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https://www.readbyqxmd.com/read/28104974/rare-manifestation-of-digoxin-toxicity-right-bundle-branch-block
#1
Dalvir Gill, Samana Zaidi
A 76-year-old female, with medical history significant for systolic congestive heart failure, who presented to the emergency department with lethargy and abdominal pain with diarrhea for the past 3 weeks. Due to hypotension, the patient received multiple boluses of isotonic saline and was started on norepinephrine. Laboratories were significant for severe digoxin toxicity (29 ng/mL), in setting of acute kidney injury. Electrocardiogram (EKG) revealed a new right bundle branch block (RBBB). She was given Digibind and her repeat digoxin level was 20 ng/mL...
December 2016: Journal of Basic and Clinical Pharmacy
https://www.readbyqxmd.com/read/28104139/a-renal-paratransplant-hernia-causing-complete-small-bowel-obstruction-a-case-report-and-review-of-the-literature
#2
T Zingg, H Teixeira Farinha, N Demartines, M Pascual, M Matter
A rare type of acquired internal hernia, the renal paratransplant hernia (RPTH), of which only 11 cases have been reported in the literature so far, can follow renal transplantation. We report a patient who presented with acute abdominal pain and vomiting 6 weeks after renal transplantation in the right iliac fossa. A noncontrast abdominal computed tomography scan showed signs of small bowel obstruction. The patient was taken to the operating room for a midline laparotomy, and RPTH with incarcerated small bowel was diagnosed...
January 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/28102481/perforation-of-jejunal-diverticulum-with-ectopic-pancreas
#3
Hiroshi Shiratori, Takeshi Nishikawa, Yukako Shintani, Koji Murono, Kazuhito Sasaki, Koji Yasuda, Kensuke Otani, Toshiaki Tanaka, Tomomichi Kiyomatsu, Keisuke Hata, Kazushige Kawai, Hiroaki Nozawa, Soichiro Ishihara, Masashi Fukayama, Toshiaki Watanabe
Perforation of jejunal diverticulum is a rare complication. Here, we report a case of jejunal diverticulum penetration with surrounding ectopic pancreas. An 83-year-old female patient was admitted to our department with acute onset of severe abdominal pain lasting for half a day. Abdominal computed tomography showed outpouching of the small intestine that contained air/fluid, with multiple surrounding air bubbles in the mesentery of the small intestine. She was diagnosed with penetration of the small intestine, and an emergency laparotomy was indicated...
January 19, 2017: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/28100951/an-unusual-cause-of-duodenal-obstruction-persimmon-phytobezoar
#4
Shengxian Fan, Jing Wang, Yousheng Li
Duodenal phytobezoar, an unusual cause of acute duodenal obstruction, is rarely seen. The most common cause of this type of bezoar is persimmon. It frequently arises from underlying gastrointestinal tract pathologies (gastric surgery, etc.). Here, we report the case of a 66-year-old man who had undergone distal gastrectomy with Billroth I reconstruction for gastric cancer and experienced severe epigastric discomfort, abdominal pain, and vomiting for a few days. The abdominal computed tomography scan showed a large-sized mass in the horizontal portion of the duodenum...
December 2016: Indian Journal of Surgery
https://www.readbyqxmd.com/read/28100060/boerhaave-s-syndrome-diagnostic-gastroscopy
#5
Rocío Ferreiro-Iglesias, Manuel Narciso Blanco Freire, Manuel Paz Novo, J Enrique Domínguez Muñoz
A 47-year-old man was attended at the emergency room for severe chest pain after eating sausage with subsequent vomiting and mild upper gastrointestinal bleeding. In the chest radiography we could not see abnormalities. He referred previous episodes of choking without consulting. The urgent gastroscopy detected tertiary contractile activity (nutcracker esophagus) and a foreign body in the lower third of the esophagus. After removing the food bolus, we observed a 4 cm longitudinal tear compatible with esophageal rupture or Boerhaave's syndrome in the right posterior wall of the lower esophagus, proximal to the gastroesophageal junction...
