cases of incomplete wound healing in the control group, the healing rate was 64.7%(P=0.018). No recurrence was found after 6 months of operation through reviewing gastroscopy. Conclution: It indicates good feasibility and efficacy about the purse string suture with Harmonious Clip and Olympus endoloop in single channel endoscopy for large gastric antrum mucosa defect. It is safe and reliable, worth of being generalized.
- [The Hungarian adaptation of the Pregnancy Related Thoughts scale measuring pregnancy related anxiety]. [Journal Article]
- OHOrv Hetil 2018; 159(43):1754-1760
- CONCLUSIONS: The Hungarian version of the Pregnancy Related Thoughts can be a useful instrument for mapping pregnancy anxiety in Hungary. Orv Hetil. 2018; 159(43): 1754-1760.
New Search Next
- An unusual finding of obstructive jaundice-a case report and review of the literature. [Journal Article]
- OMOxf Med Case Reports 2018; 2018(11):omy088
- Biliary ascariasis is a tropical infectious disease, endemic in regions such as the Far East, Indian subcontinent and parts of the Middle East. The responsible organism is the Ascaris lumbricoides wo...
Biliary ascariasis is a tropical infectious disease, endemic in regions such as the Far East, Indian subcontinent and parts of the Middle East. The responsible organism is the Ascaris lumbricoides worm. This case study presents a 54-year-old British Caucasian female patient, admitted with a 1-week history of generalized abdominal pain. Ultrasound scan of the abdomen showed a collapsed and abnormal image of the gallbladder. Further imaging for better visualization by magnetic resonance cholangiography showed a 6 cm linear structure in the gallbladder. The morphology was characteristic of gallbladder ascariasis. Detailed history revealed that 6 months ago she had travelled to Turkey. Stool cultures confirmed the presence of ascaris eggs. She was treated conservatively with a 500 mg stat dose of Mebendazole. She was followed up in 6 weeks showing complete resolution of her symptoms.