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Index of suspicion

Osher Cohen, Arthur Baazov, Inbal Samuk, Michael Schwarz, Dragan Kravarusic, Enrique Freud
BACKGROUND: Wandering spleen is a rare entity that may pose a surgical emergency following torsion of the splenic vessels, mainly because of a delayed diagnosis. Complications after surgery for wandering spleen may necessitate emergency treatment. OBJECTIVES: To describe the clinical course and treatment for children who underwent emergency surgeries for wandering spleen at a tertiary pediatric medical center over a 21 year period and to indicate the pitfalls in diagnosis and treatment as reflected by our experience and in the literature...
June 2018: Israel Medical Association Journal: IMAJ
B Finlay, T Ramachandren, K Hussey, S Parkyn, K Meyer, K Barrett
Despite being recognised and reported in the literature for decades, subungual melanoma of the foot remains a diagnostic pitfall, with it commonly being mistaken for benign conditions. We present an interesting case of delayed diagnosis of subungual melanoma of the hallux that was misdiagnosed in the community for over one year. With melanoma being the fourth most commonly diagnosed cancer in Australia in 2013, this case serves as a reminder to all clinicians about the importance of maintaining a high index of suspicion for melanoma of the foot...
January 1, 2018: Scottish Medical Journal
Georgios Nikolakaros, Timo Kurki, Janina Paju, Sokratis G Papageorgiou, Risto Vataja, Tuula Ilonen
Background: Non-alcoholic Wernicke's encephalopathy and Korsakoff syndrome are greatly underdiagnosed. There are very few reported cases of neuropsychologically documented non-alcoholic Korsakoff syndrome, and diffusion tensor imaging (DTI) data are scarce. Methods: We report clinical characteristics and neuropsychological as well as radiological findings from three psychiatric patients (one woman and two men) with a history of probable undiagnosed non-alcoholic Wernicke's encephalopathy and subsequent chronic memory problems...
2018: Frontiers in Psychiatry
Parikshaa Gupta, Nalini Gupta, Amanjit Bal, Inderpaul Singh Sehgal, Valliappan Muthu, Arvind Rajwanshi
Thoracic endometriosis is the presence of endometrial tissue in the pleura, lung parenchyma and/or airways. It is an extremely rare occurence and is challenging to diagnose clinically due to variable clinical presentations. A high index of clinical suspicion and recognition of the association of the clinical symptoms with menstruation is important to establish a clinical diagnosis of pleural endometriosis. The definitive diagnosis requires tissue diagnosis, demonstrating the presence of endometrial tissue in pleura, either by cytological or histopathological examination...
June 14, 2018: Cytopathology: Official Journal of the British Society for Clinical Cytology
Himanshu Suri, Carrie Dougherty
PURPOSE OF REVIEW: This article provides an overview of headache in the setting of pituitary adenoma. The purpose of this article is to educate providers on the association, possible pathophysiology, and the clinical presentation of headache in pituitary tumor. RECENT FINDINGS: Recent prospective evaluations indicate that risk factors for development of headache in the setting of pituitary adenoma include highly proliferative tumors, cavernous sinus invasion, and personal or family history of headache...
June 15, 2018: Current Pain and Headache Reports
Giuseppe Tarantini, Alberto Barioli, Luca Nai Fovino, Chiara Fraccaro, Giulia Masiero, Sabino Iliceto, Massimo Napodano
BACKGROUND: Invasive physiological assessment of myocardial bridges (MBs) is largely unsettled. Unlike fractional flow reserve (FFR), instantaneous wave-free ratio (iFR) is a diastole-specific index. As such, its value might not be hampered by systolic pressure overshooting and negative systolic pressure gradient caused by the compression of the tunneled coronary artery. METHODS AND RESULTS: We prospectively enrolled 20 patients with angina and/or positive noninvasive stress test, absence of significant coronary artery stenosis, and angiographic suspicion/evidence of MB in the left anterior descending artery...
June 2018: Circulation. Cardiovascular Interventions
Irene Andaluz García, Cristina Suárez Ferrer, Pedro Mora Sanz
We report the case of a male with no medical history with acute cholangitis secondary to a pancreatic head´s mass suggestive of neoplasm. An EUS-FNA was performed where no atypical cells were identified but a granulomatous component did. The patient was finally diagnosed of disseminated tuberculosis with pancreatic involvement. Pancreatic tuberculosis is an infrequent entity that requires a high index of suspicion due to the variability of its forms of presentation and the high morbidity and mortality without targeted therapy...
