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Archives of Disease in Childhood Jul 2002To assess the efficacy of a new regimen of intravenous atropine treatment for infantile hypertrophic pyloric stenosis (IHPS) with special reference to regression of...
AIMS
To assess the efficacy of a new regimen of intravenous atropine treatment for infantile hypertrophic pyloric stenosis (IHPS) with special reference to regression of pyloric hypertrophy.
METHODS
Atropine was given intravenously at a dose of 0.01 mg/kg six times a day before feeding in 19 patients with IHPS diagnosed from radiographic and ultrasonographic findings. When vomiting ceased and the infants were able to ingest 150 ml/kg/day formula after stepwise increases in feeding volume, they were given 0.02 mg/kg atropine six times a day orally and the dose was decreased stepwise.
RESULTS
Of the 19 infants, 17 (89%) ceased projectile vomiting after treatment with intravenous (median seven days) and subsequent oral (median 44 days) atropine administration. The remaining two infants required surgery. No significant complications were encountered. Ultrasonography showed a significant (p < 0.05) decrease in pyloric muscle thickness, but no significant shortening of the pyloric canal after completion of the atropine treatment. The patients exhibited failure to thrive at presentation, but were thriving at 6 months of age (p < 0.01).
CONCLUSIONS
This atropine therapy resulted in satisfactory clinical recovery. Pyloric muscle thickness was significantly reduced.
Topics: Atropine; Female; Follow-Up Studies; Humans; Hypertrophy; Infant; Infant, Newborn; Infusions, Intravenous; Male; Muscarinic Antagonists; Pyloric Stenosis; Pylorus; Ultrasonography; Vomiting
PubMed: 12089130
DOI: 10.1136/adc.87.1.71 -
Journal of the ASEAN Federation of... 2022A 35-year-old female presented with abdominal pain, fever, projectile vomiting, and a diffuse tender epigastric mass. She was diagnosed to have acute persistent...
A 35-year-old female presented with abdominal pain, fever, projectile vomiting, and a diffuse tender epigastric mass. She was diagnosed to have acute persistent pancreatitis with a pancreatic pseudocyst. Elevated serum calcium levels provided an etiologic link between hypercalcemia and pancreatitis. On examination, a nodule was found in the left side of her neck which was later diagnosed as a giant left inferior parathyroid adenoma. This report highlights the critical analysis of history, examination, and investigations to reach an ultimate diagnosis. Pseudocyst drainage and parathyroidectomy resolved her symptoms.
Topics: Female; Humans; Adult; Parathyroid Neoplasms; Adenoma; Neck; Pancreatitis, Chronic; Hypercalcemia; Gastric Outlet Obstruction
PubMed: 35800590
DOI: 10.15605/jafes.037.01.11 -
Journal of Medical Case Reports Apr 2021Although central nervous system tumors are the most common etiology of malignancies in the pediatric age group, choroid plexus carcinomas are rare, with an annual...
INTRODUCTION/BACKGROUND
Although central nervous system tumors are the most common etiology of malignancies in the pediatric age group, choroid plexus carcinomas are rare, with an annual incidence rate of 0.10 per 100,000 children.
CASE PRESENTATION
We report the case of an adolescent male belonging to central India who had presented with a history of persistent headache, projectile vomiting, neck stiffness, and an episode of generalized tonic-clonic seizure. Neurological examination was suggestive of a space-occupying lesion. Further neuroimaging was suggestive of a large left-sided choroid plexus carcinoma, later confirmed on pathological examination. Gross total resection was achieved and followed by radiation therapy. His recovery was satisfactory without any major events despite suffering from such a malignancy with a poor prognosis.
CONCLUSION
In the absence of a global consensus on choroid plexus carcinoma management, our patient underwent a successful gross total resection and received postoperative radiotherapy. He made a satisfactory recovery with a further plan to review with gadolinium-enhanced neuroimaging at a later date. We conclude that, when possible, achieving gross total resection is of utmost importance.
Topics: Adolescent; Carcinoma; Choroid Plexus Neoplasms; Headache; Humans; India; Male; Neuroimaging; Radiotherapy, Adjuvant; Treatment Outcome; Vomiting
PubMed: 33879216
DOI: 10.1186/s13256-021-02801-w -
Balkan Medical Journal Jun 2014Moyamoya syndrome associated with protein S deficiency is rarely encountered and is usually reported in paediatric cases with cerebral ischaemia.
