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PLoS Neglected Tropical Diseases May 2024Human cystic echinococcosis (CE) is a parasitic infection caused by the larval stage of the tapeworm Echinococcus granulosus sensu lato, primarily affecting the liver...
Human cystic echinococcosis (CE) is a parasitic infection caused by the larval stage of the tapeworm Echinococcus granulosus sensu lato, primarily affecting the liver and lungs. Although the heart is affected in only 0.02-2% of all CE cases, a considerable number of cases have been, and continue to be, published. However, due to the rare occurrence of cardiac CE and the resulting lack of clinical trials, knowledge about various aspects of the disease remains limited. To obtain a clearer picture of anatomical, clinical, diagnostic as well as therapeutic aspects of cardiac CE, we systematically reviewed the literature published between 1965 and 2022. The anatomical pattern of the affected cardiac structures follows the extension of the supplying capillary bed. The majority of patients (82.7%) are symptomatic and present with prolonged non-specific symptoms such as dyspnoea, chest pain and palpitations. Acute complications generally derive from cyst rupture, occur in 18.3% of cases and manifest as embolism, pericardial tamponade, or anaphylactic reaction in 83.2%, 17.8% and 10.9% of these cases, respectively. As for CE cysts localized in other organs, the diagnosis of cardiac CE is made by imaging. Serology plays a minor role due to its limited sensitivity. Unlike abdominal CE cysts, cardiac CE cysts are usually resected independent of their stage (active/inactive), because their presence impairs cardiac performance and carries the risk of long-term sequelae. More than 80% of patients are treated with a single surgical intervention. We found a disease-related case fatality rate of 11.1%. Since local recurrence was reported up to 108 months and secondary CE up to 72 months after surgery, patients should be followed up for a minimum of 10 years.
Topics: Humans; Echinococcosis; Animals; Heart Diseases; Echinococcus granulosus; Heart
PubMed: 38814859
DOI: 10.1371/journal.pntd.0012183 -
Frontiers in Pain Research (Lausanne,... 2024
PubMed: 38812854
DOI: 10.3389/fpain.2024.1402918 -
SAGE Open Medical Case Reports 2024Intrauterine device is a widely used contraceptive method. However, it may translocate to other sites within the pelvic cavity, including the intestines and the bladder....
Intrauterine device is a widely used contraceptive method. However, it may translocate to other sites within the pelvic cavity, including the intestines and the bladder. This contraceptive method has failure rate between 1 and 3 out of 100 women/year. The use of intrauterine device also slightly increases the risk of ectopic pregnancy upon its failure. The combination of intrauterine device translocation and contraceptive failure is rare. We present such a case. A 29-year-old woman (Gravida 4, Para 2) presented with a complaint of abdominal pain and presence of blood spotting over the last 7 h. She tested positive for pregnancy. Upon arrival, her vital signs were normal, but she was moderately obese with a body mass index (BMI) of 38.8 kg/m. She displayed tenderness during abdominal examination and cervical motion tenderness. Her blood test results showed no significant abnormalities. Abdominal ultrasound revealed a translocated part of intrauterine device to the cervix and transvaginal ultrasound confirmed the presence of a hypoechoic complex structure in the left adnexa, measuring 53 mm, alongside free fluid in Morrison's pouch. An emergency laparotomy was performed, revealing a normal uterus and a ruptured left fallopian tube with approximately 800 cc of blood in the abdomen.
PubMed: 38812838
DOI: 10.1177/2050313X241258840 -
Journal of Surgical Case Reports May 2024Peutz-Jeghers syndrome (PJS) is a rare genetic disorder causing gastrointestinal polyps and skin pigmentation. Our case report highlights a unique instance of...
