Surgery and ObGyn: Beyond the Chief Complaint

Introduction: Renal colic is a colicky-type of flank pain that can commonly be presented in patients undergoing dialysis especially if they are anuric considering the fact that there are multiple controversies and little published experience on this topic, we found it very important to report this case. We also aimed to increase awareness and emphasize the importance of renal colic in anuric patients on dialysis. Case description: We herein report a case of a 42-year old man with a chief complaint of bilateral colic flank pain, He had developed end stage renal disease due to ADPKD and was on hemodialysis since the past 5 years. Previously, he went through a series of workup but was left undiagnosed. Abdomen-pelvic and chest CT scan without contrast was performed showing bilateral renal pelvic stones and some nephrocalcinosis in both kidneys. bilateral ureteroscopy was performed and bilateral DJ was installed for a total of 6 weeks and extracorporeal shock wave lithotripsy was done. With prompt diagnosis, the patient was pain free and stone free before discharge. The patient is also reported to be stone free 6 months after the procedure. Conclusion: Patients on dialysis are still capable of forming symptomatic renal tract stones even if they are anuric.

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Initial assessment in emergency departments by chief complaint and respiratory rate

Journal of General and Family Medicine ◽

10.1002/jgf2.423 ◽

2021 ◽

Author(s):

Shoko Soeno ◽

Konan Hara ◽

Ryo Fujimori ◽

Katsuhiko Hashimoto ◽

Toru Shirakawa ◽

...

Keyword(s):

Respiratory Rate ◽

Emergency Departments ◽

Chief Complaint ◽

Initial Assessment

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Refractory Dry Eye Syndrome after Transconjunctival Excision of the Palpebral Lobe of the Lacrimal Gland

Medicina ◽

10.3390/medicina57060608 ◽

2021 ◽

Vol 57 (6) ◽

pp. 608

Author(s):

Yong-Jae Lee ◽

Han-Sol Choi ◽

Seong-Jun Park ◽

Hae-Jung Sun ◽

Sun-Young Jang

Keyword(s):

Female Patient ◽

Dry Eye ◽

Lacrimal Gland ◽

Medical Center ◽

Chief Complaint ◽

Incisional Biopsy ◽

Lacrimal Glands ◽

Palpable Mass ◽

Tear Secretion ◽

Palpebral Lobe

The aim of the present study was to report two cases of refractory dry eye syndrome (DES) after transconjunctival excision of the palpebral lobe of the lacrimal gland. A 25-year-old female patient with a chief complaint of a palpable mass in both upper eyelids visited our medical center. Preoperative orbital computer tomography showed high-attenuation lesions in both lacrimal glands. Incisional biopsy of the lacrimal gland palpebral lobe via transconjunctival incision was performed in January 2019. At 1 month after the biopsy, a lack of tears and persistent corneal erosions were found in both eyes. Artificial tears, punctal occlusion, autologous serum eye drops, and therapeutic contact lenses were applied in an attempt to control the dry eye symptoms. The patient continues to suffer from intractable DES at 2.5 years after the procedure. The second case involved a 52-year-old female patient who visited our medical center with a chief complaint of a palpable mass in both upper eyelids. Bilateral orbital tumors were diagnosed with preoperative magnetic resonance imaging. An incisional biopsy of the lacrimal gland was performed. Immunoglobulin G4-related dacryoadenitis was confirmed through lacrimal palpebral lobe incisional biopsy. Intractable DES and corneal erosion of her left eye persisted thereafter. A transconjunctival incision is an effective approach for minimizing postoperative scars and is suitable for the biopsy of tumors that are visible through the conjunctiva. After a biopsy of the palpebral lobe of the main lacrimal glands, the secretion of reflex tears decreases due to damage to the secreting ducts of the main lacrimal glands. However, total tear secretion can be maintained by basal tear secretion from the accessory lacrimal glands. In this report, we describe two cases of refractory DES due to decreased total tear secretion, although only the palpebral lobes of the main lacrimal glands were biopsied.

