scholarly journals EP.FRI.159 Crohn’s terminal ileal perforation peri partum; a case report and review of the literature

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Evripidis Tokidis ◽  
Francesca Malcolm ◽  
Timothy White
Keyword(s):  
Abdominal Pain ◽  
Case Report ◽  
Case Reports ◽  
Post Partum ◽  
Meta Analysis ◽  
Surgical Care ◽  
Fistula Formation ◽  
Gravid Uterus ◽  
Patient Reported ◽  
Operative Recovery

Abstract Introduction Surgical care of complicated Crohn’s disease (CD) during pregnancy is often a clinicodiagnostic conundrum. We present a case of a 26 year old with active CD and subsequent terminal ileal (TI) perforation diagnosed post-partum. Case A 26 year old with known CD presented with abdominal pain at 24 weeks pregnant to Obstetrics. Surgical opinion was sought due to increasing abdominal pain; MRI was performed and found active TI CD but no free gas. Within 24 hours the patient prematurely delivered. Immediately post-partum the patient reported worsening pain with notable peritonism on examination. Urgent CT abdomen was arranged demonstrating free aim secondary to TI perforation. The patient underwent laparotomy. Intraoperatively there was 4 quadrant peritonitis, confined TI loops behind the gravid uterus and TI perforations. Following drainage of the intrabdominal sepsis, a ileo-caecal resection was performed with end ileostomy and colonic mucous fistula formation. Post-operative recovery was uneventful and the patient was discharged 5 days later. Discussion There is a paucity of evidence describing manifestations of CD during pregnancy. Meta-analysis has shown a correlation of active CD and adverse perinatal outcome. The specific complication of TI perforation is a rare sequelae of CD; documented in less than 5% of cases. TI perforation during pregnancy has been described in only a handful of case reports. Conclusion This case report illustrates diagnostic challenges faced in the investigation and management of active CD in pregnant patients. It also highlights the importance of dynamic reassessment and the collaborative efforts of the multidisciplinary team.

Bevacizumab-induced dysphonia: A case report with brief review of literature

2019 ◽  
Vol 26 (4) ◽  
pp. 1032-1036
Author(s):  
So Yi Lam ◽  
Chung-Shien Lee ◽  
Sandhya Sharma ◽  
Kit Cheng
Keyword(s):  
Ovarian Cancer ◽  
Case Report ◽  
Side Effect ◽  
Case Reports ◽  
Palliative Therapy ◽  
Ovarian Adenocarcinoma ◽  
Voice Changes ◽  
Patient Reported ◽  
Rare Side Effect

Introduction Anti-angiogenic treatment in adjunct with chemotherapy is widely used for the treatment of various cancers. These agents inhibit vascular endothelial growth factor (VEGF) signaling thereby inhibiting tumor proliferation and invasion. Dysphonia, or voice changes, has been documented, but is an underreported side effect of anti-angiogenic agents. We report a case of intermittent dysphonia in a patient with metastatic, platinum-refractory ovarian cancer treated with bevacizumab. Case report A 48-year-old female with high grade mixed type ovarian adenocarcinoma and concurrent left sided breast cancer was transitioned to palliative therapy with gemcitabine-bevacizumab for her ovarian cancer. At a follow-up visit after three cycles of the new therapy, the patient complained of intermittent changes in her voice, describing periods of hoarseness or softness in her voice after the chemotherapy—sometimes to the point that her voice was inaudible. Management and outcome: A new pelvic thrombus was discovered upon assessment of the patient’s disease. Bevacizumab was held and she was referred to ear, nose, and throat evaluation for dysphonia. Laryngoscopic examination showed normal vocal cord, with normal movements and no lesion or necrosis. During subsequent follow-up, the patient reported improvement in her voice with no additional dysphonia. Discussion Vocal adverse effects of anti-VEGF agents have been documented in landmark trials and case reports; however, clinicians are often unaware of this rare side effect. Although VEGF-induced dysphonia may be rare and may not impede the patient’s quality of life in some cases, it is critical to acknowledge and not underestimate this adverse effect.

