scholarly journals Asymptomatic Presacral Paraganglioma: Management of an Unpredictable Intraoperative Finding

2020 ◽  
Vol 06 (02) ◽  
pp. e131-e134
Author(s):  
Athina A. Samara ◽  
Alexandros Diamantis ◽  
Dimitrios Symeonidis ◽  
Athanasios Anagnostou ◽  
Andreas Marios Diamantis ◽  
...  
Keyword(s):  
Neural Crest ◽  
Neuroendocrine Tumors ◽  
Rare Case ◽  
Intraoperative Complications ◽  
Hypertensive Crisis ◽  
Clinical Suspicion ◽  
Anatomical Location ◽  
Presacral Mass ◽  
Life Threatening ◽  
High Level

AbstractParagangliomas are rare neuroendocrine tumors originating from the embryological neural crest. We report a rare case of a patient with an asymptomatic presacral mass (incidentaloma) who experienced an unpredictable intraoperative hypertensive crisis after manipulation of the tumor. Presacral neoplasms pose a diagnostic and therapeutic challenge due to their obscure anatomical location and the difficulty in performing an R0 excision. Furthermore, the management of asymptomatic paragangliomas requires a high level of clinical suspicion and expertise due to potential life-threatening intraoperative complications.

scholarly journals Undiagnosed pheochromocytoma presenting as a pancreatic tumor: A case report

Open Medicine ◽  
2020 ◽  
Vol 15 (1) ◽  
pp. 103-106 ◽  
Author(s):  
Malgorzata Emilia Legocka ◽  
Sadegh Toutounchi ◽  
Ryszard Pogorzelski ◽  
Ewa Krajewska ◽  
Krzysztof Celejewski ◽  
...  
Keyword(s):  
Adrenal Gland ◽  
Surgical Complications ◽  
Intraoperative Complications ◽  
Hypertensive Crisis ◽  
Preoperative Treatment ◽  
Tumor Type ◽  
Abdominal Incision ◽  
Alpha Blockers ◽  
Severe Hypotension ◽  
Life Threatening

AbstractPheochromocytoma is a rare catecholamine-producing tumor of the adrenal gland. Patients with known pheochromocytoma undergoing surgery require preoperative treatment with alpha-blockers to reduce the risk of intraoperative complications related to catecholamine release. If undiagnosed, pheochromocytoma can lead to life-threatening surgical complications. We report the case of a patient with a suspected solid pseudopapillary neoplasm in the pancreatic tail, for whom pancreatoduodenectomy was scheduled. However, shortly after abdominal incision, hypertensive crisis developed and was followed by severe hypotension requiring intravenous vasopressors, which prompted discontinuation of the operation. Further diagnostic evaluation revealed marked elevations in urinary excretion of methylated catecholamines and suggested that the tumor was in fact a pheochromocytoma extending from the left adrenal gland. After preoperative treatment with doxazosin, the patient underwent lateral transperitoneal laparoscopic adrenalectomy, with no major complications and an uneventful postoperative course. The pathological report confirmed a diagnosis of pheochromocytoma. Due to the potential for life-threatening surgical complications in patients with pheochromocytoma not treated preoperatively with alpha-blockers, this tumor type should be included in the differential diagnosis of abdominal tumors of unknown origin.

318. POLYURIA IN PREGNANCY - CHALLENGES OF DIAGNOSIS!

2010 ◽  
Vol 22 (9) ◽  
pp. 118
Author(s):  
A. Sakthivel ◽  
A. J. Nankervis ◽  
J. Conn ◽  
J. Oats ◽  
S. Chitturi
Keyword(s):  
Rare Complication ◽  
Clinical Suspicion ◽  
Urinary Frequency ◽  
Osmotic Homeostasis ◽  
Life Threatening ◽  
Acute Fatty Liver ◽  
High Level ◽  
Circulating Levels ◽  
Experienced Symptom ◽  
In Pregnancy

Increased urinary frequency is a widely experienced symptom in pregnancy; true polyuria is less common and can have a number of causes. It is essential, however that it should be recognized and appropriately investigated, as it may be potentially life threatening to mother and fetus. Diabetes insipidus (DI) is a rare complication of pregnancy. It can be the first presentation of pre-gestational DI, gestational DI or DI associated with acute fatty liver of pregnancy. The latter conditions are illustrated by the following two clinical cases. Osmotic homeostasis can be altered in pregnancy due to resetting of the osmostat and degradation of vasopressin by vasopressinase secreted by the placenta in increasing quantities in the 2nd and 3rd trimesters. Liver failure results in the availability of higher circulating levels of vasopressinase. These cases highlight the difficulties and importance of diagnosis and treatment. Pregnant women often report polyuria during the 3rd trimester. It is important to have a high level of clinical suspicion for the pathological causes, despite the non-specific presentation as underlying conditions can have catastrophic sequelae.

