scholarly journals TP10.1.3SARS-Cov-2 and Colitis: A Case Series

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Jessica Banks ◽  
Dheepa Nair ◽  
Richard Guy
Keyword(s):  
Young Patients ◽  
Case Series ◽  
Gi Tract ◽  
Ischaemic Colitis ◽  
Emergency General Surgery ◽  
Medical Comorbidities ◽  
Gi Symptoms ◽  
Nasal Swabs ◽  
History Of ◽  
The Right

Abstract Background Up to a third of patients with COVID-19 infection present with gastrointestinal (GI) symptoms. The Sars-Cov-2 virus enters enterocytes through a novel mechanism via ACE- 2 receptors, which are expressed throughout the GI tract, especially in the mid-gut. Small bowel and colonic inflammation and alteration of the gut microbiome (“altered inflammasome”) have been observed. Aims We report a cluster of cases during the first and second wave UK pandemics involving young patients with unexplained segmental CT-proven colitis. Methods All patients diagnosed with CT proven colitis with no history of IBD, ischaemic colitis or significant medical comorbidities were included. Results Fifteen patients (median age 33 years; 8 females) were admitted under Emergency General Surgery between Mar 2020 & Jan 2021. All patients were previously well with no history of IBD, ischaemic colitis or significant medical comorbidities. Thirteen patients underwent CT imaging, showing evidence of colitis in 12, with changes affecting the right colon predominating. Campylobacter jejuni was identified in 4 of 7 stool cultures but only 1 patient had a positive PCR nasal swab and another had COVID antibodies detected in serum. Endoscopic and histological appearances of those undergoing colonoscopy were non-specific. Conclusion These cases may represent Covid-19 involvement of the gut. Nasal swabs are not validated for use in the GI tract and detection of SARS-Cov-2 virus requires faecal or mucosal sampling. Disruption of the microbiome permits emergence of pathogenic species such as Campylobacter. More work is required in this important area to further define and elucidate COVID-19 GI involvement.

scholarly journals Three unusual parapharyngeal space masses resected via the endoscopy-assisted transoral approach: case series and literature review

2020 ◽  
Vol 48 (8) ◽  
pp. 030006052093606
Author(s):  
Li-Fang Shen ◽  
Ya-Lian Chen ◽  
Shui-Hong Zhou
Keyword(s):  
Parapharyngeal Space ◽  
Case Series ◽  
Transoral Approach ◽  
Carcinoma Ex Pleomorphic Adenoma ◽  
Branchial Cleft Cyst ◽  
Current Time ◽  
History Of ◽  
Cosmetic Outcomes ◽  
Branchial Cleft ◽  
The Right

Tumors of the parapharyngeal space (PPS) are rare, most originate from salivary and neurogenic tissues, and most are benign. However, there are some rarer masses in the PPS, with just a few published reports in the literature worldwide, and we may not consider them in the differential diagnosis of PPS neoplasms. We report three cases of rare masses in the PPS: Warthin’s tumor, branchial cleft cyst, and carcinoma ex pleomorphic adenoma. The three patients were admitted to our department with complaints of painless swelling in the lower side of the right face or a long history of snoring; diagnoses were confirmed histopathologically. An endoscopy-assisted transoral approach was used that allowed wide visibility for safe resection and resulted in a short hospitalization time and good functional and cosmetic outcomes. All patients have been followed to the current time, and there have been no recurrences. The transoral endoscopy-assisted approach appears to be safe, effective, and less invasive for excision of masses in the PPS.

Herpes zoster ophthalmicus following onabotulinumtoxinA administration for chronic migraine: A case report and literature review

Cephalalgia ◽  
2014 ◽  
Vol 35 (5) ◽  
pp. 443-448 ◽  
Author(s):  
Paul M Gadient ◽  
Jonathan H Smith ◽  
Stephen J Ryan
Keyword(s):  
Herpes Zoster ◽  
Literature Review ◽  
Chronic Migraine ◽  
Young Patients ◽  
Viral Reactivation ◽  
Herpes Zoster Ophthalmicus ◽  
Local Trauma ◽  
Physician Awareness ◽  
History Of ◽  
The Right