January 2017: Revista Española de Enfermedades Digestivas
https://www.readbyqxmd.com/read/28093873/diagnostic-and-management-challenges-from-childhood-puberty-through-to-transition-in-severe-insulin-resistance-due-to-insulin-receptor-mutations
#6
Christina Wei, Christine P Burren
Two Caucasian girls, both of normal weight and body mass indices, were diagnosed with type A insulin resistance (IR) in childhood. Case 1 presented with premature adrenarche aged 7 years, then by age 12 years had hirsutism, acne, acanthosis nigricans, and asymptomatic diabetes. Subsequent investigation revealed raised adiponectin (15.3 mg/L) and heterozygous p.Pro1205Leu mutation in the INSR gene encoding the insulin receptor. She experienced postprandial hypoglycaemia on metformin; acarbose was trialled and discontinued aged 16 years, as she became normoglycaemic...
January 17, 2017: Pediatric Diabetes
https://www.readbyqxmd.com/read/28093134/management-of-clostridium-difficile-infection-in-inflammatory-bowel-disease-expert-review-from-the-clinical-practice-updates-committee-of-the-aga-institute
#7
REVIEW
Sahil Khanna, Andrea Shin, Ciarán P Kelly
The purpose of this expert review is to synthesize the existing evidence on the management of Clostridium difficile infection in patients with underlying inflammatory bowel disease. The evidence reviewed in this article is a summation of relevant scientific publications, expert opinion statements, and current practice guidelines. This review is a summary of expert opinion in the field without a formal systematic review of evidence. Best Practice Advice 1: Clinicians should test patients who present with a flare of underlying inflammatory bowel disease for Clostridium difficile infection...
February 2017: Clinical Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/28092257/-chilaiditi-s-sign-and-syndrome-case-report
#8
César Raúl Aguilar-García, Jesús García-Acosta
The interposition of a portion of the colon between the liver and the diaphragm is called Chilaiditi sign and discovered incidentally during radiological study for other reasons and usually asymptomatic presentation. When the discovery is accompanied by clinical symptoms such as abdominal pain, nausea, vomiting, bloating, constipation called Chilaiditi Syndrome. The Chilaiditi sign is a very rare condition, and the Chilaiditi syndrome is even more, especially if associated with other acute diseases. We report the case of a man of 41 years was admitted with right upper quadrant abdominal pain, nausea, vomiting, difficulty was diagnosed with radiographic and tomographic images making the differential diagnosis with lung abscess and diaphragmatic hernia...
January 2017: Revista Médica del Instituto Mexicano del Seguro Social
https://www.readbyqxmd.com/read/28090187/recurrent-intestinal-obstruction-in-a-patient-with-selective-iga-deficiency
#9
Chee-Kin Hui
A 32 year old woman presented with acute onset of abdominal pain and fever. An urgent computerised tomography (CT) of the whole abdomen showed dilated loop at the terminal ileum in the right lower abdomen with thickening of the wall and oedema. The CT was suggestive of distal small bowel obstruction at the ileum with surrounding wall oedema. Multiple biopsies taken from the terminal ileum and colon on colonoscopy were all unremarkable. She represented one-year later with a recurrence of intestinal obstruction...
November 2016: Malaysian Journal of Medical Sciences: MJMS
https://www.readbyqxmd.com/read/28079834/intestinal-brucellosis-associated-with-celiac-artery-and-superior-mesenteric-artery-stenosis-and-with-ileum-mucosa-and-submucosa-thickening-a-case-report
#10
Miaoqian Wang, Qingli Zhu, Qian Yang, Wenbo Li, Xinning Wang, Wei Liu, Baotong Zhou, Zhenghong Li, Hong Yang
RATIONALE: Brucellosis is a multisystem infection found worldwide that has a broad range of characteristics, which range from acute fever and hepatomegaly to chronic infections that most commonly affect the central nervous system, cardiovascular system, or skeletal system. Gastrointestinal and splanchnic artery involvements in brucellosis are relatively uncommon. PATIENT CONCERNS: We report a case of brucellosis in an adolescent presenting as intermittent abdominal pain, diarrhea, and fever, with intestinal tract involvement...