Postauricular swelling secondary to salmonella extradural abscess in a toddler: a near miss condition

2021 ◽  
Vol 14 (7) ◽  
pp. e243412
Author(s):  
Chee Chean Lim ◽  
Jeyasakthy Saniasiaya ◽  
Jeyanthi Kulasegarah
Keyword(s):  
Infectious Disease ◽  
Rare Case ◽  
Clinical Suspicion ◽  
Near Miss ◽  
Emergency Setting ◽  
History Taking ◽  
Suppurative Otitis Media ◽  
High Clinical Suspicion ◽  
Life Threatening ◽  
History Of

Postauricular swelling is usually encountered in an emergency setting in otorhinolaryngology, resulting from complication of acute or chronic suppurative otitis media. Besides that, postauricular swelling may occur secondary to various other conditions including infectious disease, tumour, vascular malformation, granulomatous condition and even trauma. Children less than 2 years old are prone to fall and up to 10% sustain traumatic brain injury without any obvious signs of neurological deficit. We describe a rare case of a postauricular swelling in a toddler which turned out to be salmonella extradural abscess from an infected traumatic haematoma. The importance of high clinical suspicion especially in a child with a history of fall cannot be emphasised more because a missed brain abscess could lead to potentially life-threatening problems. We would like to highlight that meticulous history taking along with prompt assessment and intervention is prudent for a better prognosis and recovery.

scholarly journals Hair Dye poisoning – A rare case Report

2015 ◽  
Vol 3 (2) ◽  
pp. 72-73
Author(s):  
N.S. Neki ◽  
Ankur Jain ◽  
Rohit Bajaji ◽  
Mohit Manav Jindal
Keyword(s):  
Internal Medicine ◽  
Case Report ◽  
Rare Case ◽  
Multiorgan Failure ◽  
Supportive Therapy ◽  
Clinical Suspicion ◽  
Hair Dye ◽  
Rare Case Report ◽  
Life Threatening ◽  
Main Component

Hair dye poisoning is not uncommon but an emerging entity in India with increased morbidity and mortality. The main component of hair dye poisoning is paraphenylenediamine (PPD), which is highly toxic thus making it life threatening. PPD poisoning can result in various toxic effects, multiorgan failure and ultimately death. Clinical suspicion and timely management can improve the outcome. We report a case of 35 year old male presented to hospital within 4 hours of consuming hair dye with complaints of swelling of face and neck, vomiting and difficulty in breathing. He was satisfactorily managed with supportive therapy and endotracheal intubation and discharged without any ill effects.Journal of Advances in Internal Medicine 2014;3(2):72-73

Evaluation and Anesthetic Management for Patients With Cardiac Trauma

2019 ◽  
pp. 348-359
Author(s):  
Daniel Smith ◽  
Eric Ness ◽  
Amanda M. Kleiman
Keyword(s):  
Anesthetic Management ◽  
Clinical Suspicion ◽  
Operating Conditions ◽  
Mechanical Support ◽  
Cardiovascular Collapse ◽  
Cardiac Trauma ◽  
Complex Patients ◽  
Threatening Condition ◽  
Life Threatening ◽  
High Level

Cardiac trauma, either blunt or penetrating, is a life-threatening condition often requiring immediate intervention. Cardiac trauma causes varied hemodynamic effects, from stable arrhythmia to cardiovascular collapse. The diagnosis of cardiac trauma relies on a high level of clinical suspicion paired with imaging, including transthoracic echocardiography. Anesthetic management for cardiac trauma focuses primarily on maintenance of preload and cardiac function while optimizing operating conditions for surgical repair. Depending on the injuries involved, support that includes inotropes, vasopressors, and potentially mechanical support may be required. This chapter discusses the pathophysiology and presentation of cardiac trauma and explores the intricate anesthetic management of these complex patients.

