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BMJ Case Reports Apr 2018This is the first reported case of a Chiari 1 malformation in association with tuberculous (TB) meningitis. We present a case of a 23-year-old woman with a 2-week...
This is the first reported case of a Chiari 1 malformation in association with tuberculous (TB) meningitis. We present a case of a 23-year-old woman with a 2-week history nocturnal fever, vertigo, headache and projectile vomiting. She had nystagmus, scanning speech, bilateral papilloedema and ataxia. Cranial imaging showed a 10 mm tonsillar herniation. Posterior fossa decompression was done. Because the patient's gamut of symptoms was highly suspicious for a central nervous system infection, a lumbar tap was done which revealed TB meningitis. Four years later, after anti-TB medications and rehabilitation, all her symptoms except gait instability resolved.
Topics: Arnold-Chiari Malformation; Cranial Fossa, Posterior; Decompression, Surgical; Disease Progression; Female; Fever; Headache; Humans; Magnetic Resonance Imaging; Spinal Puncture; Treatment Outcome; Tuberculosis, Meningeal; Vertigo; Vomiting; Young Adult
PubMed: 29622715
DOI: 10.1136/bcr-2018-224245 -
Cancer Biology & Therapy 2018Advanced gastric cancer with a pathological complete response to neoadjuvant chemotherapy and surgery followed by early brain metastasis is rare. A 52-y-old male patient... (Review)
Review
Early brain metastasis of advanced gastric cancer with a pathological complete response to neoadjuvant chemotherapy followed by surgery: A case report and literature review.
Advanced gastric cancer with a pathological complete response to neoadjuvant chemotherapy and surgery followed by early brain metastasis is rare. A 52-y-old male patient who was diagnosed with advanced gastric cancer (cT4N2M0, stage ШB). Radiological examinations after three cycles of preoperative chemotherapy with a modified FOLFOX6 (mFOLFOX6) regimen showed a partial response (PR) had been achieved. The patient underwent curative surgery consisting of proximal gastrectomy, and D2 lymph node dissection. The lack of abnormal gastric cancer cells in the primary lesion or lymph nodes confirmed a pathological complete response (pCR). Postoperative chemotherapy with oral S-1 was administrated. However, during the second cycles of postoperative chemotherapy, the patient experienced headaches, projectile vomiting and convulsion. Upon further examination, a tumor representing metastasis to the brain was recognized by cranial enhanced magnetic resonance imaging (MRI) examination and cytopathology of cerebrospinal fluid. In addition to documenting the case report, we reviewed the literature associated to features of metastatic brain malignancies that form from gastric cancer. In short, advanced gastric cancer patents achieved pCR after preoperative chemotherapy typically have good prognosis; however, great attention should be paid on detecting metastatic events.
Topics: Antineoplastic Combined Chemotherapy Protocols; Biomarkers, Tumor; Biopsy; Brain Neoplasms; Combined Modality Therapy; Gastrectomy; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neoadjuvant Therapy; Neoplasm Staging; Stomach Neoplasms; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 29580147
DOI: 10.1080/15384047.2018.1456600 -
African Journal of Paediatric Surgery :... 2017Gastric volvulus is an uncommon entity found in the paediatric population. We are reporting a case of chronic gastric volvulus presented to us with the complaints of... (Review)
Review
Gastric volvulus is an uncommon entity found in the paediatric population. We are reporting a case of chronic gastric volvulus presented to us with the complaints of recurrent vomiting after each feed. The vomiting was projectile, nonbilious, and the content was milk. The patient was evaluated by clinical and radiological means in the form of the X-ray abdomen, ultrasound abdomen, upper gastrointestinal (GI) contrast study, and computed tomography scan of the abdomen. The upper GI contrast study was suggestive of gastric volvulus. The patient was operated and gastropexy was done. There was lax gastrocolic ligament with increased distance between stomach and transverse colon without any obvious gastric volvulus. Postsurgery, the patient was symptom-free.
Topics: Chronic Disease; Female; Humans; Infant; Recurrence; Stomach Volvulus; Vomiting
PubMed: 29487269
DOI: 10.4103/ajps.AJPS_36_16 -
The Journal of Hospital Infection Jun 2018Healthcare workers caring for patients with high-consequence infectious diseases (HCIDs) require protection from pathogen exposure, for example by wearing personal...
BACKGROUND
Healthcare workers caring for patients with high-consequence infectious diseases (HCIDs) require protection from pathogen exposure, for example by wearing personal protective equipment (PPE). Protection is acquired through the inherent safety of the PPE components, but also their safe and correct use, supported by adequate training and user familiarity. However, the evidence base for HCID PPE ensembles and any associated training is lacking, with subsequent variation between healthcare providers.
AIM
To develop an evidence-based assessment and training tool for evaluating PPE ensembles and doffing protocols, in the assessment of patients with suspected HCIDs.