Background There is a growing body of literature documenting local herpes zoster outbreak following procedures. The mechanism underlying these outbreaks remains elusive. We present a case of zoster following onabotulinumtoxinA (BTX) for migraine and a literature review. Methods Chart and literature review. Case A 72-year-old woman with chronic migraine received BTX injections for 3 years without incident. She had a history of thoracic zoster with subsequent post-herpetic neuralgia. In August 2013, 48 hours after receiving BTX injections, she developed a painful rash in the right V1 distribution consistent with herpes zoster ophthalmicus. One week later the rash had resolved without treatment. Literature review We identified 65 (including 2 from Juel-Jenson) cases of zoster reactivation following minor procedures. These cases tend to be in young patients without specific risk factors. Outbreaks characteristically occur at the level of exposure to local trauma. Discussion Our review suggests that local trauma, regardless of the nature of stimuli, may be sufficient for zoster reactivation. We hypothesize that the stressors in these reported cases exert a local epigenetic influence on viral transcription, allowing for viral reactivation. Conclusion Zoster is a potential complication of BTX administration for chronic migraine in adults. Physician awareness can reduce the significant morbidity associated with this disease.

scholarly journals A Rare Cause of Supraventricular Ectopic Beats and Angina in a Young Patient

2018 ◽  
Vol 4 (2) ◽  
pp. 106-109
Author(s):  
Monica Jurcău ◽  
Mariana Floria ◽  
Bogdan Mazilu ◽  
Anca Ouatu ◽  
Daniela Maria Tanase
Keyword(s):  
Coronary Artery ◽  
Stress Test ◽  
Young Patients ◽  
Physical Exertion ◽  
Diagnostic Techniques ◽  
History Of ◽  
Ectopic Beats ◽  
Artery Disease ◽  
One Year ◽  
The Right

Abstract Introduction: We present the case of a young man with multiple atherosclerotic risk factors and a rare cause of angina and supraventricular ectopic beats. Case presentation: A 35-year-old man with one-year history of stable angina pectoris and supraventricular ectopic beats, without any medication, presented to the emergency room complaining of anterior chest pain that occurs at moderate physical exertion. The rest electrocardiogram, transthoracic echocardiography, and chest X-ray were normal; the exertion stress test was also normal, except for supraventricular ectopic beats (trigeminal rhythm). Due to the intermediate pre-test probability of coronary artery disease, he was evaluated using coronary computed tomography angiography. An anomalous origin of the right coronary artery from the left coronary sinus, with an inter-arterial course and without any atheroma plaques, was observed. During hospitalization the evolution was stable, without complications. The patient was further referred to a cardiac surgery clinic to evaluate the possibility of surgical treatment of this anomaly. Conclusions: Coronary artery anomalies are very rare; however, they present multiple implications in current practice. The most severe complication of this condition is represented by sudden death in young patients due to malignant ventricular arrhythmias. Imaging diagnostic techniques allow for a rapid, noninvasive diagnosis of this rare cause of angina.

scholarly journals Chronic subdural hematoma

2021 ◽  
pp. 1-7
Author(s):  
Blanca Piedra Herrera ◽  
Yanet Yanet Acosta Piedra
Keyword(s):  
Subdural Hematoma ◽  
Head Injuries ◽  
Young Patients ◽  
Chronic Subdural Hematoma ◽  
Complete Recovery ◽  
Computed Tomography Scan ◽  
History Of ◽  
Third Cranial Nerve Palsy ◽  
The Right ◽  
Tomography Scan

Chronic subdural hematoma (CSH) is a common neurosurgical pathology that is recognized as a consequence of minor head injuries that are usually diagnosed in senile patients, although it can occur in young patients without a history of trauma. The objective of this work is the presentation of a patient with a bilateral CSH, with unusual characteristics. Clinical case: a 46-year-old female patient with no history of head trauma or other concomitant pathology is presented, who consulted for a 15-day-old headache. Physical examination confirmed mydriasis, Hutchinson’s pupil, bilateral papilledema and exophoria of the right eye, third cranial nerve palsy, and trunk ataxia. She was cataloged with Glasgow 13. Early anti-cerebral edema treatment was performed and the manifestations largely disappeared. A computed tomography scan diagnosed a bilateral fronto temporal subdural hematoma with displacement of the midline structures to the left. She underwent emergency surgery and was discharged completely recovered three days later. Conclusion: HSC can present with different clinical forms, simulating expansive tumor processes, cerebrovascular attacks, dementias or neurological entities of another nature. The case management by clinicians and neurosurgeons was quick and effective, which explains that the patient had an early and complete recovery. In these cases, medical action is decisive in the success of the treatment.