Descending necrotising mediastinitis: how a sore throat can result in purulent peritonitis

2021 ◽  
Vol 14 (5) ◽  
pp. e242145
Author(s):  
Darragh Rice ◽  
Naomi Fearon ◽  
John V Reynolds ◽  
Narayanasamy Ravi
Keyword(s):  
Rare Case ◽  
Antimicrobial Treatment ◽  
Clinical Suspicion ◽  
Management Options ◽  
Cervical Incision ◽  
Oropharyngeal Infection ◽  
Purulent Peritonitis ◽  
Remarkable Recovery ◽  
Life Threatening ◽  
Deteriorating Patient

This is a rare case of descending necrotising mediastinitis (DNM) that originated as an oropharyngeal infection, before spreading caudally to include all compartments of the mediastinum and the peritoneum beyond. The mediastinitis was treated early and aggressively with drainage, lavage and debridement in conjunction with broad-spectrum antimicrobial treatment. This case includes a right cervical incision, and a seldom needed surgical laparotomy approach to address the intra-abdominal involvement, and necessity of peritoneal washout. Following a prolonged Intesive Care Unit (ICU) stay and antibiotic course as well as other interventions detailed, the patient made a remarkable recovery and was discharged 101 days post presentation. This report goes on to discuss the rapidly evolving, life-threatening nature of DNM as well as providing an overview of possible management options, outlining how we think such cases should be approached and the clinical suspicion required in a deteriorating patient.

scholarly journals A Case of Chronic Cough and Pneumonia Secondary to a Foreign Body

2017 ◽  
Vol 2017 ◽  
pp. 1-3 ◽  
Author(s):  
Joan Dabu ◽  
Meredith Lindner ◽  
Moh’d Azzam ◽  
Anas Al-Khateeb ◽  
Muqueet Kadri ◽  
...  
Keyword(s):  
Risk Factors ◽  
Foreign Body ◽  
Physical Examination ◽  
Chronic Cough ◽  
Foreign Body Aspiration ◽  
Clinical Suspicion ◽  
Recurrent Pneumonia ◽  
Life Threatening ◽  
High Level

Foreign body aspiration occurs when a solid or semisolid object becomes lodged in the larynx or trachea. It can be a life-threatening emergency, especially if it is large enough to occlude the airway. However, small aspirated objects may go unnoticed until symptoms occur. Therefore, it is frequently misdiagnosed. A high level of clinical suspicion, patient’s risk factors, and thorough history and physical examination are essential in making the diagnosis. It should be considered in cases where there is unresolved chronic cough with or without associated recurrent pneumonia especially in patients with risks for aspiration.

A Rare Case of Tuberculous Prostatitis

2016 ◽  
Vol 1 (2) ◽  
pp. 33
Author(s):  
Nurul Yaqeen Mohd Esa ◽  
Mohammad Hanafiah ◽  
Marymol Koshy ◽  
Hilmi Abdullah ◽  
Ahmad Izuanuddin Ismail ◽  
...  
Keyword(s):  
Rare Case ◽  
Correct Diagnosis ◽  
Immunocompetent Patient ◽  
Clinical Suspicion ◽  
Tuberculosis Infection ◽  
Advanced Age ◽  
Immunocompromised Patients ◽  
Prostatic Biopsy ◽  
High Clinical Suspicion

Tuberculous prostatitis is an uncommon form of tuberculosis infection. It is commonly seen in immunocompromised patients and in those of middle or advanced age. The diagnosis is often not straight forward due to the nature of its presentation. We report a case of tuberculous prostatitis in a young, healthy and immunocompetent patient, who initially presented with respiratory features, followed by episodes of seizures and testicular swelling. He was finally diagnosed with tuberculous prostatitis after prostatic biopsy. This case illustrates that in a high TB prevalence environment, when symptoms warrant, there should be a high clinical suspicion coupled with a thorough approach in order to arrive at a correct diagnosis of TB prostatitis.

