-
BMJ Case Reports Feb 2020We report a retroviral positive patient who presented to us with recurrent skin lesions along with intermittent, colicky periumbilical abdominal pain associated with...
We report a retroviral positive patient who presented to us with recurrent skin lesions along with intermittent, colicky periumbilical abdominal pain associated with non-projectile, postprandial vomiting. Contrast-enhanced CT (CECT) of abdomen and pelvis was suggestive of proximal jejunal obstruction. Double balloon enteroscopy done which showed extensive deep ulceration with surrounding nodular surface and friable mucosa at 60 cm from pylorus with luminal narrowing. The biopsy from this region as well as the skin lesion on the forehead grew She was initially treated with liposomal amphotericin B for 2 weeks following which she received itraconazole for 3 weeks for disseminated talaromycosis infection. She had already been started on antiretroviral therapy (ART) 1 year back however her cluster of differentiation 4 (CD4) counts did not show any improvement. Proximal bowel obstruction leading to poor nutritional status compounded with ineffective ART therapy due to suboptimal absorption, dictated the staged management of her condition. Feeding jejunostomy was done with a plan to offer her resection and anastomosis of affected jejunal segment, should she require one, after optimising her nutritional and immunological status.
Topics: AIDS-Related Opportunistic Infections; Adult; Amphotericin B; Anti-Retroviral Agents; Antifungal Agents; Enteral Nutrition; Female; HIV Infections; HIV Seropositivity; Humans; Intestinal Obstruction; Itraconazole; Jejunostomy; Mycoses; Nutritional Status
PubMed: 32060105
DOI: 10.1136/bcr-2019-230121 -
Journal of Medical Case Reports Feb 2020Atrial myxoma remains a rare clinical entity with an incidence of surgically resected cases of 0.5-0.7 per million population and prevalence of < 5 per 10,000. It...
BACKGROUND
Atrial myxoma remains a rare clinical entity with an incidence of surgically resected cases of 0.5-0.7 per million population and prevalence of < 5 per 10,000. It typically manifests in woman after third decade of life; symptoms vary greatly and may present with arrhythmia, intracardiac flow obstruction, embolic phenomenon, and associated constitutional symptoms. Neurological complications associated with atrial myxoma most frequently include cerebral infarct due to embolus. Cerebellar involvement is very rare and only a few cases have been reported in the literature.
CASE PRESENTATION
A 55-year-old Brahmin man with no history of diabetes mellitus and hypertension, presented with complaints of dizziness, headache, vomiting, double vision, and unsteadiness of gait for 2 weeks. His headache was sudden in onset, of a pulsating type and localized on left temporal side. Vomiting was projectile and bilious. Double vision was present in all directions of gaze and he had uncoordinated movement of his body and tilting to the left side. On examination, his cerebellar functions were impaired. He was thoroughly investigated for the cause of stroke after abnormal magnetic resonance imaging results with normal computed tomography angiography of his brain. Echocardiography and computed tomography of his chest showed a mass attached to intra-atrial septum and prolapsing through mitral valve, which was suggestive of left atrial myxoma. Five days following admission, he developed abdominal pain due to thromboembolism causing splenic and renal infarct.
CONCLUSION
Although rare, atrial myxoma has to be considered a cause of stroke and other embolic phenomenon causing multiorgan infarctions. Early and timely diagnosis of the condition can prevent further recurrence and inappropriate anticoagulant therapy. It would be pertinent to have echocardiography done in patients who present with a stroke, arrhythmias, and other constitutional symptoms. The tumor once detected must be removed surgically as early as possible, which not only reduces serious thromboembolic complications but can be potentially curative.
Topics: Heart Atria; Heart Neoplasms; Humans; Male; Middle Aged; Myxoma; Splenic Infarction; Stroke
PubMed: 32051024
DOI: 10.1186/s13256-020-2356-5 -
Case Reports in Pediatrics 2020Congenital duodenal web causing proximal duodenal obstruction leading to gastroduodenal emphysema is a very rare presentation in infancy. Due to persistent...
