Medical and Surgical Management of Empyema

AbstractInfection of the pleural space is an ancient and common clinical problem, the incidence which is on the rise. Advances in therapy now present clinicians of varying disciplines with an array of therapeutic options ranging from thoracentesis and chest tube drainage (with or without intrapleural fibrinolytic therapies) to video-assisted thoracic surgery (VATS) or thoracotomy. A framework is provided to guide decision making, which involves weighing multiple factors (clinical history and presentation, imaging characteristics, comorbidities); multidisciplinary collaboration and active management are needed as the clinical course over a few days determines subsequent refinement. The initial choice of antibiotics depends on whether the empyema is community-acquired or nosocomial, and clinicians must recognize that culture results often do not reflect the full disease process. Antibiotics alone are rarely successful and can be justified only in specific circumstances. Early drainage with or without intrapleural fibrinolytics is usually required. This is successful in most patients; however, when surgical decortication is needed, clear benefit and low physiologic impact are more likely with early intervention, expeditious escalation of interventions, and care at a center experienced with VATS.

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Evaluation of a Child with Spells: A “Prefixed” Approach

Journal of Pediatric Neurology ◽

10.1055/s-0039-1688720 ◽

2019 ◽

Vol 18 (01) ◽

pp. 007-012

Author(s):

Jatinder S. Goraya

Keyword(s):

Clinical Practice ◽

Electrical Activity ◽

Cortical Neurons ◽

Diagnostic Errors ◽

Clinical History ◽

Clinical Problem ◽

Detailed Account ◽

History Taking ◽

Clinical Events ◽

Common Clinical Problem

AbstractSpells are a common clinical problem in children and can be broadly classified into epileptic and nonepileptic spells. Epileptic spells are clinical events that result from abnormal, excessive, and synchronous electrical activity of the cortical neurons. All other spells are included under the category of nonepileptic events. Precise differentiation between epileptic and nonepileptic spells, and their final characterization depend chiefly on obtaining a detailed account of the episode from the patient and/or witness. Physical and neurological examinations are generally non-revealing. In clinical practice, however, misdiagnosis of nonepileptic spells as epilepsy is fairly common and often is a result of incomplete history-taking. Explicit guidelines to elicit a thorough history in children who present with spells are lacking. The purpose of this article is to describe an instinctive and easy-to-remember approach to clinical history-taking in children with spells so as to minimize diagnostic errors.

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Compression Neuropathies

10.2310/ps.10079 ◽

2020 ◽

Author(s):

Todd A. Theman ◽

Kodi Azari

Keyword(s):

Early Recognition ◽

Clinical History ◽

Clinical Problem ◽

Detailed Examination ◽

Cubital Tunnel Syndrome ◽

Electrodiagnostic Testing ◽

Pronator Syndrome ◽

Tunnel Syndrome ◽

Anatomic Locations ◽

Common Clinical Problem

Compression neuropathies result from entrapment at specific anatomic locations. They are a common clinical problem, particularly in the upper extremity, where a patient’s underlying medical conditions can affect the likelihood of symptoms. Early recognition from the clinical history and a detailed examination, including provocative maneuvers, combined with electrodiagnostic testing or imaging modalities is imperative to guide treatment and prevent permanent dysfunction. This review contains 7 figures, 2 tables, and 45 references. Keywords: carpal tunnel syndrome, cubital tunnel syndrome, radial tunnel syndrome, ulnar tunnel syndrome, pronator syndrome, anterior interosseous syndrome, entrapment neuropathy, electrodiagnostic studies

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Chronic pain following elective inguinal hernia repair—is it a common clinical problem?

Regional Anesthesia and Pain Medicine ◽

10.1097/00115550-200709001-00337 ◽

2007 ◽

Vol 32 (Suppl. 1) ◽

pp. 174

Author(s):

Z. M. Kirkor ◽

T. N. Evans ◽

H. Mathew ◽

C. Swart ◽

C. Morris ◽

...

Keyword(s):

Chronic Pain ◽

Inguinal Hernia ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Clinical Problem ◽

Common Clinical Problem

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The risk of shoulder pain after laparoscopic surgery for infertility is higher in thin patients

Scientific Reports ◽

10.1038/s41598-021-92762-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Xin You Li ◽

Ming Tian ◽

Ai Zhi Li ◽

Chun Lei Han ◽

Ke Zhong Li

Keyword(s):

