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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 Cancer Research and... 2007The occurrence of a second malignancy in a patient with a known malignant tumour is not uncommon. Synchronous primary malignancies are still unusual We are presenting...
The occurrence of a second malignancy in a patient with a known malignant tumour is not uncommon. Synchronous primary malignancies are still unusual We are presenting two cases treated successfully at our centre. Case report 1-A 70 year old female presented to us with lump in right breast for two years and bleeding per vaginum for two years. Histopathology of cervix showed squamous cell carcinoma (large cell non keratinizing) and clinical stage was IIIB. HPE mastectomy specimen showed infiltrating duct carcinoma and stage II. Patient was treated with external beam radiotherapy for carcinoma cervix and breast simultaneously and chemotherapy as required. Patient is on regular follow up and clinically no evidence of disease. Case Report 2 -A 40 year old female presented with mild headache off and on for one year, projectile vomiting for three months and right side facial swelling for three months. HPE brain tissue showed astrocytoma grade II and HPE parotid tumour showed low grade muco-epidermoid carcinoma. Patient was treated with surgery first then radiotherapy. Patient is in regular follow up,having no complain,clinically no neurological dysfunction and no evidence of disease at right parotid and neck region. Thus it was concluded that patients responded well to treatment. Treatment strategies in case of synchronous double malignancy depend on treating the malignancy that is more advanced first or sometimes both could be treated simultaneously. In our case we concluded that synchronous double malignancy may be treated successfully. Both sites should be treated fully as if they were occurring separately considering toxicities.
Topics: Adult; Aged; Astrocytoma; Brain Neoplasms; Breast Neoplasms; Carcinoma, Ductal, Breast; Carcinoma, Squamous Cell; Combined Modality Therapy; Female; Humans; Neoplasms, Multiple Primary; Treatment Outcome; Uterine Cervical Neoplasms
PubMed: 18079578
DOI: 10.4103/0973-1482.37408 -
Canadian Medical Association Journal Aug 1976A 3-month-old male infant had two episodes of fever, projectile vomiting, dehydration, generalized fine tremors and gross metabloic ketoacidosis. Methylmalonic acid was...
A 3-month-old male infant had two episodes of fever, projectile vomiting, dehydration, generalized fine tremors and gross metabloic ketoacidosis. Methylmalonic acid was found in high concentration in both serum and urine, although the concentration of serum vitamin B12 was normal. A therapeutic trial of vitamin B12, administered parenterally, reduced greatly the methylmalonic aciduria. The patient has since been given vitamin B12 supplements continuously, initially 1 mg intramuscularly every other day, then 15 mg/d orally, and the protein in his diet was subsequently restricted. The most effected control of the methylmalonic aciduria was achieved with the combined regimen of oral vitamin therapy and dietary protein restriction. His physical and intellectual development have progressed normally and he has survived several acute respiratory tract infections without recurrence of metabolic acidosis.
Topics: Acidosis; Administration, Oral; Humans; Infant; Male; Malonates; Methylmalonic Acid; Vitamin B 12
PubMed: 953884
DOI: No ID Found -
Case Reports in Emergency Medicine 2012This is a 3-month-old infant with a diagnosis of acute cholecystitis presenting with projectile vomiting and no fever and no abdominal pain.
This is a 3-month-old infant with a diagnosis of acute cholecystitis presenting with projectile vomiting and no fever and no abdominal pain.
PubMed: 23326730
DOI: 10.1155/2012/913481 -
Sudanese Journal of Paediatrics 2013Dandy-Walker Malformation (DWM) is a rare congenital malformation of the brain. It is characterized by cystic enlargement of the fourth ventricle which is communicating...