June 14, 2018: Revista Española de Enfermedades Digestivas
Ronaldo Rodrigues da Costa, Suzane Fernandes da Silva, Romário Costa Fochat, Raquel Leite Macedo, Thamiris Vilela Pereira, Marcio Roberto Silva, Carmen Perches Gomide Pinto, Isabel Cristina Gonçalves Leite
OBJECTIVE: To compare the performance of the Ogawa-Kudoh method with the modified Petroff technique in diagnosis of pulmonary tuberculosis. METHODS: A total of 205 sputum samples from 166 patients with clinical suspicion or under pulmonary tuberculosis follow-up, seen at a public tertiary care hospital, from July 2014 to July 2016 were used. All samples were simultaneously processed using the Ogawa-Kudoh and modified Petroff decontamination methods, according to the recommendations of the Ministry of Health...
June 11, 2018: Einstein
Lakshmy Ravi Selvaraj, Nity Rose, Meenakshi Ramachandran
Cesarean scar pregnancy (CSP) is a rare kind of ectopic pregnancy implanted in the previous cesarean scar and has an increasing incidence over the past 30 years. As the suspicion is low, the diagnosis may be delayed or misinterpreted in ultrasound, leading to treatment strategies that might end up in uterine rupture or hysterectomy. The objective here is to review the ultrasound findings in CSP with varied presentations. Transabdominal and transvaginal sonography combined with color Doppler is a reliable tool for the diagnosis of CSP...
June 2018: Journal of Obstetrics and Gynaecology of India
Swasti Shubham, Arvind Ahuja, Minakshi Bhardwaj
Filariasis is traditionally diagnosed on finding microfilaria in peripheral blood smear and in cases of occult filariasis by immunological tests. Clinically, it presents with a wide range of symptoms and signs. We present two cases of filariasis presenting with renal symptoms warranting kidney biopsy. Histopathology of both revealed microfilaria in the glomerular capillary loop. First case was a 23-year-old male who presented with complaints of passage of milky urine. Second case was a 36-year-old female patient who presented with complaints of gross hematuria...
June 9, 2018: Journal of Infection and Public Health
Aysha Aslam, Ammu Susheela, Sentia Iriana, Suzanne S Chan, Daryl Lau
Reactivation of chronic hepatitis B (CHB) can be associated with significant morbidity and mortality. There are many different causes of hepatitis B reactivation. This case describes an Asian woman with stable CHB presenting with significant hepatitis flare with markedly elevated serum aminotransferases and hepatitis B virus DNA level. The clinical symptoms were subtle with fatigue and vague right upper quadrant tenderness. We ruled out drug-associated hepatotoxicity and screened for common causes of acute hepatitis...
June 10, 2018: BMJ Case Reports
Matthis Synofzik, Andrea H Németh
Recessive ataxias (spinocerebellar ataxias, recessive or SCARs) are a heterogeneous group of rare, mostly neurodegenerative genetic disorders which usually start in childhood or early adult life. They can be subdivided into two major groups: predominant sensory or afferent ataxias, which are disorders mainly of the peripheral input to the cerebellum, and predominant cerebellar ataxias, in which the cerebellum is primarily affected. Next-generation sequencing technology has enabled the identification of >100 novel SCAR genes in the last 5 years, although most of them are ultrarare...
2018: Handbook of Clinical Neurology
Chi-Hao Liu, An-Hang Yang, Shuo-Ming Ou, Der-Cherng Tarng
Cytomegalovirus (CMV) infection is a common infectious complication in immunocompromised patients. The colon is the most common site of CMV infection in the gastrointestinal tract. Rarely, however, invasion of the upper gastrointestinal tract, such as the esophagus or stomach, has been reported. Herein, we describe the first reported case of CMV gastritis in a patient with end-stage renal disease and uremic symptoms (including nausea, vomiting, and poor appetite) who had begun hemodialysis therapy. This patient was not a transplant recipient and was not receiving immunosuppressant treatment...
June 2018: American Journal of the Medical Sciences
Manesh Kumar Gangwani, Salman B Mahmood, Fariha Hasan, Javaid A Khan
Constrictive pericarditis is a rare presentation. We need a very high index of clinical suspicion to diagnose the disease. It most commonly presents secondary to tuberculosis (TB) in the developing world and post-radiation therapy in the developed world. Classically, it presents with symptoms of heart failure and as pericardial thickening or calcification on imaging studies. In hospital settings, constrictive pericarditis is not usually considered as a differential in patients presenting with pleural effusion...