scholarly journals Juvenile Osteochondritis Dissecans of the Knee. About A Case

2017 ◽  
Vol 5 (1_suppl) ◽  
pp. 2325967117S0002
Author(s):  
Ignacio Astore ◽  
Juan Ignacio Agotegaray ◽  
Ignacio Comba ◽  
Luciana Bisiach
Keyword(s):  
Osteochondritis Dissecans ◽  
Femoral Condyle ◽  
Young Patients ◽  
Body Burden ◽  
Acute Onset ◽  
Type Iv ◽  
Juvenile Osteochondritis Dissecans ◽  
Osteosynthesis Material ◽  
History Of ◽  
The Right

Introduction: Juvenile osteochondritis dissecans is a pathology that affects the superficial articular cartilage and subchondral bone in patients with open physes. Treatment of this disease is based on patient’s age and the stage of the disease. Methods: 16-year-old patient, athlete, with a history of knee pain on the right side of acute onset, without traumatic history. A physical examination shows pain in the external compartment of the knee. MRI shows a stable lesion that involves the external femoral condyle, over a posterior area of 16 mm by 20mm. Crutches are indicate for walking without body burden. Symptoms continue for six months and there are no changes in MRI. It is decided to do a stabilization with a Herbert type screw. After the surgery, pain persists and in x-ray controls, osteointegration is not observed. Osteosynthesis material is extracted and mosaicplasty is performed. We used Guhl’s intraoperative classification. Results: In this case, for a young patient with Guhl’s lesion type III, the reduction with a Herbert type screw was indicated, as the lesion was stable, of a significant size and congruent. Lesion progressed to type IV in 6 months. Thus, mosaicplasty was performed, obtaining a good functional result according to the physical exam, with a complete range of flexion and extension. A second-look arthroscopic assessment was carried out 2 months after surgery, showing osteointegration and stability of the allogenic graft. Conclusion: The variable of stability of the fragment is very important when determining the treatment. Most of the stable lesions can be successfully treated with a conservative treatment. Also, it has been demonstrated that young patients have a higher rate of healing. Instead, unstable lesions require surgical treatment.

scholarly journals Outcomes of COVID-19 infection in heart transplant recipients

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
D Miklin ◽  
A Mantha ◽  
A Wolfson ◽  
A Vaidya ◽  
E Depasquale
Keyword(s):  
Heart Transplant ◽  
Academic Medical Center ◽  
Case Series ◽  
Transplant Recipients ◽  
Transplant Patients ◽  
Increased Risk ◽  
Gi Symptoms ◽  
History Of ◽  
The Mean ◽  
Heart Transplant Recipients

Abstract Background Heart transplant recipients may be at increased risk for infection and adverse outcomes from infection with COVID-19. Management of these patients is complex, with limited data and no standard of care. Purpose We sought to describe the incidence and outcomes of COVID-19 infection in patients with a history of heart transplant. Methods Retrospective review of 235 heart transplant patients at a large academic medical center identified 31 patients with laboratory confirmed COVID-19 infection. Laboratory and clinical data were collected from our institution as well as other local hospitals patients had been treated at. Outcomes were followed from March 15, 2020 to March 15, 2021. All data was deidentified. Results In a cohort of 235 heart transplant patients, 31 patients were identified after testing positive for COVID-19 infection. The mean and median age of patients was 51.9 and 56.0 years respectively. 71% of patients were male and 29% of patients were female. The mean and median time from transplant to diagnosis was 6.54 and 6.50 years. Average ejection fraction prior to infection was 60.4%. Seventeen patients (55%) had atherosclerosis, ten patients (32%) had diabetes, fifteen patients (48%) had hypertension, and twelve patients (39%) had a history of smoking. 84% of patients were on three types of immunosuppression and 16% were on two. Eight patients (26%) were asymptomatic, six patients (19%) had acute hypoxic respiratory failure, and two patients (7%) had GI symptoms. Two patients had evidence of graft injury with mean AlloSure (donor derived cell free DNA) levels of 0.61%. Immunosuppressive regimens were decreased in 32% of patients and COVID-19 directed therapies were given in 32% of patients. The most common treatments were remdesevir (5 patients), steroids (3 patients), and bamlanivimab (2 patients). Thirteen patients (42%) were hospitalized and two patients (7%) died. Conclusions In a single center case series 31 patients were identified with COVID-19 infection. Nearly half of the patients required hospitalization, with one third of patients decreasing their immunosuppressive regimen and 7% mortality. Further investigation is needed to determine long term outcomes and optimal therapeutic regimen for COVID-19 in this unique population. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals A Case Report of an Abdominal Wall Endometrioma

