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https://www.readbyqxmd.com/read/29337450/-emergency-medicine-update-2017
#1
Frédéric Rouyer, Fabrice Dami, Olivier Grosgurin, Valériane Rossier, Majd Ramlawi, Mathieu Pasquier, Olivier T Rutschmann
Emergency medicine is part of the current stream of efficient and qualitative medicine : 1) the modified Valsava maneuver results in the resolution of almost 50% of supra-ventricular tachycardia without any drug; 2) lung echography performed by emergency physicians is a very sensitive and specific diagnostic tool for most thoracic emergencies; 3) cardiopulmonary resuscitation initiated by lay-rescuers improves short and long-term outcome; 4) no anticoagulant treatment is warranted in distal deep vein thrombosis and 5) systematic unenhanced abdominal CT might improve evaluation of elderly patients with acute abdominal pain...
January 10, 2018: Revue Médicale Suisse
https://www.readbyqxmd.com/read/29335232/smartphone-app-using-mindfulness-meditation-for-women-with-chronic-pelvic-pain-memphis-protocol-for-a-randomized-feasibility-trial
#2
Elizabeth Ball, Sian Newton, Brennan C Kahan, Gordon Forbes, Neil Wright, Clara Cantalapiedra Calvete, Harry A L Gibson, Ewelina Rogozinska, Carol Rivas, Stephanie J C Taylor, Judy Birch, Julie Dodds
BACKGROUND: Female chronic pelvic pain (CPP) is defined as intermittent or constant pelvic or lower abdominal pain occurring in a woman for at least 6 months. Up to a quarter of women are estimated to be affected by CPP worldwide and it is responsible for one fifth of specialist gynecological referrals in the United Kingdom. Psychological interventions are commonly utilized. As waiting times and funding capacity impede access to face-to-face consultations, supported self-management (SSM) has emerged as a viable alternative...
January 15, 2018: JMIR Research Protocols
https://www.readbyqxmd.com/read/29333014/is-colorectal-cancer-in-young-40-years-different-from-those-in-the-elderly-40-years-experience-from-a-regional-care-center
#3
Rudresha A Haleshappa, Suparna Ajit Rao, Sunny Garg, C Lakshmaiah Kuntegowdanahalli, Govinda Babu Kanakasetty, Lokanatha Dasappa
Background: Colorectal cancer (CRC) is considered a disease of elderly. There has been a steady decrease in the incidence in those aged >50 years, with an alarming increase noted in adults aged <50 years. Subjects and Methods: We retrospectively analyzed 89 patients diagnosed with CRC aged <40 years between the years 2010 and 2014. Their clinical profile, treatment, and outcomes were studied. Results: The median age was 33 years with a male preponderance (56...
October 2017: Indian Journal of Medical and Paediatric Oncology
https://www.readbyqxmd.com/read/29330194/telotristat-ethyl-in-carcinoid-syndrome-safety-and-efficacy-in-the-telecast-phase-3-trial
#4
Marianne E Pavel, David J Gross, Marta Benavent, Petros Perros, Raj Srirajaskanthan, Richard R P Warner, Matthew H Kulke, Lowell Anthony, Pamela Kunz, Dieter Hörsch, Martin O Weickert, Pablo Lapuerta, Wenjun Jiang, Kenneth Kassler-Taub, Suman Wason, Rosanna Fleming, Douglas Fleming, Rocio García-Carbonero
Telotristat ethyl, a tryptophan hydroxylase inhibitor, was efficacious and well tolerated in the Phase 3 TELESTAR study in patients with carcinoid syndrome (CS) experiencing ≥4 bowel movements per day (BMs/day) while on somatostatin analogs (SSAs). TELECAST, a Phase 3 companion study, assessed safety and efficacy of telotristat ethyl in patients with CS (diarrhea, flushing, abdominal pain, nausea, or elevated urinary 5-hydroxyindoleacetic acid [u5-HIAA]) with <4 BMs/day on SSAs (or ≥1 symptom or ≥4 BMs/day if not on SSAs) during a 12-week double-blind treatment period followed by a 36-week open-label extension (OLE)...