BACKGROUND
Moyamoya syndrome associated with protein S deficiency is rarely encountered and is usually reported in paediatric cases with cerebral ischaemia.
CASE REPORT
A 32-year-old woman had symptoms of sudden-onset severe headache, projectile vomiting, impaired consciousness, and slight neck stiffness. The computed tomography scan of her brain showed primary intraventricular haemorrhage, and the subsequent four vessel cerebral angiographies revealed stage 3 to 4 Moyamoya disease according to Suzuki and Takaku's angiographic classification. The coagulation profile showed the presence of protein S deficiency. The patient was treated with external ventricular drainage and conservative management until blood clot resolution. The patient was discharged with normal neurological examination findings after her initial impaired consciousness and orientation defect gradually recovered.
CONCLUSION
This case report would alert physicians to the possible coexistence of Moyamoya syndrome and protein S deficiency, even in adult cases presenting with primary intraventricular haemorrhage.
PubMed: 25207193
DOI: 10.5152/balkanmedj.2014.13028 -
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 -
International Journal of Surgery Case... Nov 2023A volvulus is a serious surgical emergency caused by torsion or hyper-flexion of the bowel loop and its mesentery on a fixed point. Cecal volvulus is an uncommon cause...
INTRODUCTION
A volvulus is a serious surgical emergency caused by torsion or hyper-flexion of the bowel loop and its mesentery on a fixed point. Cecal volvulus is an uncommon cause of intestinal obstruction, accounting for just 1-1.5 % of all cases of bowel obstruction.
CASE PRESENTATION
A 33-year-old intellectually disabled male presented to the emergency department with complaints of generalized abdominal pain, absolute constipation, and non-projectile vomiting. He had a grossly distended and rigid abdomen with generalized tenderness and guarding. The abdomen was hyper-resonant. Bowel sounds were hypoactive. Digital rectal examination revealed an empty and collapsed rectum with no stool staining of the finger. Laboratory reports showed leukocytosis and neutrophilia. Radiographic imaging was consistent with acute intestinal obstruction. Laparotomy was performed, and cecal volvulus with viable bowel and acute appendicitis was diagnosed intra-operatively. Manual detorsion, cecopexy, and appendectomy were performed. The patient had an uneventful postoperative course. The patient is still on follow-up since June 2023, and no complication has occurred.
CLINICAL DISCUSSION
Cecal volvulus is an uncommon cause of intestinal obstruction with multiple etiologies. The annual incidence of cecal volvulus is estimated to be between 2.8 and 7.1 cases per million. Cecal volvulus may lead to life-threatening complications such as bowel ischemia and perforation.
CONCLUSION
Diagnosis of cecal volvulus must be made promptly to prevent bowel gangrene and perforation. In this case, manual detorsion and cecopexy were performed as the bowel was viable per-operatively due to early surgical intervention.
PubMed: 37844385
DOI: 10.1016/j.ijscr.2023.108904 -
Annals of Medicine and Surgery (2012) Mar 2022and importance:Bilateral extradural hematomas account for less than 5% of all entities of extradural hematomas. The condition is generally caused by traumatic brain...
INTRODUCTION
and importance:Bilateral extradural hematomas account for less than 5% of all entities of extradural hematomas. The condition is generally caused by traumatic brain injury, which can form separate hematomas contralaterally or joint bilateral extradural hematomas commonly owing to superior sagittal sinus injury. In light of the above, this is the first case of such a condition to be reported from Sudan in the literature.
CASE PRESENTATION
A 31-years-old male presented with headache, confusion, and 4 episodes of non-projectile vomiting with a GCS score of 14, after being assaulted by direct blunt head trauma. CT brain showed acute extradural hematoma on the right frontotemporal part compared to a parietal extradural hematoma on the contralateral side. The patient underwent bilateral craniotomy with a wide question mark-like skin flap on the right temporoparietal side followed by 5 burr holes. On the left side, parietal craniotomy was made with an inverted U-shaped skin flap and 4 burr holes on the left parietal side, after that two surgical drains were inserted bilaterally. The patient was discharged on the third postoperative day with a GCS of 15.
DISCUSSION
Although bilateral extradural hematomas are rare and grave conditions, prompt surgical intervention has shown low morbidity and mortality rate with markedly favorable postoperative outcomes.