Congenital duodenal web causing proximal duodenal obstruction leading to gastroduodenal emphysema is a very rare presentation in infancy. Due to persistent peristalsis against the duodenal membrane, there is progressive stretching of the duodenal web leading to windsock deformity. We describe a rare case of a child with gastroduodenal emphysema and portal venous air due to duodenal obstruction secondary to a duodenal web. An eighteen-month-old male child, who was under investigation for failure to thrive, presented with a history of persistent projectile vomiting and progressive abdominal distension for two days. The abdominal ultrasound scan revealed air within the portal vein and in the wall of the stomach. Plain X-ray abdomen confirmed the presence of gas in the gastric wall and in the proximal duodenal wall. Upper gastrointestinal contrast study revealed complete obstruction at the second part of the duodenum. The child underwent emergency laparotomy, which revealed a duodenal web as the cause of the duodenal obstruction. During the surgery, windsock deformity was noted. This case illustrates that although rare, proximal duodenal obstruction due to duodenal web may present in early childhood and that alarming imaging features such as gastric emphysema and portal venous air could be associated with benign conditions.
PubMed: 32015925
DOI: 10.1155/2020/9897208 -
Biomedical Journal Oct 2019Severe headaches, projectile vomiting, focal neurological deficits and early onset seizure are regarded as early warning symptoms of subarachnoid hemorrhage (SAH)....
BACKGROUND
Severe headaches, projectile vomiting, focal neurological deficits and early onset seizure are regarded as early warning symptoms of subarachnoid hemorrhage (SAH). Earlier diagnosis based on such warning symptoms theoretically would improve the clinical prognosis. However, it is still not clear whether the prognosis is correlated with early warning symptoms. Here, we reviewed warning symptoms and other predictive factors in the emergency room (ER) setting and examined their correlations with mortality.
METHODS
Ninety saccular aneurysmal SAH cases were reviewed in a single medical center between January 2011 and December 2013. We examined differences in mortality rate related to warning symptoms, SAH scales, onset-to-ER time, hydrocephalus, and aneurysm size, location, and complexity. Logistic regression analyses were performed to determine the correlations of warning symptoms and other predictive factors with mortality. Receiver operating characteristic (ROC) curve analysis was used to calculate the area the under curve (AUC) of SAH mortality prediction tools.
RESULTS
Warning headache, projectile vomiting, the Hunt and Hess scale, Fisher scale, World Federation of Neurological Surgeons (WFNS) grading scale, and modified WFNS (m-WFNS) scale, body mass index, aneurysm complexity and hydrocephalus were significantly different between the survivors and the decedents. The warning headache and WFNS grade were strongly correlated with mortality. The rate of prognostic prediction improved from 90.4% to 94.6% when warning headache was additionally evaluated.
CONCLUSIONS
With growing healthcare costs and recognition of the value of palliative care, early identification via warning headache and a detailed clinical history review is necessary for cases of aSAH.
Topics: Adult; Aged; Area Under Curve; Female; Headache; Humans; Male; Middle Aged; Prognosis; ROC Curve; Retrospective Studies; Risk Assessment; Subarachnoid Hemorrhage; Survival Rate
PubMed: 31783996
DOI: 10.1016/j.bj.2019.04.006 -
European Journal of Pediatric Surgery... Jan 2019A male infant aged 45 days presented with projectile nonbilious vomiting for 2 weeks. Ultrasound showed picture of idiopathic hypertrophic pyloric stenosis. Laparoscopic...
A male infant aged 45 days presented with projectile nonbilious vomiting for 2 weeks. Ultrasound showed picture of idiopathic hypertrophic pyloric stenosis. Laparoscopic pyloromyotomy was done, but postoperative vomiting that was mainly nonbilious continued without improvement. After 4 days of persistent vomiting, laparoscopic exploration was done and complete pyloromyotomy was confirmed and malrotation with complete Ladd's band was found, then case converted to open laparotomy and Ladd's procedure was done. Postoperatively, vomiting stopped completely and baby began gradual feeding till reaching full feed. Despite that the presentation of concurrent Idiopathic Hypertrophic Pyloric Stenosis with malrotation is extremely rare; a formal laparoscopic abdominal exploration should be done as the first step before proceeding to pyloromyotomy.
PubMed: 31763128
DOI: 10.1055/s-0039-1698400 -
Journal of Ayub Medical College,... 2019Gastrointestinal duplication cyst is a rare congenital anomaly with a reported incidence of 1 in 4500 live births. Any part of gastrointestinal tract from mouth to anus...