Peutz-Jeghers syndrome (PJS) is a rare genetic disorder causing gastrointestinal polyps and skin pigmentation. Our case report highlights a unique instance of jejuno-jejunal intussusception associated with PJS in a 28-year-old female patient who presented to the emergency department with colicky abdominal pain, tachycardia, and gastrointestinal symptoms. Physical examination revealed mucocutaneous hyperpigmentation. Imaging studies showed a U-shaped distension in the jejunum with thickening and pneumatosis. Laparotomy revealed a jejuno-jejunal volvulus with intussusception. Surgical resection successfully addressed gangrenous jejunal tissue and ileal polyps. Histopathology confirmed PJS polyps. Postoperatively, the patient recovered well and was discharged. Family history revealed similar skin lesions in her uncle. Our case highlights the need for prompt surgical intervention to address complications associated with PJS and elucidates a unique presentation of PJS involving jejuno-jejunal intussusception and volvulus leading to complete small bowel obstruction. We aim to deepen understanding and prompt discussions on optimal therapeutic strategies.
PubMed: 38812577
DOI: 10.1093/jscr/rjae335 -
Journal of Surgical Case Reports May 2024Intussusception is defined as the telescoping of bowel into itself. Intussusception is the leading cause of bowel obstruction in children, but it is rare in adults [1,...
Intussusception is defined as the telescoping of bowel into itself. Intussusception is the leading cause of bowel obstruction in children, but it is rare in adults [1, 2]. It has a pathological intramural or extramural lead point. In adults, it accounts for 1%-5% of cases of bowel obstruction [3, 4]. Unlike presentation in the paediatric population of cramping abdominal pain, bloody mucus, and palpable mass in right iliac fossa, presentation in adults can be more varied and non-specific [1, 4]. Hence, diagnosis of small bowel intussusception (SBI) can be challenging, requiring a higher degree of clinical suspicion [5]. While cases of paediatric intestinal intussusception are often primary, most adult cases are secondary to structural lesions [5]. This case is of a 57-year-old lady who presented with SBI secondary to a small bowel lipoma (SBL), reflecting the importance of considering SBL as a differential in the causes of SBI.
PubMed: 38812574
DOI: 10.1093/jscr/rjae327 -
BMC Anesthesiology May 2024The Erector spinae plane block (ESPB) reduces postoperative pain after several types of abdominal laparoscopic surgeries. There is sparse data on the effect of ESPB in... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The Erector spinae plane block (ESPB) reduces postoperative pain after several types of abdominal laparoscopic surgeries. There is sparse data on the effect of ESPB in laparoscopic ventral hernia repair. The purpose of this study was to test the postoperative analgesic efficacy of an ESPB for this procedure.
METHODS
In this prospective, double-blind, randomized controlled study, adult patients undergoing laparoscopic ventral hernia repair were randomly assigned to either bilateral preoperative ESPB with catheters at the level of Th7 (2 × 30 ml of either 2.5 mg/ml ropivacaine or saline), with postoperative catheter top ups every 6 h for 24 h. The primary outcome was rescue opioid consumption during the first hour postoperatively. Secondary outcomes were total opioid consumption at 4 h and 24 h, pain scores, nausea, sedation, as well as Quality of Recovery 15 (QoR-15) and the EuroQol-5 Dimensions (EQ-5D-5L) during the first week.
RESULTS
In total, 64 patients were included in the primary outcome measure. There was no significant difference in rescue opioid consumption (oral morphine equivalents (OME)) at one hour postoperatively, with the ESPB group 26.9 ± 17.1 mg versus 32.4 ± 24.3 mg (mean ± SD) in the placebo group (p= 0.27). There were no significant differences concerning the secondary outcomes during the seven-day observation period. Seven patients received a rescue block postoperatively, providing analgesia in five patients.
CONCLUSION
We found no difference in measured outcomes between ESPB and placebo in laparoscopic ventral hernia repair. Future studies may evaluate whether a block performed using higher concentration and/or at a different thoracic level provides more analgesic efficacy.
TRIAL REGISTRATION
NCT04438369 ; 18/06/2020. .