2021 ◽  
Vol 11 (11) ◽  
pp. 261-264
Author(s):  
Saima Najam ◽  
Messaoud Bounnah
Keyword(s):  
Abdominal Pain ◽  
Abdominal Wall ◽  
Abdominal Mass ◽  
Young Patients ◽  
Surgical Removal ◽  
Histopathological Diagnosis ◽  
Normal Delivery ◽  
Uterine Surgery ◽  
History Of ◽  
The Right

Abdominal wall endometrioma (AWE) is one of the rarest forms of the endometriosis, and usually found in the young patients, average age is 35years. The most common triad of the symptoms is, abdominal mass at or near the scar, cyclical pain and history of previous caesarean or any other gynecological surgery. Exact pathogenesis is unknown as average time of its presentation in the patients is highly variable from 3 months till 2 decades. It can be suspected on ultrasonography and CT scan and MRI are the modalities used to assess and stage the lesion prior to the surgery. Histopathological diagnosis is confirmatory. We are reporting 30 years old, Para 2, with history of first caesarean section 6 years ago followed by the normal delivery. She presented with the history of cyclical abdominal pain with the feeling of abdominal lump from last 3 months. On examination a slightly tender 5*4 cm extra abdominal mass was palpable above the right half of the previous transverse scar of the caesarean. After evaluation endometriosis was suspected and the patient opted for the surgical resection of the mass. The mass was removed in collaboration with the surgeons and the histopathology confirmed the diagnosis of the AWE. Conclusion: AWE is a dynamic yet incompletely known entity as a result of increasing number of the caesarean and gynecological procedures. It should be kept in the differential diagnosis of the patients coming with the cyclical abdominal pain and abdominal lump with the history of previous uterine surgery. Ultrasound and MRI are the main aiding modalities but the confirmation of the diagnosis is made only after histopathology. The surgical removal of the mass with negative margins represents the current best treatment. Key words: Abdominal wall, endometriosis, magnetic resonance imaging, ultrasonography.

Epiretinal membrane and cataract in a 5-year-old boy with the suspicion of neurofibromatosis type 2

Open Medicine ◽  
2013 ◽  
Vol 8 (1) ◽  
pp. 80-83 ◽  
Author(s):  
Joanna Siwiec-Proscinska ◽  
Anna Gotz-Wieckowska ◽  
Marta Pawlak ◽  
Jaroslaw Kociecki
Keyword(s):  
Visual Acuity ◽  
Family History ◽  
Young Patients ◽  
Neurofibromatosis Type ◽  
Ophthalmological Examination ◽  
Neurofibromatosis 2 ◽  
Epiretinal Membranes ◽  
Negative Results ◽  
History Of ◽  
The Right

AbstractDifferent ocular findings have been described in association with neurofibromatosis 2 (NF2). Detailed ophthalmological examination of asymptomatic subjects with a family history of NF2 could help confirm the diagnosis in young patients. We present a case of unilateral cataract and bilateral epiretinal membranes in a 5-year-old boy with a family history of neurofibromatosis 2. The patient was referred to our department with diminished visual acuity bilaterally and an initial diagnosis of cataract in the right eye. Bestcorrected visual acuity was 3/19 in the right eye and 3/24 in the left eye (LH charts). On fundus examination, bilateral macular epiretinal membranes were found and confirmed by optical coherent tomography. In view of the ophthalmic signs mentioned above and the history of the patient’s father, who suffered from NF2 and died from meningioma and ependymoma, the patient was referred for genetic examination. Seventeen exons of the NF2 gene were tested with negative results. No pathology was found on clinical neurologic examination and magnetic resonance imaging of the brain. Although the patient has not met the criteria for NF2, he is now considered as an asymptomatic subject at risk and observed. Lens opacities with epiretinal membranes in children may be regarded as part of the clinical manifestation of NF2.