January 12, 2018: Endocrine-related Cancer
https://www.readbyqxmd.com/read/29328792/identification-and-management-of-nontraumatic-splenic-rupture
#5
Samanthi De Silva
A 43-year old previously fit and well gentleman presented to the emergency department (ED) with a two day history of worsening epigastric pain. He had had coryzal symptoms the preceding week but had no other past medical history. He was haemodynamically stable at presentation and an ultrasound scan (US) performed in the ED could not definitively rule out intra-abdominal fluid. In view of his tender abdomen on examination and a haemoglobin level of 9.2g/dL, a computerised tomography (CT) scan was performed and revealed extensive high-density fluid within the peritoneal cavity, raising the possibility of a concealed bleed but no obvious source was identified by the scan...
December 2017: Journal of Perioperative Practice
https://www.readbyqxmd.com/read/29324631/pediatric-appendicitis-association-of-chief-complaint-with-missed-appendicitis
#6
Zachary Drapkin, Jennifer Dunnick, Troy E Madsen, Matthew Bryce, Jeff E Schunk
OBJECTIVES: We evaluated the association between the emergency department (ED) triage chief complaint and rate of missed appendicitis in children. METHODS: We performed a retrospective chart review of patients who presented to a pediatric ED and were diagnosed with appendicitis over 5 years (July 1, 2009 to June 30, 2014). We reviewed the medical record for any additional ED visits in the 7 days preceding the diagnosis of appendicitis. Triage chief complaints were classified as "suggestive of appendicitis" (abdominal pain, right lower quadrant pain, or rule out appendicitis) or "nonspecific" (fever, vomiting, dehydration, etc)...
January 11, 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29323836/segmental-arterial-mediolysis-an-unusual-case-mistaken-to-be-a-strangulated-hernia
#7
Russell D Japikse, James E Sevenson, Perry J Pickhardt, Michael D Repplinger
INTRODUCTION: Segmental arterial mediolysis (SAM) is a rare nonatherosclerotic, noninflammatory vasculopathy causing arterial wall necrosis that leads to strictures, dissections, and aneurysms, particularly in medium-sized abdominal arteries. Awareness of SAM is important because, unlike vasculitides, immunosuppressive treatment may worsen the disease process. CASE: A 58-year-old man with multiple medical comorbidities presented with acute epigastric pain and a right incarcerated inguinal hernia that was interpreted as showing bowel strangulation on computed tomography...
August 2017: WMJ: Official Publication of the State Medical Society of Wisconsin
https://www.readbyqxmd.com/read/29321946/clinical-and-radiologic-considerations-for-idiopathic-superior-mesenteric-artery-syndrome
#8
Mina S Makary, Anand Rajan, Anthony M Aquino, Suresh K Chamarthi
Superior mesenteric artery (SMA) syndrome often occurs in the setting of rapid weight loss and scoliosis corrective spinal surgery. A reduction of fat around the third part of the duodenum can predispose the duodenum to compression and obstruction by the SMA as it emerges from the abdominal aorta. In this report, we describe this underdiagnosed condition in a previously healthy young female presenting with progressive post-prandial emesis, non-specific abdominal pain, and weight loss. A critical review of this disease process is explored to highlight pathology, imaging characteristics, and essential alternative diagnostic considerations...
November 5, 2017: Curēus
https://www.readbyqxmd.com/read/29320323/multimodality-imaging-including-dual-energy-ct-in-the-evaluation-of-gallbladder-disease
#9
Lisa Ratanaprasatporn, Jennifer W Uyeda, Jeremy R Wortman, Ian Richardson, Aaron D Sodickson
Imaging of the gallbladder has a key role in the examination of patients with abdominal pain-especially pain localized to the right upper quadrant. Pathologic conditions that affect the gallbladder include cholelithiasis and associated complications such as acute and chronic cholecystitis, choledocholithiasis, gallstone pancreatitis, and cancer. Modalities used to image the gallbladder include ultrasonography (US), computed tomography (CT), magnetic resonance (MR) imaging, and nuclear scintigraphy. US is the primary imaging modality used to evaluate entities suspected of being gallbladder disease, as it is both sensitive and specific for demonstrating gallstones, biliary duct dilatation, and inflammatory features...
