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International Journal of Surgery Case... 2016Spontaneous esophageal perforation, or Boerhaave's syndrome, is a life-threating condition which usually requires emergent surgery. An upside down stomach is defined as...
INTRODUCTION
Spontaneous esophageal perforation, or Boerhaave's syndrome, is a life-threating condition which usually requires emergent surgery. An upside down stomach is defined as a gastric volvulus in a huge supradiaphragmatic sac. In general, this condition can result in ischemia and perforation of the stomach. This is the first report of a patient with Boerhaave's syndrome and an upside down stomach.
CASE PRESENTATION
A 79-year-old woman presented with sudden epigastric pain following hematemesis. Evaluation of the patient showed both an esophageal perforation and an upside down stomach. Surgical drainage and irrigation of the mediastinum and pleural cavities were undertaken emergently. Due to the concurrent gastric volvulus, a gastrostomy was placed to fix and decompress the stomach. The patient had an uneventful hospital course and was discharged.
DISCUSSION AND CONCLUSION
Boerhaave's syndrome is a rare but severe complication caused by excessive vomiting, due to a sudden elevation in intraluminal esophageal pressure resulting in esophageal perforation. Acute gastric volvulus can result in ischemia and perforation of the stomach, but has not previously been reported with esophageal perforation. The most likely mechanism associating an upside down stomach with Boerhaave's syndrome is acute gastric outlet obstruction resulting in vomiting, and subsequent esophageal perforation. Perforation of the esophagus as well as perforation of the stomach must be considered in patients with an upside down stomach although both upside down stomach and Boerhaave's syndrome are rare clinical entities.
PubMed: 26710329
DOI: 10.1016/j.ijscr.2015.12.016 -
PloS One 2015Streptococcus pneumoniae (Spn) is a major causative organism of empyema, an inflammatory condition occurring in the pleural sac. In this study, we used human and Spn...
Streptococcus pneumoniae (Spn) is a major causative organism of empyema, an inflammatory condition occurring in the pleural sac. In this study, we used human and Spn cDNA microarrays to characterize the transcriptional responses occurring during initial contact between Spn and a human pleural mesothelial cell line (PMC) in vitro. Using stringent filtering criteria, 42 and 23 Spn genes were up-and down-regulated respectively. In particular, genes encoding factors potentially involved in metabolic processes and Spn adherence to eukaryotic cells were up-regulated e.g. glnQ, glnA, aliA, psaB, lytB and nox. After Spn initial contact, 870 human genes were differentially regulated and the largest numbers of significant gene expression changes were found in canonical pathways for eukaryotic initiation factor 2 signaling (60 genes out of 171), oxidative phosphorylation (32/103), mitochondrial dysfunction (37/164), eIF4 and p70S6K signaling (28/142), mTOR signaling (27/182), NRF2-mediated oxidative stress response (20/177), epithelial adherens junction remodeling (11/66) and ubiquitination (22/254). The cellular response appeared to be directed towards host cell survival and defense. Spn did not activate NF-kB or phosphorylate p38 MAPK or induce cytokine production from PMC. Moreover, Spn infection of TNF-α pre-stimulated PMC inhibited production of IL-6 and IL-8 secretion by >50% (p<0.01). In summary, this descriptive study provides datasets and a platform for examining further the molecular mechanisms underlying the pathogenesis of empyema.
Topics: Algorithms; Cell Adhesion; Cell Line; Cytokines; DNA, Complementary; Empyema; Epithelial Cells; Epithelium; Gene Expression Profiling; Gene Expression Regulation; Humans; Inflammation; Oligonucleotide Array Sequence Analysis; Phosphorylation; Pneumococcal Infections; RNA, Messenger; Signal Transduction; Streptococcus pneumoniae; Transcriptome; Up-Regulation; p38 Mitogen-Activated Protein Kinases
PubMed: 26566142
DOI: 10.1371/journal.pone.0142773 -
World Journal of Gastrointestinal... May 2015Pseudocyst formation is a common complication of acute and chronic pancreatitis. Most common site of pseudocyst is lesser sac; mediastinal extension of pseudocyst is...
Pseudocyst formation is a common complication of acute and chronic pancreatitis. Most common site of pseudocyst is lesser sac; mediastinal extension of pseudocyst is rare. Other possibilities of posterior mediastinal cyst must be considered. This patient presented with computed tomography abdomen with thorax showing a large thoraco-abdominal pseudocyst with right sided pleural effusion. It was confirmed to be pancreatic pseudocyst by analyzing fluid for amylase and lipase during surgery. In our patient, the pseudocyst was accessible transabdominaly. Cystogastrostomy was not possible as it was causing twisting of cardio-esophageal junction; we did retrocolic and retrogastric Roux-en-Y cystojejunostomy. Only two such cases were reported in literature.
PubMed: 26015854
DOI: 10.4240/wjgs.v7.i5.82 -
Taiwanese Journal of Obstetrics &... Dec 2014Pelvic actinomycosis almost always presents as a "dry" type, and pelvic actinomycosis with ascites is extremely rare. We present an unusual case of pelvic actinomycosis...
OBJECTIVE
Pelvic actinomycosis almost always presents as a "dry" type, and pelvic actinomycosis with ascites is extremely rare. We present an unusual case of pelvic actinomycosis with ascites, pleural effusion, and lymphadenopathy. Because of these atypical clinical features, a malignant process such as ovarian cancer or peritoneal carcinomatosis was suspected, but an endometrial biopsy revealed pelvic actinomycosis, which was treated without surgical intervention.