Is there a role for neoadjuvant radiation dose escalation in esophageal cancer? A meta-analysis.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 102-102
Author(s):  
Laila Lobo ◽  
Danny Yakoub ◽  
Caroline Ripat ◽  
Rishika Sharma ◽  
Raphael Yechieli
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Radiation Dose ◽  
Esophageal Carcinoma ◽  
Meta Analysis ◽  
Survival Rates ◽  
Fistula Formation ◽  
Significant Difference ◽  
Patient Reported

102 Background: In treating esophageal cancer chemo-radiation is used in the definitive as well as neo-adjuvant setting. Optimal dosage of radiation for best outcome has been debated. The aim of this study is to evaluate clinical outcomes of lower radiation dosage compared to higher. Methods: Online search for studies comparing radiation dose from 1990 to present was performed. Primary outcome was overall-survival rates for up to 5 years. Secondary outcomes included post-treatment complications and treatment response. A cut point of 51 Gy and less was considered as lower dose and greater than 51 Gy was considered higher dose. Quality of included studies was evaluated by STROBE criteria. Relative Risk (RR) and 95% Confidence Intervals (CI) were calculated from pooled data. Results: The search strategy yielded 142 studies, 12 met our selection criteria and included 1876 patients receiving radiation for resectable esophageal carcinoma. Of these patients, 1057 received lower and 819 were treated with greater than 51 Gy. Median age was 63 and 64 years for lower and higher radiation dose respectively. Meta-analysis showed no statistically significant difference in survival and toxicities between the two groups. 1 year overall survival (RR = 0.97, 95% CI 0.84-1.13, p = 0.69), 2 year overall survival (RR = 1.29, 95% CI 0.76-2.19, p = 0.34), 3 year overall survival (RR = 1.18, 95% CI 0.83-1.68, p = 0.37), 4 year overall survival (RR = 1.37, 95% CI 0.64-2.94, p = 0.41), 5 year overall survival (RR = 1.11, 95% CI 0.72-1.69, p = 0.64), Esophagitis (RR = 0.76, 95% CI 0.39-1.50, p = 0.43), Dermatitis (RR = 0.98, 95% CI 0.12-7.94, p = 0.99), Fistula formation (RR = 0.72, 95% CI 0.32-1.60, p = 0.42), Hematologic complications (RR = 1.10, 95% CI 0.20-6.02, p = 0.91), Stricture formation (RR = 1.39, 95% CI 0.54-3.58, p = 0.5). Conclusions: Lower radiation dose appears to be as effective as higher dose in esophageal carcinoma with similar toxicity profile and survival rates. Larger prospective randomized trials, focusing on patient-reported quality-of-life are required to consolidate these results.

scholarly journals Homoeopathic management of chronic replapsing pancreatitis in a paediatric patient: A case report

2022 ◽  
Vol 4 ◽  
pp. 133-141
Author(s):  
Bipin Sohanraj Jain ◽  
Akshata Damodar Nayak
Keyword(s):  
Abdominal Pain ◽  
Case Report ◽  
Acute Exacerbation ◽  
Recurrent Fever ◽  
Age Group ◽  
Patient Reported ◽  
Paediatric Age ◽  
History Of ◽  
Chronic Relapsing Pancreatitis ◽  
Over Time

Chronic relapsing pancreatitis in the paediatric age group is a challenging case, especially when presenting in its acute exacerbation. This case report highlights the management of chronic relapsing pancreatitis in a 9-year-old female patient with homoeopathic treatment. The patient reported a year-long history of recurrent fever, abdominal pain, and raising titres of lipase and amylase; she had been admitted to a higher centre twice. The totality was constructed on day 1 and a homoeopathic remedy was prescribed. Detailed case taking, done after a week, confirmed the same remedy. Later, when the patient had an acute exacerbation, the same remedy-frequently repeated, helped settle the acute episode in a couple of days. The patient has been following up regularly for 3 years; the frequency and intensity of relapses reduced considerably over time and there have been no episodes for more than a year.