scholarly journals Acute Intravenous Calcium Antagonist for Suspected Hemiplegic Migraine – A Case Story

2017 ◽  
Vol 9 (1) ◽  
pp. 98-105 ◽  
Author(s):  
Charlotte Lützhøft Rath ◽  
Jun He ◽  
Mette Maria Nordling ◽  
Troels Wienecke
Keyword(s):  
Symptom Onset ◽  
Right Hemisphere ◽  
Young Patients ◽  
Brain Magnetic Resonance Imaging ◽  
Recombinant Tissue Plasminogen Activator ◽  
Hemiplegic Migraine ◽  
Brain Ct ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
The Right

Stroke mimics, like attacks of hemiplegic migraine, are challenging in acute stroke evaluation. We present a 28-year-old woman with a suspected hemiplegic migraine attack with left-sided hemiparalysis. Brain CT with perfusion imaging 1 h 54 min after symptom onset revealed hypoperfusion in the right hemisphere. The patient was treated with intravenous recombinant tissue plasminogen activator (rtPA) with no effect. After a subsequent intravenous verapamil infusion, the patient gained full motor function within 10 min. Brain magnetic resonance imaging (MRI) performed 5 h 46 min after symptom onset revealed diffusion restriction in the same area as the hypoperfusion on CT. There were no notable changes on T2 images. The patient stayed clinically in remission, except for reduced sensation for all modalities on the extremities on the left side. Although brain CT 24 h after symptom onset revealed an edema in the same area, an MRI performed 17 days later showed no new infarctions. Young patients with a history of migraine with aura admitted with symptoms of acute ischemic stroke are at risk of insufficient treatment. Calcium antagonists might be considered if there is no effect of first-line treatment with rtPA.

scholarly journals Pneumatosis intestinalis in COVID-19

2020 ◽  
Vol 7 (1) ◽  
pp. e000434 ◽  
Author(s):  
Simone Meini ◽  
Chiara Zini ◽  
Maria Teresa Passaleva ◽  
Anna Frullini ◽  
Francesca Fusco ◽  
...  
Keyword(s):  
Pneumatosis Intestinalis ◽  
Respiratory Illness ◽  
Gi Tract ◽  
Right Colon ◽  
Case Presentation ◽  
Gi Symptoms ◽  
The Right ◽  
Cytomegalovirus Infections

IntroductionCOVID-19 is a respiratory illness due to novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), described in December 2019 in Wuhan (China) and rapidly evolved into a pandemic. Gastrointestinal (GI) tract can also be involved.Case presentationA 44-year-old man was hospitalised for COVID-19-associated pneumonia. A rapid recovery of respiratory and general symptoms was observed after 1 week of treatment with lopinavir/ritonavir plus hydroxychloroquine and broad-spectrum antibiotics (piperacillin–tazobactam plus teicoplanin). No GI symptoms were reported during hospitalisation, but a lung contrast-enhancement CT (CE-CT) excluding thromboembolism showed, as collateral finding, intraperitoneal free bubbles not present on a previous CT examination; the subsequent abdominal CE-CT described pneumatosis intestinalis (PI) involving the caecum and the right colon. Ciprofloxacin plus metronidazole was started, and the 2-week follow-up CT showed the complete resolution of PI.DiscussionThe pathogenesis of PI is poorly understood. PI involving the caecum and right colon has been described for HIV and Cytomegalovirus infections, but, to our best knowledge, never before in COVID-19. We hypothesise a multifactorial aetiopathogenesis for PI, with a possible role of the bowel wall damage and microbiota impairment due to SARS-CoV-2 infection, and we suggest a conservative management in the absence of symptoms.

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