METHODS
VIOLET (Visualising Infection with Optimised Light for Education and Training) comprises a healthcare mannequin adapted to deliver simulated bodily fluids containing UV-fluorescent tracers. On demand and remotely operated, the mannequin projectile vomits (blue), coughs (red), has diarrhoea (yellow) and is covered in sweat (orange). Wearing PPE, healthcare staff participate in an HCID risk assessment and examination of the 'patient', thereby becoming exposed to these bodily fluids. Contamination of PPE is visualized and body-mapped under UV light before and after removal. Observational findings and participant feedback, around its use as a training exercise, is also recorded.
FINDINGS
Significant contamination from different exposure events was seen, enabling evaluation of PPE and doffing procedures used. Observational data and participant feedback demonstrated its strengths and success as a training technique.
CONCLUSION
Simulation exercises using VIOLET provide evidence-based assessment of PPE ensembles, and are a valuable resource for training of healthcare staff in wearing and safe doffing of PPE.
Topics: Cross Infection; Education, Medical; Fluorescent Dyes; Health Personnel; Humans; Infection Control; Personal Protective Equipment; Retrospective Studies; Staining and Labeling; United Kingdom; Volunteers
PubMed: 29421340
DOI: 10.1016/j.jhin.2018.01.021 -
African Journal of Paediatric Surgery :... 2017Infantile hypertrophic pyloric stenosis (IHPS) is the most common surgical cause of nonbilious, projectile vomiting in children. Its incidence is estimated to be...
Infantile hypertrophic pyloric stenosis (IHPS) is the most common surgical cause of nonbilious, projectile vomiting in children. Its incidence is estimated to be 2-5/1000 live births and has been noted to be quite rare in African-Americans, Asians, and Indians. It is more common in infants under 6 months of age and is quite rare in older infants. While IHPS is invariably intrinsic in nature, extrinsic pyloric stenosis is very rare. Children who present with nonbilious, projectile vomiting after the age of 6 months should, therefore, be thoroughly investigated for causes other than IHPS. This is a case report of an 8-month-old child who had a band of tissue constricting the pylorus which mimicked IHPS.
Topics: Diagnosis, Differential; Humans; Infant; Male; Pyloric Stenosis; Pyloric Stenosis, Hypertrophic; Vomiting
PubMed: 30688283
DOI: 10.4103/ajps.AJPS_118_16 -
Archives de Pediatrie : Organe Officiel... Sep 2017In recent years, developments in virological tools have led to the easy detection of rhinoviruses and enteroviruses (E/RV). Their detection is very frequent in cases of...
INTRODUCTION
In recent years, developments in virological tools have led to the easy detection of rhinoviruses and enteroviruses (E/RV). Their detection is very frequent in cases of airway involvement in children and their demonstrated causality. But the morbidity of E/RV in the neonatal period is unknown due to lack of epidemiological data. The objective of this study was to evaluate the incidence and clinical characteristics of these infections in hospitalized neonates.
MATERIALS AND METHODS
We retrospectively analyzed the virology specimens of all neonates hospitalized at the Caen University Hospital between 2006 and 2011. Clinical characteristics were obtained from the charts.
RESULTS
During the study period, 4544 infants aged less than 28 days were hospitalized: 4159 in the neonatal ward and 385 in the pediatric ward. Among these, 711 virology specimens were available, 31 % of which identified at least one virus. An E/RV was identified in 87 patients (1.9 % of the neonates admitted during the study period): 52 in the pediatric ward (13.5 % of 385), and 35 in the neonatal ward (0.8 % of 4159). The mean gestational age was 39 weeks in the pediatric cohort and 35 weeks in the neonatal cohort. The main indication for virological analysis was persistent drowsiness (28 %), temperature above 38°C (25 %), an apparently life-threatening event (23 %), bradycardia (20.5 %), and pallor (20.5 %). Respiratory symptoms associated with E/RV infection were coryza (74 %), cough (35 %), hypoxemia (32 %), accessory muscle use, and recession (31 %). Digestive symptoms were poor feeding (59 %), regurgitation (38 %), abdominal distension (24 %), and projectile vomiting (17 %). Twenty-three percent of the patients required admission to the neonatal ICU or pediatric ICU. Respiratory treatments included oxygen (24 % of 87 patients), continuous positive airway pressure (11 %), and ventilation (5 %). Antibiotics were prescribed in 41 % of the patients (46), but only 10 % (9) had an identified concomitant bacterial infection. In the neonatal department, nosocomial acquisition was suspected in 50 % of E/RV infections.
CONCLUSION
E/RV infections have a significant morbidity in neonates, and nosocomial transmission of the virus is underestimated. We recommend that respiratory viruses, including E/RV, be tested for in any unexplained signs in a neonate. Better identification of viruses might shorten the duration of unnecessary antibiotics.
Topics: Enterovirus Infections; Female; Humans; Infant; Infant, Newborn; Male; Picornaviridae Infections; Retrospective Studies; Rhinovirus
PubMed: 28822736
DOI: 10.1016/j.arcped.2017.06.012 -
Cureus Jun 2017Patients with penetrating head trauma with retained projectiles develop intracranial abscesses as a common complication. The most common presentation is a suddenly...