scholarly journals CHRONIC NON-CANCER ABDOMINAL WALL PAIN AMELIORATION VIA PHENOL NEUROLYSIS BY TRANVERSUS ABDOMINIS PLANE APPROACH: A CASE REPORT

2019 ◽  
pp. 127-130
Author(s):  
Heath McAnally
Keyword(s):  
Abdominal Pain ◽  
Case Report ◽  
Abdominal Wall ◽  
Anterior Abdominal Wall ◽  
Case Reports ◽  
Tap Block ◽  
Abdominal Wall Pain ◽  
Chemical Denervation ◽  
Chronic Abdominal Wall Pain ◽  
Noncancer Pain

Abdominal pain is common and has multiple etiologies. We present a case of chronic abdominal wall pain that was treated with phenol neurolysis via a tranversus abdominis plane (TAP). To date, only 4 case reports utilizing TAP neurolysis have been reported and all were performed in the context of malignancy-related pain. The TAP block has become an integral component of the regional anesthesiologist’s perioperative anesthesia and analgesia arsenal. In summary, chemical denervation of the anterior abdominal wall is feasible and efficacious in palliating chronic non-cancer pain via a TAP block technique. Key words: TAP, transversus abdominal plane, phenol, abdominal wall pain, neurolytic, noncancer pain

Pedicled Lingual Flap to Provide Keratinized Tissue Regeneration Over Dental Implants: A Description of the Technique and a Case Report

2015 ◽  
Vol 41 (2) ◽  
pp. 196-199 ◽  
Author(s):  
Alan S. Herford ◽  
Rahul Tandon ◽  
Luca Pivetti ◽  
Marco Cicciù
Keyword(s):  
Case Report ◽  
Soft Tissue ◽  
Case Reports ◽  
Tissue Loss ◽  
Pedicle Flap ◽  
Collagen Matrices ◽  
Keratinized Tissue ◽  
Patient Reported ◽  
Implant Dentistry ◽  
Soft Tissue Loss

The aim of this study is to report the efficacy of a lingual pedicle flap for soft tissue pre-prosthetic surgery in implant rehabilitation. While it has been demonstrated that keratinized gingiva is an important factor for implant success, there remains a dearth of case reports concerning the use of a lingual pedicle flap to achieve this desired outcome in such a large reconstructive effort. For this case report, the patient underwent an anterior mandibular resection of an ameloblastoma and subsequent reconstruction, resulting in soft tissue loss. To satisfy the patient's desires, both functionally and esthetically, a bilateral rotated pedicled lingual flap was performed to augment keratinized tissue on the anterior mandibular ridge. An additional vestibuloplasty with two collagen matrices was also performed, and an acrylic splint was then applied to achieve better stabilization. The primary outcome was to evaluate the efficacy of this technique, which, until now, was used only for exposed root coverage. The site demonstrated excellent healing over time, even resulting in an excess of healthy and pink soft tissue, which later had to be corrected with a small gingivectomy. Although the patient reported slight discomfort for a few days after surgery, she was nonetheless pleased both with her ability to function and her appearance. The results of this study show that the bilateral rotated pedicled lingual flap is a viable technique for the correction of soft tissue defects in implant dentistry, providing a good amount of keratinized gingiva.

scholarly journals Recurrent Acute Pancreatitis Probably Induced by Rosuvastatin Therapy: A Case Report

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
JayaKrishna Chintanaboina ◽  
Deepa Gopavaram
Keyword(s):  
Acute Pancreatitis ◽  
Abdominal Pain ◽  
Case Report ◽  
General Population ◽  
Conservative Management ◽  
Case Reports ◽  
Underlying Mechanism ◽  
Intravenous Contrast ◽  
Recurrent Acute Pancreatitis