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Comparison of masticatory muscle myofascial pain in patients with and without a chief complaint of headache

CRANIO® ◽

10.1179/0886963413z.0000000006 ◽

2014 ◽

Vol 32 (1) ◽

pp. 57-62 ◽

Cited By ~ 1

Author(s):

Hiroyuki Karibe ◽

Greg Goddard ◽

Masakazu Okubo

Keyword(s):

Myofascial Pain ◽

Chief Complaint ◽

Masticatory Muscle

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A 37-year-old Man Presenting with a Chief Complaint of Numbness in Both Hands

Nihon Naika Gakkai Zasshi ◽

10.2169/naika.97.457 ◽

2008 ◽

Vol 97 (2) ◽

pp. 457-458

Author(s):

Kiyonori Takada ◽

Tamami Abe ◽

Taichi Azuma ◽

Masaki Yasukawa ◽

Eiji Sada

Keyword(s):

Chief Complaint

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The diagnostic value of human epididymis protein 4 for endometrial cancer is moderate

Scientific Reports ◽

10.1038/s41598-020-79960-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Jing Liu ◽

Lili Han ◽

Zhen Jiao

Keyword(s):

Endometrial Cancer ◽

Sensitivity And Specificity ◽

Diagnostic Value ◽

Critical Value ◽

Chief Complaint ◽

Human Epididymis Protein 4 ◽

Human Epididymis ◽

Clinical Stages ◽

Spss Software ◽

Xinjiang Uyghur Autonomous Region

AbstractHuman epididymis protein 4 (HE4) has been used as a biomarker of endometrial cancer (EC) in clinical practice. However, there remains a lack of systemic research on the critical values of HE4 for diagnosing different clinical stages and pathological types of EC. This study investigated the accuracy of human epididymis protein 4 (HE4) in the diagnosis of EC. Patients who were hospitalized for a chief complaint of abnormal vaginal hemorrhage at Xinjiang Uyghur Autonomous Region People's Hospital between 2014 and 2019 were consecutively included. Pathological biopsy confirmed the diagnosis of EC; there were a total of 136 EC patients and 127 non-EC patients. The accuracy of HE4 in the diagnosis of EC was assessed with SPSS software. The accuracy of HE4 for diagnosing different clinical stages and pathological types of EC was also explored. The critical value of HE4 for endometrial cancer was 52.40 mmol/L, with a sensitivity of 57.35% and a specificity of 76.38%. For different stages of EC, the critical value was 36.9 mmol/L, and the sensitivity and specificity were 28% and 87.39%, respectively. For different pathological types, the critical value was 30.60 mmol/L, and the sensitivity and specificity were 93.85% and 33.33%, respectively. The diagnostic value of HE4 for EC is moderate, and the serum HE4 level cannot reflect the stage and type of EC.

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Urinary Tract Infection

Pediatrics in Review ◽

10.1542/pir.1.5.133 ◽

1979 ◽

Vol 1 (5) ◽

pp. 133-136

Author(s):

Richard H. Rapkin

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Urine Culture ◽

Underlying Disease ◽

Chief Complaint ◽

Voiding Cystourethrogram ◽

Intravenous Pyelogram ◽

Rapid Generation

The identification of urinary tract infection (UTI) is important in order to reduce its morbidity, to prevent its sequelae, and to identify underlying disease. This article will discuss methods of diagnosis and management of UTI, screening for UTI, and the importance of further evaluation and follow-up of children with UTIs. Much of what we know about UTI is controversial and rapid generation of new knowledge may make current recommendations passé. CASE V.M., a 4-year-old girl, was brought to the physician's office with the chief complaint of frequency of urination. Nine months before she had been seen because of frequency and dysuria and two consecutive midstream urine cultures grew >100,000 colonies/ml of a Gramneative rod. Sulfisoxazole was begun and a urine culture was sterile 48 hours after therapy was begun. The dysuria and frequency disappeared; therapy was continued for ten days and a urine culture four days later was sterile. One week later a voiding cystourethrogram (VCU) and an intravenous pyelogram (IVP) were performed and were interpreted as normal. Repeat urine cultures at one, two, three, and six months after the episode were sterile. Two days before the child was seen, she had become irritable and wet the bed during sleep (she had been successfully trained at 27 months of age), and she began to void frequently during the next 24 hours.