Gastrointestinal duplication cyst is a rare congenital anomaly with a reported incidence of 1 in 4500 live births. Any part of gastrointestinal tract from mouth to anus can be affected with this anomaly. Among gastrointestinal tract duplications, gastric duplication cyst is extremely rare (2- 9%). We are presenting a case of the stomach duplication in a four (04) day old male child who presented in our Emergency Department with complaints of non-bilious, non-projectile vomiting and visible bulge in upper abdomen since birth. Workup showed enteric duplication cyst which was excised. Complete surgical resection is the treatment of choice in gastric duplication cyst.
Topics: Congenital Abnormalities; Gastric Outlet Obstruction; Humans; Infant, Newborn; Male; Stomach
PubMed: 31535531
DOI: No ID Found -
Pediatrics International : Official... Nov 2019I.v. atropine (IA) for infantile hypertrophic pyloric stenosis (IHPS) is a good alternative to pyloromyotomy but has not been broadly accepted. The lower success rate is...
BACKGROUND
I.v. atropine (IA) for infantile hypertrophic pyloric stenosis (IHPS) is a good alternative to pyloromyotomy but has not been broadly accepted. The lower success rate is one of the greatest disadvantages of IA. We investigated the risk factors for unsuccessful results following IA for IHPS.
METHODS
Medical records of patients with IHPS who were admitted to Kimitsu Chuo Hospital between 2002 and 2016 and were initially given atropine sulfate were retrospectively reviewed. Atropine was given i.v. (0.1 mg/kg/day in eight divided doses). Oral feeding of milk was started with a small amount and increased in a stepwise fashion to full feed. IA therapy was defined as unsuccessful in the presence of projectile vomiting more than three times a day or intolerance to a predetermined amount of milk.
RESULTS
Of the 48 patients with IHPS, 33 patients were successfully treated with IA and 15 patients needed surgical intervention. On univariate analysis the risk factors for unsuccessful IA therapy were younger age, lower bodyweight, and shorter duration of symptoms before diagnosis. On multivariate analysis age at diagnosis < 30 days was the only significant risk factor for unsuccessful IA therapy (OR, 5.7 l P = 0.03).
CONCLUSIONS
Age at diagnosis < 30 days is a risk factor for unsuccessful IA therapy in IHPS. This might be considered when IA therapy is used for neonates with IHPS.
Topics: Atropine; Digestive System Surgical Procedures; Dose-Response Relationship, Drug; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Infusions, Intravenous; Male; Muscarinic Antagonists; Prognosis; Pyloric Stenosis, Hypertrophic; Pylorus; Retrospective Studies; Risk Factors; Treatment Failure; Ultrasonography
PubMed: 31520503
DOI: 10.1111/ped.14009 -
South African Journal of Surgery.... Jun 2019Infantile hypertrophic pyloric stenosis (IHPS) is the thickening of both muscle layers of the pylorus and is most commonly found in first-born males. It usually presents...
BACKGROUND
Infantile hypertrophic pyloric stenosis (IHPS) is the thickening of both muscle layers of the pylorus and is most commonly found in first-born males. It usually presents with projectile, non-bilious vomiting. Late presentation leads to severe dehydration and malnutrition with deranged serum-electrolytes and acid-base imbalance delaying treatment and prolonging hospital stay. This study aims to evaluate the profile, management and outcome of IHPS at a tertiary hospital in Bloemfontein, South Africa.
METHOD
The study was a retrospective, descriptive record review including all patients with IHPS admitted to Universitas Hospital from January 2008 to February 2016. Of the 22 patients admitted, files for 19 patients were available for inclusion.
RESULTS
Sixteen (84.2%) of the 19 patients were male. Of the 11 patients with available birth order, two were first-, two second-, six third- and one fourth-born. The patients' ages ranged from 27 to 194 days (median 51 days). The most common symptoms were projectile vomiting (78.9%) and poor weight gain (68.4%). Six patients had no ultrasound done, and 17 patients underwent a Ramstedt-pyloromyotomy. Eight patients received atropine as part of their initial management. The duration of symptoms ranged from 1 to 58 days (median 14 days). There was no reported mortality. The length of stay ranged from 2 to 60 days (median 7 days).