CONCLUSION
Bilateral extradural hematomas can be attributed to extended linear fracture caused by superior sagittal sinus injury. CT scan is the gold standard imaging. However, MRI and MRV can be used to demonstrate injury or occlusion of the Superior sagittal sinus.
PubMed: 35198197
DOI: 10.1016/j.amsu.2022.103377 -
The Israel Medical Association Journal... Mar 2004Hypertrophic pyloric stenosis classically presents as projectile vomiting during the third to fourth week of life, associated with good appetite. Additional classical... (Comparative Study)
Comparative Study
BACKGROUND
Hypertrophic pyloric stenosis classically presents as projectile vomiting during the third to fourth week of life, associated with good appetite. Additional classical presenting findings include palpation of the pyloric tumor, described as olive-shaped; a visible gastric peristaltic wave after feeding; and hypochloremic, hypokalemic metabolic alkalosis. It was recently claimed that this presentation has changed due to the easier access to gastrointestinal imaging.
OBJECTIVE
To validate this contention and discuss possible reasons.
METHODS
We conducted a retrospective chart review of all patients who underwent pyloromyotomy for HPS between 1990 and 2000. Only patients with confirmed HPS at the time of surgery were included. We also performed a comprehensive review of older studies for comparison.
RESULTS
Seventy patients underwent pyloromyotomy over the 10 year period. Overall, 81% of patients were male infants and the mean age at diagnosis was 40 days. The mean duration of symptoms was 8 days. A firstborn child was noted in 43% of the cases. The classical symptom of projectile vomiting was absent in one-third of the patients, a pyloric tumor was not palpated in one-half of the cases, bicarbonate was higher than 28 mEq/L in 20%, and a pH of above 7.45 was present in 25% of patients. Hypochloremia was noted in about one-third. We found a good correlation between ultrasonographic width and length of the pylorus and the intraoperative findings. Pylorus length +/- 24 mm correlated with significantly longer duration of symptoms. When compared with previous studies, the main findings were not significantly different; namely, mean age at diagnosis, percentage of male gender, and duration to diagnosis. The decrease in the number of pyloric tumors palpated paralleled the increase in the use of upper gastrointestinal series and ultrasonography in particular.
CONCLUSIONS
The clinical presentation of HPS has not actually changed despite the easier accessibility of GI imaging studies. However, the one significant change is the low percentage of pyloric tumors palpated, probably due to declining clinical skills accompanied by earlier utilization of imaging studies. The use of imaging and laboratory studies did not change the age at diagnosis but may have shortened the time for diagnosis and reduced the postoperative stay. Imaging and laboratory studies may be helpful for the subgroup with a non-classical clinical presentation.
Topics: Digestive System Surgical Procedures; Female; Follow-Up Studies; Humans; Hypertrophy; Incidence; Infant; Infant, Newborn; Israel; Male; Pyloric Stenosis; Pylorus; Recovery of Function; Retrospective Studies; Risk Factors; Severity of Illness Index; Sex Distribution; Treatment Outcome
PubMed: 15055266
DOI: No ID Found -
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 -
BMJ Case Reports Oct 2012A 3-year-old male child presented with moderate-to-high grade fever and non-projectile vomiting, generalised seizures and altered sensorium for 1 month. CT scan...
A 3-year-old male child presented with moderate-to-high grade fever and non-projectile vomiting, generalised seizures and altered sensorium for 1 month. CT scan revealed a communicating hydrocephalus with no basal exudates. The microbiological tests were negative for Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitides, brucellosis, cryptococcosis, HIV and Mycobacterium tuberculosis. Intracranial pressure was relieved by ventriculo-peritoneal shunt, and the child was empirically started on ceftriaxone, and antitubercular therapy with isoniazid, rifampicin, ethambutol and streptomycin, along with steroids and supportive treatment for seizures. The symptoms persisted. On further investigation the cerebrospinal fluid showed growth of Acanthamoeba spp., following which the initial treatment was stopped and a combination antiamoebic regimen of cotrimoxazole, rifampicin and ketoconazole was started, after which he showed clinical improvement. The treatment was continued for 6 months and on follow-up at 1, 3 and 6 months, there was a remarkable clinical improvement with no residual symptoms.
Topics: Acanthamoeba; Amebiasis; Anti-Infective Agents; Central Nervous System Infections; Cerebrospinal Fluid; Child; Humans; Hydrocephalus; Intracranial Hypertension; Male; Malnutrition
PubMed: 23097578
DOI: 10.1136/bcr-2012-007449