January 2018: Radiographics: a Review Publication of the Radiological Society of North America, Inc
https://www.readbyqxmd.com/read/29316583/-foreign-body-ingestion-a-rare-cause-of-abdominal-pain
#10
Philipp Kasper, Fabian Kütting, Hans Anton Schlößer, Stefan Paul Mönig, Tobias Goeser, Natalie Jaspers
HISTORY AND FINDINGS UPON ADMISSION:  A 50-year-old man presented at the emergency unit with abdominal pain in the right lower quadrant and dysuria. He described an increase in pain during micturition. EXAMINATIONS:  After multiple examinations (CT-scan, MR-scan, ileocolonoscopy) were performed to no avail, a toothpick was detected in the terminal ileum during an ultrasound scan of the small intestine. Prompted elevation of intra-abdominal pressure led to migration of the radiolucent sharp foreign body into the wall of the urinary bladder, inducing pain...
January 2018: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/29310972/porto-mesenteric-venous-thrombosis-after-laparoscopic-sleeve-gastrectomy-a-case-report-and-systematic-review-of-the-104-cases
#11
Kerem Karaman, Mehmet Aziret, Ali Bal, Volkan Öter, Metin Ercan, Erdal Birol Bostancı
INTRODUCTION: Porto-mesenteric venous thrombosis (PMVT) is a rare but fatal complication after bariatric surgery. However, an increasing number of PMVT complications have been observed in the last years after laparoscopic sleeve gastrectomy (LSG) operations. CASE REPORT: A 35-year-old male was admitted to the emergency clinic in a septic status with a sudden once of abdominal pain and vomiting. The patient underwent laparoscopic sleeve gastrectomy (LSG) 15 days ago...
January 5, 2018: Obesity Research & Clinical Practice
https://www.readbyqxmd.com/read/29310444/safety-of-galcanezumab-in-patients-with-episodic-migraine-a-randomized-placebo-controlled-dose-ranging-phase-2b-study
#12
Tina Marie Myers Oakes, Vladimir Skljarevsuki, Qi Zhang, William Kielbasa, Michael E Hodsdon, Holland C Detke, Angelo Camporeale, Joel R Saper
Background Safety findings from a Phase 2b study of galcanezumab, a humanized monoclonal antibody against calcitonin gene-related peptide, for prevention of migraine (NCT02163993) are reported here. Methods Patients aged 18-65 years with episodic migraine were evaluated in this multicenter, double-blind, randomized study. After randomization, 410 patients were administered 5, 50, 120 or 300 mg of galcanezumab or placebo subcutaneously once every 4 weeks for 12 weeks, followed by a post-treatment off-drug period lasting 12 weeks...
January 1, 2018: Cephalalgia: An International Journal of Headache
https://www.readbyqxmd.com/read/29306650/common-weight-loss-procedures-and-their-complications
#13
REVIEW
Maria S Altieri, Brian Wright, Andrew Peredo, Aurora D Pryor
BACKGROUND: As the number of obese patients in the United States continues to grow, there is a parallel increase in the number of bariatric surgery patients. A quarter of these patients will return to the Emergency Department (ED) within the first two years of the index procedure. OBJECTIVE: An understanding of the most common bariatric procedures and their related complications will greatly aide the Emergency Medicine physician in the care of these patients. DISCUSSION: Abdominal pain is the most common reason for bariatric patients to present to the ED and can represent a diagnostic challenge to EM physicians...
December 2, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29306266/learning-curve-and-period-of-experience-required-for-the-competent-diagnosis-of-acute-appendicitis-using-abdominal-computed-tomography-a-prospective-observational-study
#14
Ju-Hyun Song, Hajin Cho, Jong-Hak Park, Sungwoo Moon, Joo Yeong Kim, Su-Jin Kim, Sung-Hyuk Choi
OBJECTIVE: To assess the learning curve of novice residents in diagnosing acute appendicitis using abdominal computed tomography (CT) scans. METHODS: This prospective observational study was conducted within a 4-month period from March 1 to June 30, 2015. After CT scans for right lower quadrant pain or similar acute abdomen were evaluated, postgraduate year 1 (PGY-1) residents completed an interpretation checklist. The primary outcome was evaluation of the learning curve for competent CT scan interpretation under suspicion of acute appendicitis...
December 2017: Clinical and Experimental Emergency Medicine
https://www.readbyqxmd.com/read/29305305/the-safety-and-efficacy-of-the-procedureless-intragastric-balloon
#15
Salman Alsabah, Eliana Al Haddad, Shehab Ekrouf, Ahmad Almulla, Saud Al-Subaie, Mubarak Al Kendari
BACKGROUND: Obesity is on a continuous rise worldwide, and with it, novel bariatric procedures have emerged. The introduction of gastric balloons has opened up a nonsurgical option for patients opting for it. However, they still require some form of sedation and endoscopy for insertion and/or removal. OBJECTIVES: The Elipse balloon is a novel creation that has managed to bypass both these procedures; therefore, the investigation into its effectiveness is of importance...