OPERATIONS FOR ANEURISM OF THE ABDOMINAL AORTIC DEPARTMENT - RESECTION WITH THE FOLLOWING PROSTHETICS AND ENDOPROSTHETICS: A COMPARATIVE ANALYSIS OF COMPLICATIONS

2020 ◽  
pp. 43-49
Author(s):  
Андрей Анатольевич Иванов ◽  
Александр Иванович Жданов ◽  
Максим Сергеевич Шевелин ◽  
Александр Сергеевич Брежнев
Keyword(s):  
Comparative Analysis ◽  
Postoperative Complications ◽  
Statistical Significance ◽  
Aortic Aneurysms ◽  
Surgical Interventions ◽  
Vein Thrombosis ◽  
Scientific Hypothesis ◽  
Abdominal Aortic ◽  
Life Threatening ◽  
High Level

В статье представлены данные оригинального исследования по улучшению хирургического лечения аневризм брюшного отдела аорты. С этой целью произведен сравнительный анализ двух альтернативных друг другу операций: 1) резекции аневризмы с последующим протезированием аорты; 2) эндопротезирования аорты. Сформулировано научное предположение о том, что замена «классических» операций резекции аневризмы на «альтернативные» операции эндопротезирования приведет к принципиальному снижению уровня послеоперационных осложнений. В независимых группах пациентов с использованием сравниваемых хирургических вмешательств произведена точная качественная и количественная оценка послеоперационных осложнений: нетромботических - кардиальных, пульмональных, ренальных и тромботических - тромбозов глубоких вен и тромбозов браншей протеза. После реализации исследования было установлено, что замена «классических» операций на «альтернативные» достоверно приводит к принципиальному снижению уровня наиболее жизнеопасных осложнений - кардиальных (острых форм ишемической болезни сердца, нарушений сердечного ритма), пульмональных (пневмоний, тромбоэмболии легочной артерии, респираторного дистресс-синдрома взрослых) и ренальных (острой почечной недостаточности). Некоторое исключение составили менее жизнеопасные тромботические осложнения. Полученные результаты имеют высокий уровень статистической значимости, что позволяет рекомендовать их к рассмотрению к использованию в практике сосудистой хирургии The article presents data from an original study to improve the surgical treatment of abdominal aortic aneurysms. For this purpose, a comparative analysis of two alternate operations was performed: 1) aneurysm resection followed by aortic prosthetics; 2) aortic endoprosthetics. The scientific hypothesis is formulated that the replacement of the «classical» operations of resection of the aneurysm with «alternative» operations of endoprosthetics will lead to a fundamental decrease in the level of postoperative complications. In independent groups of patients using the compared surgical interventions, an accurate qualitative and quantitative assessment of postoperative complications was made: non-thrombotic - cardiac, pulmonary, renal and thrombotic - deep vein thrombosis and prosthetic jaw thrombosis. After the study was completed, it was found that the fundamental replacement of «classical» operations with «alternative» reliably leads to a fundamental decrease in the level of the most life-threatening complications - cardiac (acute forms of coronary heart disease, cardiac arrhythmias), pulmonary (pneumonia, pulmonary thromboembolism, respiratory distress syndrome of adults) and renal (acute renal failure). Some exceptions were less life-threatening thrombotic complications. The results obtained have a high level of statistical significance, which allows us to recommend them for consideration in the practice of vascular surgery

The Chemistry of Drugs to Treat Candida albicans

2019 ◽  
Vol 19 (28) ◽  
pp. 2554-2566 ◽  
Author(s):  
Aurelio Ortiz ◽  
Estibaliz Sansinenea
Keyword(s):  
Candida Species ◽  
Antifungal Drugs ◽  
New Drugs ◽  
Drug Classes ◽  
Life Threatening ◽  
Antifungal Substances ◽  
High Level ◽  
Systemic Infections ◽  
New Compounds ◽  
Level Resistance

Background:: Candida species are in various parts of the human body as commensals. However, they can cause local mucosal infections and, sometimes, systemic infections in which Candida species can spread to all major organs and colonize them. Objective:: For the effective treatment of the mucosal infections and systemic life-threatening fungal diseases, a considerably large number of antifungal drugs have been developed and used for clinical purposes that comprise agents from four main drug classes: the polyenes, azoles, echinocandins, and antimetabolites. Method: : The synthesis of some of these drugs is available, allowing synthetic modification of the molecules to improve the biological activity against Candida species. The synthetic methodology for each compound is reviewed. Results: : The use of these compounds has caused a high-level resistance against these drugs, and therefore, new antifungal substances have been described in the last years. The organic synthesis of the known and new compounds is reported. Conclusion: : This article summarizes the chemistry of the existing agents, both the old drugs and new drugs, in the treatment of infections due to C. albicans, including the synthesis of the existing drugs.

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