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Medical Record Documentation of Seizures

Pediatrics in Review ◽

10.1542/pir.13.2.76 ◽

1992 ◽

Vol 13 (2) ◽

pp. 76-77

Keyword(s):

Medical Record ◽

Chief Complaint ◽

Total Loss ◽

Loss Of Consciousness ◽

Pertinent Data ◽

Sample Record ◽

Medical Record Documentation

This sample record is meant to demonstrate comprehensive recording of pertinent data. Actual records will vary in format; many will be written in a more abbreviated style. Name: Sharon DiStefano1 Date of birth: December 8, 19832 Drug allergies: None; cramps from erythromycin3 Immunizations: Fully immunized4 Thursday, February 6, 1992 Telephone Teacher called parents — Sharon "suddenly gets a blank look" for brief periods. Has done this several times. Parents will get further information from teacher, watch carefully over weekend, bring in for visit next week. Tuesday, February 11, 1992 CHIEF COMPLAINT: "We think she's having spells." PRESENT ILLNESS: (See letter from teacher). He has noted over the last week, on 5 or 6 occasions, that Sharon will develop "blank stare" suddenly. When talked to, will not respond at first but will after several repetitions. Once did this in the middle of talking; paused noticeably for a number of seconds, then resumed talking. Eyes always stay open; blinking noted; no total loss of consciousness. No jerking, twitching, slumping, drooling, incontinence. Seems normal afterwards; not aware of any lapse. Over the weekend parents saw similar spells: three times at meals, twice when watching television, once after she had been running around backyard and had just sat down. "Like a shade was drawn behind her eyes."

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Medical Record Documentation of Head Injury

Pediatrics in Review ◽

10.1542/pir.14.8.300 ◽

1993 ◽

Vol 14 (8) ◽

pp. 300-301

Keyword(s):

Blood Pressure ◽

Head Injury ◽

Chief Complaint ◽

Problem List ◽

Past Medical History ◽

Retinal Hemorrhages ◽

Parietal Area ◽

Regular Rhythm ◽

Optic Discs ◽

Medical Record Documentation

Name: Roger Horton1 Date of Birth: June 1, 19842 Drug Allergies: None known3 Immunizations: Complete4 Wednesday, June 9, 1993 1 PM CHIEF COMPLAINT: Fell and hit side and head. PRESENT ILLNESS: At 12:15 PM was swinging high on swing at schoolyard. Fell off at top of arc and landed on hard ground, striking right side of body and right side of head. Remembers landing and "seeing stars," then being surrounded by others. Does not think he lost consciousness. Walked into school, with help. PAST MEDICAL HISTORY (as recorded on problem list): Occasional wheezing, relieved by albuterol inhaler. Fracture, left radius, age 6. PHYSICAL EXAMINATION: Slim, pale boy, sitting quietly on table. Complains of headache; feels "sick to my stomach" and cold. Right shoulder and hip hurt; neck does not. Weight: 58 lb Temperature: 98.2°F, orally Pulse rate: 92 beats/min Respiratory rate: 20 breaths/min Blood pressure: 120/70 Head: Tender and mildly swollen over right parietal area. Eyes: Sclerae clear. Pupils equal in size and reactive. Extraocular movements full without nystagmus. Media clear. Optic discs sharp. Venous pulsations noted. No retinal hemorrhages. Acuity 20/26 in each eye. Ears: Clear tympanic membranes without blood. Nose: Clear; no discharge. Mouth/throat: Clear; no injury noted. Neck: Full movement without pain. Mild tenderness on right side. Chest: Breathing easily. Clear sounds. No tenderness of ribs. Heart: Good sounds in regular rhythm without murmurs.

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