Topics: Humans; Pain, Postoperative; Double-Blind Method; Female; Male; Laparoscopy; Middle Aged; Nerve Block; Prospective Studies; Hernia, Ventral; Herniorrhaphy; Analgesics, Opioid; Anesthetics, Local; Ropivacaine; Adult; Paraspinal Muscles; Aged
PubMed: 38811911
DOI: 10.1186/s12871-024-02566-x -
Internal Medicine (Tokyo, Japan) May 2024A 69-year-old man was diagnosed with follicular lymphoma (Grade 3A). Obinutuzumab combined with bendamustine (OB) therapy was initiated as salvage chemotherapy. Nausea,...
A 69-year-old man was diagnosed with follicular lymphoma (Grade 3A). Obinutuzumab combined with bendamustine (OB) therapy was initiated as salvage chemotherapy. Nausea, abdominal pain, and hyponatremia appeared after six courses of OB therapy; cytomegalovirus (CMV) enteritis with primary adrenal insufficiency (PAI) was a complication. Ganciclovir and hydrocortisone were administered, and the clinical findings improved. PAI caused by CMV infection has mainly been reported in patients with acquired immunodeficiency syndrome. In the present case, the PAI triggered by CMV infection led to immunodeficiency after chemotherapy.
PubMed: 38811229
DOI: 10.2169/internalmedicine.3334-23 -
International Journal of Surgery Case... May 2024Caecal volvulus is a form of intestinal obstruction with life-threatening potential. While rare, it represents a perilous aetiology of intestinal blockage, with clinical...
INTRODUCTION
Caecal volvulus is a form of intestinal obstruction with life-threatening potential. While rare, it represents a perilous aetiology of intestinal blockage, with clinical manifestations spanning from abdominal discomfort to mortality.
CASE SERIES
We report the cases of three young adults (two males and one female) who presented to the emergency department with different manifestations of severe abdominal pain. All occurred within one month in a tertiary referral centre. Radiological evaluations confirmed the diagnosis of caecal volvulus in all. Subsequently, these individuals underwent right hemicolectomies with end-to-end anastomosis. All experienced an uncomplicated perioperative course.
CLINICAL DISCUSSION
Caecal volvulus is uncommon, but its yearly incidence is increasing. Early detection and a heightened level of suspicion lead to a timely diagnosis, reducing morbidity and mortality rates.
CONCLUSION
We report a case series of caecal volvulus, emphasizing its variable presentation and highlighting the critical importance of an early diagnosis. Typically, patients have a history of similar episodes that resolve without any medical intervention. Definitive treatment involves right hemicolectomy while conservative management is associated with very high recurrence rates. Early detection allows for prompt intervention, resulting in reduced morbidity and mortality rates.
PubMed: 38810294
DOI: 10.1016/j.ijscr.2024.109776 -
DEN Open Apr 2025A 68-year-old man was admitted with hematochezia. Emergency computed tomography showed multiple diverticula throughout the colon. Initial colonoscopy on day 2 showed no...
A 68-year-old man was admitted with hematochezia. Emergency computed tomography showed multiple diverticula throughout the colon. Initial colonoscopy on day 2 showed no active bleeding, but massive hematochezia on day 3 led to the performance of an emergency endoscopy. Substantial bleeding in the ileocecal area obscured the visual field, making it challenging to view the area around the bleeding site. Two endoscopic band ligations (EBLs) were applied at the suspected bleeding sites. Hemostasis was achieved without active bleeding after EBL. However, the patient developed lower right abdominal pain and fever (39.4°C) on day 6. Urgent computed tomography revealed appendiceal inflammation, necessitating emergency open ileocecal resection for acute appendicitis. Pathological examination confirmed acute phlegmonous appendicitis, with EBLs noted at the appendiceal orifice and on the anal side. This case illustrates the efficacy of EBL in managing colonic diverticular bleeding. However, it also highlights the risk of appendicitis due to EBL in cases of ileocecal hemorrhage exacerbated by poor visibility due to substantial bleeding. Endoscopists need to consider this rare but important complication when performing EBL in similar situations.
PubMed: 38808314
DOI: 10.1002/deo2.392