CONCLUSION
The gender distribution and age at presentation were in keeping with the literature but not the birth order. The delay before surgery emphasises the poor general health and deranged biochemical state the patients present at the hospital.
Topics: Adult; Female; Humans; Male; Registries; Retrospective Studies; Self-Injurious Behavior; South Africa; Trauma Centers
PubMed: 31342690
DOI: No ID Found -
South African Journal of Surgery.... Jun 2019Infantile hypertrophic pyloric stenosis (IHPS) is the thickening of both muscle layers of the pylorus and is most commonly found in first-born males. It usually presents...
BACKGROUND
Infantile hypertrophic pyloric stenosis (IHPS) is the thickening of both muscle layers of the pylorus and is most commonly found in first-born males. It usually presents with projectile, non-bilious vomiting. Late presentation leads to severe dehydration and malnutrition with deranged serum-electrolytes and acid-base imbalance delaying treatment and prolonging hospital stay. This study aims to evaluate the profile, management and outcome of IHPS at a tertiary hospital in Bloemfontein, South Africa.
METHOD
The study was a retrospective, descriptive record review including all patients with IHPS admitted to Universitas Hospital from January 2008 to February 2016. Of the 22 patients admitted, files for 19 patients were available for inclusion.
RESULTS
Sixteen (84.2%) of the 19 patients were male. Of the 11 patients with available birth order, two were first-, two second-, six third- and one fourth-born. The patients' ages ranged from 27 to 194 days (median 51 days). The most common symptoms were projectile vomiting (78.9%) and poor weight gain (68.4%). Six patients had no ultrasound done, and 17 patients underwent a Ramstedt-pyloromyotomy. Eight patients received atropine as part of their initial management. The duration of symptoms ranged from 1 to 58 days (median 14 days). There was no reported mortality. The length of stay ranged from 2 to 60 days (median 7 days).
CONCLUSION
The gender distribution and age at presentation were in keeping with the literature but not the birth order. The delay before surgery emphasises the poor general health and deranged biochemical state the patients present at the hospital.
Topics: Female; Humans; Infant; Infant, Newborn; Length of Stay; Male; Pyloric Stenosis, Hypertrophic; Retrospective Studies; South Africa; Tertiary Care Centers
PubMed: 31342689
DOI: No ID Found -
Journal of Postgraduate Medicine 2019Intracranial hemorrhage (ICH) is rarely seen in patients with thalassemia. A seven-year-old male, known case of beta-thalassemia major, on irregular packed cell...
Intracranial hemorrhage (ICH) is rarely seen in patients with thalassemia. A seven-year-old male, known case of beta-thalassemia major, on irregular packed cell transfusions (elsewhere) and non-compliant with chelation therapy, presented with congestive cardiac failure (Hb-3 gm/dl). He received three packed red cell transfusions over 7 days (cumulative volume 40 cc/kg). On the 9th day, he developed projectile vomiting and two episodes of generalized tonic-clonic convulsions with altered sensorium. He had exaggerated deep tendon reflexes and extensor plantars. CT-scan of brain revealed bilateral acute frontal hematoma with diffuse subarachnoid hemorrhage (frontal and parietal). Coagulation profile was normal. CT-angiography of brain showed diffuse focal areas of reduced caliber of anterior cerebral, middle cerebral, and basilar and internal carotid arteries (likely to be a spasmodic reaction to subarachnoid hemorrhage). He required mechanical ventilation for 4 days and conservative management for the hemorrhage. However, on the 18th day, he developed one episode of generalized tonic-clonic convulsion and his sensorium deteriorated further (without any new ICH) and required repeat mechanical ventilation for 12 days. On the 28th day, he was noticed to have quadriplegia (while on a ventilator). Nerve conduction study (42nd day) revealed severe motor axonal neuropathy (suggesting critical illness polyneuropathy). He improved with physiotherapy and could sit upright and speak sentences at discharge (59th day). The child recovered completely after 3 months. It is wise not to transfuse more than 20 cc/kg of packed red cell volume during each admission and not more than once in a week (exception being congestive cardiac failure) for thalassemia patients.
Topics: Child; Humans; Intracranial Hemorrhages; Male; Polyneuropathies; beta-Thalassemia
PubMed: 31317877
DOI: 10.4103/jpgm.JPGM_127_19