Dandy-Walker Malformation (DWM) is a rare congenital malformation of the brain. It is characterized by cystic enlargement of the fourth ventricle which is communicating with an enlarged posterior fossa, cerebellar dysgenesis, high tentorial insertion and hydrocephalus. Neurocutaneous Melanosis (NCM) is a congenital neurocutaneous syndrome characterized by large or multiple melanocytic nevi and benign or malignant melanocytic tumors of the leptomeninges. We report three months old boy who presented with projectile vomiting associated with a noticeable increase in head size. Several congenital nevi were seen all over his body with evident signs of hydrocephalus. The association of DWM and NCM is a rare complex, and to our knowledge, this is the eleventh case to be reported in the literature. In this article, we discuss the proposed pathogenesis, classification and management of the condition.
PubMed: 27493376
DOI: No ID Found -
Clinical Practice and Cases in... Nov 2017A 15-day-old male who was born at term presented with non-bilious projectile vomiting. He was nontoxic and his abdomen was benign without masses. Point-of-care...
A 15-day-old male who was born at term presented with non-bilious projectile vomiting. He was nontoxic and his abdomen was benign without masses. Point-of-care ultrasound (POCUS) showed hypertrophic pyloric stenosis (HPS). Typical findings include target sign; pyloric muscle thickness greater than three millimeters (mm); channel length greater than 15-18 mm; and lack of gastric emptying. The patient was admitted; consultative ultrasound (US) was negative, but repeated 48 hours later for persistent vomiting. This second US was interpreted as HPS, which was confirmed surgically. Pyloromyotomy was successful. Few reports describe POCUS by general emergency physicians to diagnose HPS. Here, we emphasize the value in repeat US for patients with persistent symptoms.
PubMed: 29849342
DOI: 10.5811/cpcem.2017.9.35016 -
Archives of Pathology & Laboratory... Mar 2001The etiology of idiopathic hypertrophic pyloric stenosis (IHPS) is unknown. Epstein-Barr virus (EBV) infects smooth muscle cells and is associated with leiomyomas and...
CONTEXT
The etiology of idiopathic hypertrophic pyloric stenosis (IHPS) is unknown. Epstein-Barr virus (EBV) infects smooth muscle cells and is associated with leiomyomas and leiomyosarcomas of immunocompromised persons, including persons with the acquired immunodeficiency syndrome.
OBJECTIVE
To determine whether EBV is causally associated with IHPS.
DESIGN
Biopsy samples of the pylorus were obtained from 10 infants with projectile vomiting and pyloric hypertrophy on ultrasound, with confirmation of hypertrophy at the time of pyloromyotomy. The presence of EBV infection was tested by in situ hybridization for EBV-encoded RNA 1 (EBER1) in smooth muscle cells of IHPS.
SETTING
Biopsy specimens were obtained from children treated for IHPS at a tertiary referral hospital and were tested in a clinical molecular diagnostics laboratory.
RESULTS
All of the 10 smooth muscle biopsies were negative for EBER1. Cellular U6 RNA was detected in all smooth muscle samples, confirming that the RNA in the specimens was intact and capable of detection by in situ hybridization.
CONCLUSIONS
The absence of EBER1 in 10 cases of clinically diagnosed and histopathologically confirmed cases of IHPS effectively excludes EBV infection of smooth muscle cells as a causal factor in the pathogenesis of IHPS.
Topics: Biopsy; Epstein-Barr Virus Infections; Female; Herpesvirus 4, Human; Humans; Hypertrophy; In Situ Hybridization; Infant; Infant, Newborn; Male; Muscle, Smooth; Pyloric Stenosis; RNA, Viral; Ultrasonography
PubMed: 11231484
DOI: 10.5858/2001-125-0361-AOEBVI -
Annals of Saudi Medicine Mar 1991We describe seven patients who suffered chronic gastric torsion, seen during a 28-month period. Four were children, of which three were infants. The infants had...