Context. Approximately 1.4–2% of all cases of acute pancreatitis are drug related in general population. The literature on statin-induced pancreatitis consists primarily of anecdotal case reports. We report a case of possible rosuvastatin-induced pancreatitis.Case Report. A 67-year-old female presented with progressively worsening abdominal pain and vomiting for 7 days. Home medications included rosuvastatin and clonidine. CT scan of abdomen, with intravenous contrast, showed findings consistent with acute pancreatitis. She responded to conservative management. Rosuvastatin was resumed at the time of discharge from the hospital, and she presented two months later with recurrence of acute pancreatitis. Further workup ruled out all likely causes of acute pancreatitis. Rosuvastatin was stopped completely when she was discharged the second time, and she did not have any further episodes of acute pancreatitis. She was completely asymptomatic throughout the 18-month follow-up period.Conclusion. This paper reinforces the possible association of rosuvastatin, a novel statin, with acute pancreatitis, even though the exact underlying mechanism of statin-induced pancreatitis remains unknown.

scholarly journals 1136 Cochlear Implant Outcomes in Patients with Otosclerosis: A Systematic Review

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
C M Lam ◽  
H L Cornwall ◽  
A Chaudhry ◽  
J Muzaffar ◽  
M Bance ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cochlear Implantation ◽  
Case Reports ◽  
Meta Analysis ◽  
Case Series ◽  
Significant Heterogeneity ◽  
Patient Counselling ◽  
Study Objective ◽  
Patient Reported ◽  
Hearing Outcomes

Abstract Introduction In otosclerosis, spongiotic bone replaces normal bone in the ossicular chain. Focal deposits may also be found within the cochlea leading to sensorineural hearing loss refractory to conventional treatment. Cochlear implantation can play an important role in the management of otosclerosis in these patients. Our study objective is to establish hearing outcomes following cochlear implantation in patients with otosclerosis. Method Systematic review and narrative synthesis. Databases searched: Medline, PubMed, Embase, Web of Science, Cochrane Collection and ClinicalTrials.gov. No limits placed on language or year of publication. Review conducted in accordance with the PRISMA statement. Results Searches identified 68 studies meeting the inclusion criteria and reporting outcomes in a minimum of 481 patients with at least 516 implants. The methodological quality of included studies was modest, predominantly consisting of case reports and non-controlled case series with small numbers of patients. Significant heterogeneity existed in terms of outcomes and methods of reporting, which precluded a meta-analysis. Access to good rehabilitation support is essential to achieving the good hearing outcomes and Patient Reported Outcome Measures that can be expected by 12 months post-implantation in most cases. There was significant association between the radiological severity of otosclerosis and an increase in surgical and post-operative complications. Post-operative facial nerve stimulation can occur and may require deactivation of electrodes and subsequent hearing detriment. Conclusions Hearing outcomes are typically good, but patients should be counselled on associated surgical complications which may compromise hearing. Modern diagnostic techniques may help to identify potentially difficult cases to aid operative planning and patient counselling.

scholarly journals O56: THE TREND OF SURGICAL PUBLICATIONS IN THE UNITED KINGDOM OVER THE LAST 10 YEARS

2021 ◽  
Vol 108 (Supplement_1) ◽  
Author(s):  
LYA Kwan ◽  
J Chan
Keyword(s):  
Academic Medicine ◽  
Case Reports ◽  
Meta Analysis ◽  
Surgical Care ◽  
Current Situation ◽  
Impact Factors ◽  
Original Research ◽  
The Usa ◽  
The Uk ◽  
Surgical Journals