January 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28079612/thrombopoietin-as-early-biomarker-of-disease-severity-in-patients-with-acute-pancreatitis
#11
Enrico Lupia, Luca Pigozzi, Emanuele Pivetta, Ornella Bosco, Barbara Vizio, Maria Loiacono, Manuela Lucchiari, Stefania Battista, Fulvio Morello, Corrado Moiraghi, Giulio Mengozzi, Giuseppe Montrucchio
OBJECTIVES: To study the concentrations of thrombopoietin (TPO), a growth factor recently involved in the pathogenesis of experimental acute pancreatitis (AP), and its potential role as an early diagnostic and prognostic biomarker in patients with AP. METHODS: Thrombopoietin was measured in 44 AP patients, 18 patients with nonpancreatic acute abdominal pain, and 18 healthy volunteers. Acute pancreatitis severity was classified on the basis of the 2012 International Atlanta Symposium on Acute Pancreatitis criteria...
February 2017: Pancreas
https://www.readbyqxmd.com/read/28078172/gastric-rupture-in-pregnancy-case-series-from-a-tertiary-institution-in-rwanda-and-review-of-the-literature
#12
David Ntirushwa, Stephen Rulisa, Febronie Muhorakeye, Lisa Bazzett-Matabele, Theogene Rurangwa, Maria Small
Background Gastric rupture is a rare, life-threatening condition during pregnancy. Case study We present three cases of gastric perforation during pregnancy and the puerperium. The first patient presented with gastric perforation 4 days following an uncomplicated cesarean delivery for obstetric indications. She initially complained of epigastric pain; however, those symptoms resolved. She later demonstrated worsening abdominal distension, intra-abdominal free fluid, and signs of peritonitis. At laparotomy, an ascariasis-associated gastric rupture was diagnosed...
October 2016: American Journal of Perinatology Reports
https://www.readbyqxmd.com/read/28075196/typhlitis-neutropenic-enterocolitis-in-patients-with-acute-leukemia-a-review
#13
Rodrigo Portugal, Marcio Nucci
Typhlitis is an abdominal complication of cancer chemotherapy, affecting mostly patients receiving intensive chemotherapeutic regimens with high potential to induce mucosal damage, such as patients with acute leukemia. Despite being relatively frequent, there are no randomized trials or high-quality cohort studies addressing important aspects of the diagnosis and management of the disease. Areas covered: In this review we discuss the gaps in the literature, acknowledging that the evidences for recommendations regarding the management of typhlitis are mostly expert opinion...
January 11, 2017: Expert Review of Hematology
https://www.readbyqxmd.com/read/28074461/acute-appendicitis-during-pregnancy-case-series-of-20-pregnant-women
#14
İlker Murat Arer, Songül Alemdaroğlu, Hasan Yeşilağaç, Hakan Yabanoğlu
BACKGROUND: Acute appendicitis (AA) is the most common cause of acute abdomen during pregnancy. Most of the signs of appendicitis are also found during normal pregnancy period, however, and diagnosis of appendicitis during pregnancy remains challenging. The aim of the current study was to report our clinical experience of AA during pregnancy and investigate optimal management of this difficult situation. METHODS: Records of 20 pregnant women with diagnosis of AA who underwent appendectomy between 2005 and 2015 were included in this study...
November 2016: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
https://www.readbyqxmd.com/read/28074452/hemoptysis-caused-by-pulmonary-sequestration-in-perforated-appendicitis-a-rare-case-report
#15
Dario Tartaglia, Francesca Cascione, Matteo Modesti, Desiree Gianardi, Rosilde Caputo, Christian Galatioto, Massimo Chiarugi
Pulmonary sequestration is a rare and usually asymptomatic congenital anomaly. Optimal management of this condition is still a subject of debate, including superiority of surgical resection or angiographic embolization of the aberrant arterial vessel. Presently described is rare case of a 51-year-old male who presented with hemoptysis related to pulmonary sequestration associated with acute right lower quadrant abdominal pain caused by perforated appendicitis.