Patients with penetrating head trauma with retained projectiles develop intracranial abscesses as a common complication. The most common presentation is a suddenly worsening headache. The most common pathogen identified is staphylococcus. Outcomes are related to adherence of Matson's tenets. This case study details the presentation of a 19-year-old patient that presented to the neurological surgery clinic without neurologic deficits. Further questioning revealed complaints of intermittent diffuse headaches with bilateral upper extremity shock-like sensation for two weeks. Eight weeks prior he had undergone right craniotomy, after a gunshot wound, for debridement and watertight dural closure. The patient denied symptoms of fever, chills, nausea, vomiting, diarrhea, or seizure. The patient presented with a noncontrast head computed tomography (CT) which revealed retained projectile fragments without clear evidence of abscess. On physical exam, the patient was without any neurological deficit. Laboratory investigation revealed normal white blood cell count, erythrocyte sedimentation rate, C-reactive protein, and negative blood cultures. Head CT with contrast revealed a large intracerebral abscess adjacent to the thalamus. The patient was taken to the operating room for repeat craniotomy with resection of the abscess and removal of the intracranial projectile fragments. Post-operatively, the patient remained neurology intact. Intraoperative cultures were not significant for the growth of any bacteria. In eight weeks time, the patient returned to his employment and his baseline level of activity. This case underscores the importance of thorough assessment in patients with retained intracranial projectiles as well as the need to routine follow-up. The unique presentation of this patient prompted further investigation which elucidated a lesion which correlated to his symptoms although laboratory assessment was without abnormality.
PubMed: 28690961
DOI: 10.7759/cureus.1328 -
African Journal of Emergency Medicine :... Sep 2016Increased intracranial pressure is usually measured with invasive methods that are not practical in resource-limited countries. However, bedside ultrasound, a...
INTRODUCTION
Increased intracranial pressure is usually measured with invasive methods that are not practical in resource-limited countries. However, bedside ultrasound, a non-invasive method, measures the optic nerve sheath diameter and could be a safe and accurate alternative to measure intracranial pressure, even in children.
CASE REPORT
We report a case of a 15-year old patient who presented with severe headache, projectile vomiting, and neck pain for two months. The bedside ultrasound showed a 10 mm optic nerve sheath diameter and a Computed Tomography scan of her brain revealed obstructive hydrocephalus secondary to a mass in the fourth ventricle. After intervening, we were able to monitor the decrease in her optic nerve sheath diameter with ultrasound.
CONCLUSION
Performing invasive procedures continues to be a challenge in the resource limited setting. However, bedside ultrasound can be a useful tool in emergency centres for early detection and monitoring of intracranial pressure.
PubMed: 30456086
DOI: 10.1016/j.afjem.2016.06.002 -
BMJ Case Reports Jan 2016A 64-year-old woman with a previous right colectomy presented with severe epigastric abdominal pain and nausea of several weeks' duration, which then escalated to...
A 64-year-old woman with a previous right colectomy presented with severe epigastric abdominal pain and nausea of several weeks' duration, which then escalated to projectile faeculent emesis. During her clinical course, she remained afebrile with normal vital signs. Physical examination revealed abdominal distension, moderate tenderness in the bilateral upper quadrants and provoked voluntary abdominal wall guarding. Haematology and laboratory chemistries were only notable for a mild (14.6 K/μL) leucocytosis. Acute abdominal plain radiological series revealed dilated small bowel loops and possible pneumoperitoneum. Abdominal CT demonstrated a mechanical small bowel obstruction and no extraluminal air. An exploratory laparotomy was performed, revealing an obstructing enterolith related to actively inflamed jejunal diverticulitis (complicated JD). This case report aims to describe the non-specific presentation of a poorly understood disease entity that presents a diagnostic and therapeutic challenge for the medical community.
Topics: Abdominal Pain; Colectomy; Diverticulitis; Female; Humans; Intestinal Obstruction; Jejunal Diseases; Laparotomy; Middle Aged; Tomography, X-Ray Computed; Vomiting
PubMed: 26729826
DOI: 10.1136/bcr-2015-212826 -
Oncology Letters Sep 2015Atypical teratoid/rhabdoid tumor (AT/RT) is an aggressive embryonic brain tumor that is predominantly found in young children. The present study reports the unusual case...
Atypical teratoid/rhabdoid tumor (AT/RT) is an aggressive embryonic brain tumor that is predominantly found in young children. The present study reports the unusual case of an adult male AT/RT patient with a history of another type of tumor, hereditary multiple exostoses (EXT or HME), who survived for 18 years. The patient's first and chief complaint was a 1-month history of progressive projectile vomiting. The patient was admitted twice for treatment, and on the second admission, a craniotomy was performed to remove a intracranial mass. However, no radiotherapy or chemotherapy treatment was administered. Pathology revealed monotonous medium- to large-sized neoplastic cells. The patient succumbed to a pulmonary infection and respiratory failure 14 days after the initial treatment. The prognosis for AT/RT is extremely poor; furthermore, the patient presented with another tumor. There may have been an association between the two tumors that worsened the clinical phenotype and prognosis of this patient. Additionally, symptomatic treatment for this condition is insufficient; early surgery and radiotherapy may be more useful for preventing the aggressive progression of these tumors.
PubMed: 26622709
DOI: 10.3892/ol.2015.3389