Abstract Introduction Research plays an important role in the surgical field. It has been deemed to be the keystone on the progression of surgical care and the introduction of new directions in surgery. We aimed to evaluate the output of UK surgeons in ten high impact factor surgical journals over the last three decades. Method Ten surgical journals were selected and investigated, based on 1997,2007, and 2017 journal impact factors. All articles that have contributed academically were examined, these included: original research articles, meta-analysis, debate articles, case reports and studies. Result The number of total publications from the ten journals has increased by 35.4% (from 2403 papers in 2007 to 3722 papers in 2017). The number of papers from these journals from the UK has increased by 19.5% (63 papers), however, the percentage output when compared to other regions, has decreased by 2.1% from 10.8% in 2007 to 8.7% in 2017. The USA remains to have the greatest contribution. Conclusion The result shows a decline in the percentage output of the UK when compared to other countries. This result aligns with other studies published. Focus should be made on improving the current situation of academic medicine in the UK. Take-home message There is a decline in the percentage output of the UK when compared to other countries. Focus should be made on improving the current situation of academic medicine in the UK.

scholarly journals Cryptococcal meningitis in HIV negative pregnant women: case report and review of literature

2009 ◽  
Vol 51 (5) ◽  
pp. 289-294 ◽  
Author(s):  
Maria Laura Botelho Costa ◽  
João Paulo Dias de Souza ◽  
Antônio Francisco de Oliveira Neto ◽  
João Luiz Pinto e Silva
Keyword(s):  
Case Report ◽  
Pregnant Women ◽  
Amphotericin B ◽  
Mental Status ◽  
Cryptococcal Meningitis ◽  
Opportunistic Infections ◽  
Case Reports ◽  
Post Partum ◽  
First Trimester ◽  
Altered Mental Status

INTRODUCTION: Cryptococcosis has become an important entity due to the epidemic of AIDS and therefore it is a significant opportunistic infection. However, there are case reports of cryptococcal meningitis in immune competent pregnant women. Since pregnancy is considered a period of relative immunosuppression, which likely prevents fetal rejection, this could explain the occurrence of opportunistic infections. OBJECTIVE: To report a case of cryptococcosis, and review all cases involving pregnancy and neurocryptococcal infection in immune competent pregnant patients. METHODS: Case report and systematic review of the literature using the MEDLINE and SciELO databases. DISCUSSION: A total of 27 patients were analyzed from 19 studies. The mean age at diagnosis was 26.4 years. There were six patients in their first trimester of pregnancy, 10 in the second, eight in the third and three post-partum. The most prevalent symptoms were headache (85.2%), altered vision (44.4%), altered mental status (44.4%), nausea (40.7%) and fever (33.3%). There were nine deaths (33.3%). Most of the patients received intravenous amphotericin B as treatment (77.8%). The majority (66.6%) of the patients accomplished a term delivery with healthy infants. CONCLUSION: Cryptococcal meningitis should be considered during pregnancy in cases of unexplained headache, altered vision, altered mental status, nausea and fever. Patients with a confirmed diagnosis should be admitted and treated with amphotericin B.

scholarly journals Postcolonoscopy splenic rupture: the under-reporting of an unpropitious phenomena?

2019 ◽  
Vol 12 (9) ◽  
pp. e231047 ◽  
Author(s):  
Bing Lun Chow ◽  
Khawaja Zia
Keyword(s):  
Abdominal Pain ◽  
Case Report ◽  
Chest Pain ◽  
Ct Scan ◽  
Splenic Rupture ◽  
Case Reports ◽  
Initial Presentation ◽  
Haemodynamic Instability ◽  
Fatal Complication

Splenic rupture secondary to colonoscopy is a rare but potentially fatal complication. Given the disparity between the small number of case reports with the incidence reported by some investigators, we contend that the former is not representative of the true extent of this sequela. We present a case report of postcolonoscopy splenic rupture, where the patient had a bizarre initial presentation of chest pain and collapse; and only developed haemodynamic instability and abdominal pain on day 2 postprocedure. Diagnosis was made with a CT scan, and resolution of symptoms was achieved with a splenectomy.

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