November 2016: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
https://www.readbyqxmd.com/read/28071630/ovarian-tumors-in-children-10-year-experience-from-a-tertiary-care-center-in-south-india
#16
B Rajeswari, M Nair, A Ninan, K Parukuttyamma
BACKGROUND: Ovarian tumors are uncommon in childhood and constitute around 1% of childhood malignancies. Two thirds of pediatric ovarian tumors are germ cell tumors. Epithelial ovarian tumors and stromal tumors are less frequent. We share our experience in childhood ovarian cancers, analyzing a series of cases with respect to the clinical profile, treatment and survival. METHODS: All newly diagnosed ovarian tumors in children up to 14 years of age, registered in our Pediatric Oncology Division between January 2000 and December 2009 were retrospectively reviewed...
April 2016: Indian Journal of Cancer
https://www.readbyqxmd.com/read/28065368/a-randomised-clinical-trial-of-routine-versus-selective-ct-imaging-in-acute-abdomen-impact-of-patient-age-on-treatment-costs-and-hospital-resource-use
#17
Tiina T Lehtimäki, Hannu Valtonen, Pekka Miettinen, Petri Juvonen, Hannu Paajanen, Ritva Vanninen
OBJECTIVES: To evaluate the impact of patient age on hospital resource use and treatment costs of acute abdominal pain (AAP). MATERIALS AND METHODS: A total of 300 adult patients with AAP were randomised to either computed tomography (CT, n=150) or selective imaging practice (SIP, n=150) groups. Final analysis included 254 patients, 143 (42 patients ≥65years) in the CT and 111 (32 patients ≥65years) in the SIP group. All CT group patients underwent abdominal CT whereas in the SIP group, imaging was based on the clinical assessment...
February 2017: European Journal of Radiology
https://www.readbyqxmd.com/read/28062419/contained-ruptured-abdominal-aortic-aneurysm-presenting-as-cauda-equina-syndrome
#18
Serge A Engamba, Dovile Garaleviciene, Jonathan Baldry
This is the case report of a contained ruptured aortic aneurysm presenting with acute cauda equina syndrome. The patient was a 79-year-old man. A literature search revealed various unusual presentations of abdominal aortic aneurysm (AAA), including femoral neuropathy, hip pain and others; however, there are no other reports of cauda equina-like syndrome. The present case is therefore another unusual presentation of ruptured abdominal aortic aneurysm and reiterates the utmost importance of careful history taking and clinical examination...
January 6, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28062078/-coexistence-of-acute-appendicitis-and-dengue-fever-a-case-report
#19
Juan Fidel Osuna-Ramos, Carlos Silva-Gracia, Gerardo Joel Maya-Vacio, Alejandra Romero-Utrilla, Efrén Rafael Ríos-Burgueño, Jesús Salvador Velarde-Félix
BACKGROUND: Dengue is the most important human viral disease transmitted by mosquitoes. It can be asymptomatic or it can present in any of its 3clinical forms: Dengue fever, dengue haemorrhagic fever and dengue shock syndrome. However, some atypical manifestations have been reported in surgical emergencies caused by acute appendicitis in patients with dengue fever. CLINICAL CASE: We report the case of an 18-year-old Mexican male who presented to the emergency department of the General Hospital of Culiacan, Sinaloa, with symptoms of dengue fever, accompanied by crampy abdominal pain with positive Rovsing and Dunphy signs...
January 3, 2017: Cirugia y Cirujanos
https://www.readbyqxmd.com/read/28060696/acute-pancreatitis-and-posterior-reversible-encephalopathy-syndrome-a-case-report
#20
Vítor Magno Pereira, Luís Marote Correia, Tiago Rodrigues, Gorete Serrão Faria
The posterior reversible encephalopathy syndrome is a neurological syndrome characterized by headache, confusion, visual disturbances and seizures associated with identifiable areas of cerebral edema on imaging studies. The authors report the case of a man, 33 years-old, leukodermic with a history of chronic alcohol and tobacco consumption, who is admitted to the emergency department for epigastric pain radiating to the back and vomiting with about six hours of evolution and an intense holocranial headache for two hours...
September 2016: Acta Médica Portuguesa
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