Laparoscopic Surgery ◽

Shoulder Pain ◽

Prospective Observational Study ◽

Conditional Logistic Regression ◽

Specific Treatment ◽

Clinical Problem ◽

Pain Visual Analogue Scale ◽

Risk Patients ◽

Treatment Plans ◽

Common Clinical Problem

AbstractPostlaparoscopic shoulder pain (PLSP) is a common clinical problem that needs to be addressed by medical professionals who are currently perform laparoscopic surgeries. The purpose of this study was to determine the perioperative clinical factors and demographic characteristics associated with PLSP. A prospective observational study was performed with 442 inpatients undergoing laparoscopic surgery for infertility. The pain visual analogue scale was used as the measuring instrument. To identify the predictors of PLSP, we performed multivariate conditional logistic regression. PLSP was correlated with body mass index (BMI, odds ratio = 0.815). The incidence of shoulder pain and more severe shoulder pain in patients with a lower BMI was significantly higher than it was in patients with a higher BMI, and BMI was significantly negatively correlated with PLSP. Most of the patients (95%) began to experience shoulder pain on the first postoperative day, and it rarely occurred on the day of surgery. Patients with lower BMI presented a higher risk of reporting shoulder pain on the first postoperative day. We should identify high-risk patients in advance and make specific treatment plans according to the characteristics of their symptoms.

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Homeopathic Treatment of Subclinical Hypothyroidism—A Series of 19 Cases

Homeopathy ◽

10.1055/s-0041-1734028 ◽

2021 ◽

Author(s):

Luiz Carlos Esteves Grelle ◽

Luiz Antonio Bastos Camacho

Keyword(s):

Subclinical Hypothyroidism ◽

Clinical Importance ◽

Clinical Problem ◽

Thyroid Stimulating Hormone ◽

Exclusion Criteria ◽

The Mean ◽

Common Clinical Problem ◽

Prompt Diagnosis ◽

Serum Tsh ◽

Tsh Levels

Abstract Background Subclinical hypothyroidism (SCH) is a common clinical problem. Controversy surrounds the definition, clinical importance, and need for prompt diagnosis and treatment of the mild form of SCH. Aim The aim of the study was to analyze the evolution of serum thyroid stimulating hormone (TSH) levels after a therapeutic homeopathic intervention in women older than 40 years with SCH. Methods This study is a retrospective series of 19 cases of SCH, with serum TSH levels between 5 and 10 mIU/L, treated exclusively with homeopathic medicines prescribed on an individualized basis. Results Nineteen patients were included according to the inclusion and exclusion criteria. Their mean age was 56 years, they were followed for a mean duration of 69 months, the mean number of serum TSH level measurements was 18, and the intervention was successful for 13 patients. Conclusion The homeopathic therapeutic intervention was successful in 68% of the patients, with serum TSH levels back within the normal range (0.5–5.0 mIU/L).

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IDIOPATHIC HISTIOCYTOSIS

PEDIATRICS ◽

10.1542/peds.28.2.307 ◽

1961 ◽

Vol 28 (2) ◽

pp. 307-327

Author(s):

Harold A. Oberman

Keyword(s):

Poor Prognosis ◽

Soft Tissues ◽

Clinical Course ◽

Eosinophilic Granuloma ◽

Disease Process ◽

Foam Cells ◽

Tissue Eosinophilia ◽

Ultimate Outcome ◽

Eosinophilic Granuloma Of Bone ◽

Microscopic Findings

The clinical and pathologic aspects of 40 cases of eosinophilic granuloma of bone, Hand-Schüller-Christian disease and Letterer-Siwe disease have been reviewed. These cases were unified by a localized or generalized histiocytic proliferation. However, they could not be subdivided accurately on the basis of either clinical or microscopic findings. Histologically there was inconstant correlation of foam cells, tissue eosinophilia and fibrosis with clinical course. Nevertheless there was a suggestion that the presence of a homogeneous histiocytic infiltrate, with no eosinophils or foam cells, pointed to a poor prognosis, whereas the presence of large aggregates of eosinophils augured a more favorable course. With some exceptions, those patients presenting with disease confined to bone had little tendency toward dissemination, whereas those presenting with visceral on soft tissue lesions and generalized maculopapular skin eruptions usually died after a rapid course. Patients with skeletal and visceral or soft tissues lesions at onset had a variable outcome, with marked hepatomegaly and generalized cutaneous involvement being poor prognostic signs. It is concluded that these conditions probably represent various manifestations of a single disease process and that clinical assessment of rapidity of progression is the best guide to ultimate outcome.