December 9, 2017: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
https://www.readbyqxmd.com/read/29305081/extending-knowledge-of-the-clinical-picture-of-balkan-adder-vipera-berus-bosniensis-envenoming-the-first-photographically-documented-neurotoxic-case-from-south-western-hungary
#16
Csaba Varga, Tamás Malina, Viktória Alföldi, Gergely Bilics, Ferenc Nagy, Tibor Oláh
We report a severe envenoming associated with minimal local symptoms following a Balkan adder (Vipera berus bosniensis) bite in South-Western Hungary. A 63-year-old male with a history of hypertension and sinus bradycardia (45/min) was bitten by a sub-adult specimen of V. b. bosniensis in Somogy County on 04 May 2017. The patient was transported to and treated at the Emergency Department of Somogy County "Moritz Kaposi" General Hospital, Kaposvár. Locally only pain and minimal swelling with a small haematoma developed on the bitten finger...
January 2, 2018: Toxicon: Official Journal of the International Society on Toxinology
https://www.readbyqxmd.com/read/29303111/chronic-implantation-of-cuff-electrodes-on-the-pelvic-nerve-in-rats-is-well-tolerated-and-does-not-compromise-afferent-or-efferent-fibre-functionality
#17
Jonathan J Crook, Charly Brouillard, Pedro Irazoqui, Thelma Lovick
Objective Neuromodulation of autonomic nerve activity to regulate physiological processes is an emerging field. Vagal stimulation has received most attention whereas the potential of modulate visceral function by targeting autonomic nerves within the abdominal cavity remains under-exploited. Surgery to locate intra-abdominal targets is inherently more stressful than for peripheral nerves. Electrode leads risk becoming entrapped by intestines and loss of functionality in the nerve-target organ connection could result from electrode migration or twisting...
January 5, 2018: Journal of Neural Engineering
https://www.readbyqxmd.com/read/29298793/spontaneous-rupture-of-uterine-smooth-muscle-tumour-presenting-acute-abdominal-pain-and-haemoperitoneum
#18
Hanako Oda, Hiroshi Hirakawa
Uterine smooth muscle tumours are histologically categorised into benign leiomyoma, malignant leiomyosarcoma or smooth muscle tumours of uncertain malignant potentials (STUMPs).1 Common symptoms of uterine tumours are hypermenorrhea, dysmenorrhea, lumbago or irregular genital bleeding. We experienced a case of uterine tumour with atypical clinical behaviour. A 40-year-old woman who had been diagnosed with leiomyoma presented with severe abdominal pain and intraperitoneal haemorrhage. By emergent surgery, we found that the uterine tumour had ruptured spontaneously...
January 3, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29291540/open-splenectomy-for-varicella-zoster-induced-spontaneous-splenic-rupture
#19
Mark Christopher Sykes, Bilal Azhar, Laurence John, Salman Bokhari
INTRODUCTION: Here we present a case of atraumatic splenic rupture secondary to varicella infection requiring emergency splenectomy. The presentation was as would be expected for epstein barr virus (EBV) related splenic injury, which is well documented in the literature. Dermatological findings however suggested varicella zoster, and viral serology subsequently confirmed the diagnosis. PRESENTATION OF CASE: A young Romanian male presented to the emergency department with peritonism without preceding trauma...
December 24, 2017: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/29290506/thigh-emphysema-as-the-initial-presentation-of-colon-ischemia
#20
Chin-Chuan Hsu, Ping-Yuan Chen, Chih-Cheng Lai
The incidence of colon ischemia has increased in recent years, and is associated with high morbidity and mortality. The typical presentations of colon ischemia include abdominal pain, bloody diarrhea, and in severe case, ileus, fever and peritonitis. Here, we document a rare case of colon ischemia presenting with subcutaneous and intramuscular emphysema of the thigh. A 76-year-old woman presented to the emergency department for left thigh pain for three days. Physical examination revealed tenderness without obvious crepitus, erythema or swelling over the left groin area and a soft abdomen without tenderness...
December 6, 2017: American Journal of Emergency Medicine
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