CASE REPORT
A 50-year-old Korean woman presented to our clinic with a 3-month history of abdominal pain and weight loss. An abdominopelvic computed tomography scan demonstrated ascites, pleural effusion, bilateral adnexal tubular structures, several enlarged lymph nodes in the paraaortic area, and diffuse peritoneal infiltration. Ultrasonography showed fluid collections measuring 2.7 cm in the cul-de-sac, 2.42 cm in the right paracolic gutter, and 3.13 cm in the left paracolic gutter. Endometrial/endocervical specimens showed marked chronic inflammation with sulfur granules, with a colony of filamentous organisms consistent with Actinomyces infection. The patient underwent antibiotic treatment for 6 months and recovered without complications or adverse events in the 13 months of follow up.
CONCLUSION
Pelvic actinomycosis should always be considered in patients with a pelvic mass and peritoneal infiltration, especially in the presence of intrauterine device use, despite the fact that abundant ascites, pleural effusion, and lymphadenopathy almost never accompany pelvic actinomycosis. Endometrial/endocervical biopsy may yield a diagnosis without an invasive procedure and should be performed. Because of the excellent response to penicillin, medical treatment alone is an effective method to eradicate pelvic actinomycosis without the need for surgical intervention.
Topics: Actinomycosis; Amoxicillin; Anti-Bacterial Agents; Ascites; Biopsy; Drug Therapy, Combination; Endometrium; Female; Humans; Lymphatic Diseases; Middle Aged; Pelvic Infection; Penicillin G; Pleural Effusion
PubMed: 25510706
DOI: 10.1016/j.tjog.2013.08.010 -
International Journal of Infectious... Dec 2014Cryptococcosis with thoracic spine involvement is extremely rare, with most cases occurring in immunosuppressed patients. We report a case of cryptococcosis of the...
Cryptococcosis with thoracic spine involvement is extremely rare, with most cases occurring in immunosuppressed patients. We report a case of cryptococcosis of the thoracic vertebrae confirmed by histopathology. The immunocompetence of the patient is a most interesting feature of this case. Laboratory investigations were normal, but the erythrocyte sedimentation rate was raised. A computed tomography scan showed an eccentric lytic lesion with a clear boundary at T2-T3. Magnetic resonance imaging showed the endplates of the T2 and T3 vertebral bodies to be involved, but without significant loss of the intervertebral disk height. A prespinal and large paraspinal soft tissue component was spreading along T1-T4, and the pleura and dural sac at the level of T2-T3 had thickened abnormally. (18)F-fluorodeoxyglucose positron emission tomography/computed tomography showed abnormal uptake in the lesion. The above-mentioned clinical and imaging information will help improve our understanding of this rare disease.
Topics: Aged; Cryptococcosis; Female; Humans; Magnetic Resonance Imaging; Positron-Emission Tomography; Spinal Diseases; Thoracic Vertebrae; Tomography, X-Ray Computed
PubMed: 25449251
DOI: 10.1016/j.ijid.2014.07.013 -
Molecular and Clinical Oncology Nov 2014Precursor T-cell lymphoblastic lymphoma (T-LBL) is a rare type of malignant lymphoma, with clinical manifestations including diaphragmatic lymph node enlargement,...
Precursor T-cell lymphoblastic lymphoma (T-LBL) is a rare type of malignant lymphoma, with clinical manifestations including diaphragmatic lymph node enlargement, accompanied by local oppression and/or systemic lymphoma symptoms. However, extensive involvement of the mediastinum, pleura and pericardium is rare in T-LBL cases. This is the case report of a T-LBL extensively involving the mediastinum, pleura and pericardium in a 54-year-old woman. The patient complained of anhelation, chest tightness and tiredness for ~3 months. A computed tomography (CT) scan of the chest revealed a diffuse mass of soft tissue density involving the mediastinum, pleura and pericardium. Several thoracocenteses indicated inflammatory changes and cytological examination of the pleural fluid and pleural biopsy under CT guidance identified no heterotypic cells. As F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT imaging revealed a diffused moderate FDG uptake (maximum standard uptake value of 4) by the mediastinum, pleura and cardiac sac, we diagnosed a malignant lymphoma. We subsequently successfully performed needle biopsy under PET/CT guidance according to the PET/CT images and the diagnosis of T-LBL was pathologically confirmed.
PubMed: 25279178
DOI: 10.3892/mco.2014.347 -
Journal of Cardiology Cases Aug 2014Complications of percutaneous pericardial catheter insertion for pericardial effusion are rare. We describe a rare complication of percutaneous pericardial catheter...
Complications of percutaneous pericardial catheter insertion for pericardial effusion are rare. We describe a rare complication of percutaneous pericardial catheter insertion that penetrated the stomach and diaphragm before getting into the pericardial sac in a patient with lymphoma. The misplaced catheter was extracted surgically and subxiphoid pericardial tube insertion with pleural pericardial window was performed. < Although similar outcomes have been reported with both percutaneous and subxiphoid techniques, major complications may arise with the percutaneous technique. This case emphasizes that percutaneous pericardial catheter insertion may have serious complications and these procedures should be performed by experienced clinicians with the standby of a cardiac team.>.
PubMed: 30546508
DOI: 10.1016/j.jccase.2014.05.002