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Image-guided Biopsy of Mesenteric, Omental, and Peritoneal Disease

Digestive Disease Interventions ◽

10.1055/s-0038-1660499 ◽

2018 ◽

Vol 02 (02) ◽

pp. 106-115

Author(s):

Joshua Cornman-Homonoff ◽

David Madoff

Keyword(s):

Diagnostic Accuracy ◽

Patient Care ◽

Clinical History ◽

Peritoneal Disease ◽

Image Guided ◽

High Diagnostic Accuracy ◽

Guided Biopsy ◽

Imaging Characteristics ◽

Procedural Evaluation ◽

Technical Considerations

AbstractThe peritoneum, omenta, and mesenteries can be affected by a myriad of disease processes, but many common pathologies cannot be definitively distinguished based on clinical history and imaging characteristics alone. Percutaneous image-guided biopsy is a safe, well-tolerated procedure with high diagnostic accuracy, which has supplanted more invasive means of obtaining tissue and is increasingly essential in directing patient care. An understanding of the indications, pre-procedural evaluation, technical considerations, and potential complications is essential for the radiologist who performs these procedures, and more broadly for any clinician who may request them.

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Imaging Review of Skeletal Tumors of the Pelvis—Part I: Benign Tumors of the Pelvis

The Scientific World JOURNAL ◽

10.1100/2012/290930 ◽

2012 ◽

Vol 2012 ◽

pp. 1-10 ◽

Cited By ~ 3

Author(s):

Gandikota Girish ◽

Karen Finlay ◽

Yoav Morag ◽

Catherine Brandon ◽

Jon Jacobson ◽

...

Keyword(s):

Plain Film ◽

Clinical History ◽

Benign Tumors ◽

Resonance Imaging ◽

Advantages And Disadvantages ◽

Radiologic Evaluation ◽

Imaging Characteristics ◽

The Common ◽

Magnetic Resonance Imaging Mri ◽

Pelvic Lesions

The osseous pelvis is a well-recognized site of origin of numerous primary and secondary musculoskeletal tumors. The radiologic evaluation of a pelvic lesion often begins with the plain film and proceeds to computed tomography (CT), or magnetic resonance imaging (MRI) and possibly biopsy. Each of these modalities, with inherent advantages and disadvantages, has a role in the workup of pelvic osseous masses. Clinical history and imaging characteristics can significantly narrow the broad differential diagnosis for osseous pelvic lesions. The purpose of this review is to familiarize the radiologist with the presentation and appearance of some of the common benign neoplasms of the osseous pelvis and share our experience and approach in diagnosing these lesions.

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Complications of therapy for ANCA-associated vasculitis

Rheumatology ◽

10.1093/rheumatology/kez618 ◽

2020 ◽

Vol 59 (Supplement_3) ◽

pp. iii74-iii78 ◽

Cited By ~ 1

Author(s):

Rona Smith

Keyword(s):

Cardiovascular Disease ◽

Clinical Course ◽

Disease Process ◽

Organ Damage ◽

Therapeutic Strategies ◽

Early Mortality ◽

Treatment Regimens ◽

Anca Associated Vasculitis ◽

Monitoring Strategies

Abstract The introduction of immunosuppressive therapies has transformed ANCA-associated vasculitis (AAV) from a largely fatal condition to a chronic relapsing disorder. However, progressive organ damage and disability, both from the disease process itself and from therapies used for treatment, eventually affect the majority of patients. Infection, rather than uncontrolled vasculitis, is the greatest cause of early mortality and remains a major problem thereafter. Increased rates of malignancy and cardiovascular disease are additional important long term sequelae. This review focuses on the complications associated with the immunosuppressive therapies most commonly used to treat ANCA-associated vasculitis, and considers prophylactic and monitoring strategies to minimize these risks. Achieving a balance between immunosuppression to reduce relapse risk and minimizing the adverse effects associated with therapy has become key. The contribution of glucocorticoids to treatment toxicity is increasingly being recognized, and future therapeutic strategies must concentrate on glucocorticoid minimization or sparing strategies. Development of robust predictors of an individual’s future clinical course is needed in order to individually tailor treatment regimens.

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Pediatric Peritoneal Epithelial Malignant Mesothelioma Case Report

Case Reports in Radiology ◽

10.1155/2021/5581757 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Elizabeth Bellew ◽

Samantha Lee ◽

Hiren Patel ◽

Carolyn Fein Levy ◽

Rachelle Goldfisher ◽

...

Keyword(s):

Case Report ◽

Malignant Mesothelioma ◽

Crucial Role ◽

Clinical Course ◽

Pediatric Population ◽

Adult Population ◽

Initial Evaluation ◽

Peritoneal Mesothelioma ◽

Imaging Characteristics

We present a 14-year-old boy with peritoneal epithelial malignant mesothelioma (PEMM). While pathology is required to make this diagnosis, radiology plays a crucial role throughout the clinical course of this disease. The key imaging characteristics of peritoneal mesothelioma have been previously well-described in the adult population, but there are rare reports in the pediatric population. This pediatric report highlights the multidimensional use of imaging in this disease, from the initial evaluation to therapeutic supplementation and subsequent follow-up.

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