April 9, 2018: Curēus
Paula Sánchez-Moreno, Peter Olbrich, Lola Falcón-Neyra, Jose Manuel Lucena, Javier Aznar, Olaf Neth
INTRODUCTION: Development of secondary haemophagocytic lymphohistiocytosis (sHLH) in the context of typhoid fever (TF) is a very rare but serious complication. METHODS: Description of the first pediatric case of typhoid fever acquired in a non-endemic area complicated by sHLH. A systematic literature review of sHLH in the context of TF was performed with extraction of epidemiological, clinical and laboratory data. RESULTS: The literature search revealed 17 articles (22 patients)...
June 7, 2018: Enfermedades Infecciosas y Microbiología Clínica
Angel A Escobedo, Pedro Almirall, Kurt Hanevik, Sérgio Cimerman, Alfonso J Rodríguez-Morales, Caridad Almanza, Jhossmar Auza-Santivañez
Although Giardia, the aetiological agent of giardiasis, is one of the most prevalent intestinal parasitic infections world-wide, for industrialised countries, it is mainly appreciated as an imported disease with the minimal local transmission. However, the current evidence challenges this perception; Giardia has relevance beyond the high prevalence areas. This infection may be asymptomatic or cause gastrointestinal complains and long-term sequelae, including irritable bowel syndrome, chronic fatigue and impaired child growth and cognitive development...
June 11, 2018: Epidemiology and Infection
Irene Tsappa, Constantinos Missouris, Savvas Psarellis
Acyclovir has been used in the treatment of herpes simplex and varicella zoster viral infections for over 30 years. The side effects of oral treatment at standard doses are rare and include headache, diarrhoea, dizziness and malaise. We report a patient with a new diagnosis of systemic lupus erythematosus (SLE) who developed thrombocytopaenia within days on a therapeutic dose with acyclovir. Prompt discontinuation of acyclovir and treatment with intravenous immunoglobulin resulted in reversal of the above potentially serious complication...
June 8, 2018: BMJ Case Reports
Shameel Musthafa, Zia Aftab, Syed Muhammad Ali, Maneesh Khanna
Gallbladder volvulus (GBV) due to rotation of the gall bladder (GB) around its own mesentery is a rare surgical emergency and often identified intraoperatively. Typically, cholecystitis is the initial clinical diagnosis, but a high index of suspicion on imaging can alert the physician for the possibility of GBV requiring urgent surgical intervention. We describe a case of a young female patient with hypoplasia/atrophy of the posterior segment of the right liver lobe and a GB with no hepatic attachments but only mesenteric pedicle...
June 8, 2018: BMJ Case Reports
Kausar Jabeen, Jagadeeswari Karuppaswamy
The aim of this paper is to review the diagnosis and treatment of patients with a caesarean scar pregnancy (CSP), who have been managed at our unit, as well as to evaluate the effectiveness of the non-surgical treatment options. Twenty-six cases were identified over a period of 5 years and 4 months (January 2012 until April 2017). The main outcome measures were a number of previous caesarean births, a method of diagnosis of CSP, the mode of treatment and the outcome. The diagnostic criteria on the ultrasound were an empty uterine cavity and cervical canal, the presence of a gestational sac anterior to the isthmic portion of the uterus, an absent or thinned (<5 mm) myometrial thickness between the gestational sac and the bladder, with a peri-trophoblastic circulation around the gestational sac with the colour flow Doppler examination...
June 8, 2018: Journal of Obstetrics and Gynaecology: the Journal of the Institute of Obstetrics and Gynaecology
Saeed Koaban, Raheef Alatassi, Nawaf Alogayyel
INTRODUCTION: Surgical drains are inserted into the wound after an arthroscopic knee procedure mainly to decrease fluid collection after the operation. The use of postoperative surgical drains remains controversial. CASE PRESENTATION: This report presents a rare case of a forgotten retained drain that was accidentally found inside a knee 10 years after an arthroscopic procedure. The drain was removed without any complications. DISCUSSION: A retained and broken drain during removal is a very rare and preventable complication that can be stressful for both the patient and surgeon...
May 29, 2018: International Journal of Surgery Case Reports
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