We describe seven patients who suffered chronic gastric torsion, seen during a 28-month period. Four were children, of which three were infants. The infants had projectile vomiting and two also had failure to thrive. The adults presented with epigastric pain and vomiting. Upper gastrointestinal series clinched the diagnosis in all patients. The classic radiographic presentation of a stomach lying across the epigastrium with the cardia and fundus in a dependent position to the body of the stomach and pylorus may be overlooked in some cases. Choice of surgical procedure in its management has been discussed. There was no associated abnormality in four of the six operated cases. One infant had an atretic bowel, vascular anomalies, umbilical hernia, and previous meconium peritonitis; a second infant had jejunojejunal intussusception. A high index of suspicion is warranted in patients presenting with recurrent abdominal pain or in infants with unexplained vomiting and failure to thrive. Upper gastrointestinal series in adults should preferably be performed while the pain is present.
PubMed: 17588077
DOI: 10.5144/0256-4947.1991.175 -
Asian Journal of Neurosurgery 2015Pilomyxoid astrocytoma (PMA) is a recently described entity with similar features to pilocytic astrocytoma but with a rare occurrence. As a new diagnosis, no treatment...
Pilomyxoid astrocytoma (PMA) is a recently described entity with similar features to pilocytic astrocytoma but with a rare occurrence. As a new diagnosis, no treatment guideline of PMA has been established; but generally, as for any low-grade gliomas, radical resection is performed if the location is favorable. In this report, we wished to share our experience treating the PMA. The authors presented a case of a 7-year-old girl with bitemporal hemianopia. From the history, the patient had a 4-month history of headache, following with nausea and projectile vomiting 1 week before hospital admission. Past history of seizure, weakness of left extremities, and decreased consciousness were reported. Computed tomography (CT) scanning showed acute obstructive hydrocephalus and an isohypodense mass at suprasellar region with the cystic component. We performed ventriculo-peritoneal-shunt to reduce the acute hydrocephalus, followed by craniotomy tumor removal 2 weeks later. The patient underwent radiotherapy and medical rehabilitation. Diagnosis of PMA was made on the basis of pathologic anatomy result, which showed a myxoid background with pseudorosette. Postoperative CT showed a residual tumor at right parasellar area without hydrocephalus. After the surgery, the treatment was followed with radiotherapy for 20 times within 2 months. Postradiation CT performed 1-year later showed a significant reduction of the tumor mass. There were no new postoperative deficits. The patient had improvement of the visual field and motor strength. The authors reported a case of a 7-year-old girl with PMA. Surgical resection combined with radiotherapy was performed to control the growth of PMA. More observation and further studies are required to refine the treatment methods.
PubMed: 25972955
DOI: 10.4103/1793-5482.154989 -
Neuropsychiatric Disease and Treatment 2015The etiology of vasospasm after brain tumor resection remains unclear. This is the first report of diffuse cerebral vasospasm following resection of a schwannoma located...
BACKGROUND
The etiology of vasospasm after brain tumor resection remains unclear. This is the first report of diffuse cerebral vasospasm following resection of a schwannoma located in the left portion/part of the ventral medulla oblongata.
CASE PRESENTATION
A 16-year-old boy presented with dizziness and projectile vomiting without apparent cause three months before admission. Magnetic resonance imaging revealed a space-occupying lesion in the left portion of the ventral medulla oblongata. The tumor was completely resected. Pathological examination was consistent with diagnosis of schwannoma. Three days after surgery, the patient was in an unconscious state. Magnetic resonance angiography revealed the occurrence of cerebral vasospasm, with ischemic infarction and segmental cerebrovascular stenosis. Seven days after surgery, dehydration therapy was carried out and decompressive craniectomy was performed in the frontal and temporal areas. Despite treatments, the patient was in a persistent vegetative state after surgery, with normal vital signs.
CONCLUSION
This was an uncommon occurrence of diffuse cerebral vasospasm following the resection of schwannoma. Appropriate management of this condition is uncertain, but aggressive treatments including expansion of blood volume and relief of spasm should be performed to treat postsurgery vasospasm.
PubMed: 25709454
DOI: 10.2147/NDT.S73333