scholarly journals P-EGS15 Gastric pneumatosis in an elderly patient with recurrence of gastric volvulus

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Virginia Ledda ◽  
Rajesh Yagati Satchidanand
Keyword(s):  
Mortality Rate ◽  
High Mortality ◽  
Hiatus Hernia ◽  
Gastric Wall ◽  
Gastric Volvulus ◽  
Rare Event ◽  
Diagnostic Process ◽  
Porta Hepatis ◽  
Benign Condition ◽  
History Of

Abstract Background Gastric pneumatosis (GP), defined as the presence of air in the gastric wall, is a rare CT finding. It is associated with a spectrum of conditions which can range from benign and self-limiting to severe with high mortality rate. A gastric volvulus occurs with a rotation of 180 degrees or more of the stomach around its longitudinal or transverse axis. It is a rare event, and can culminate in obstruction, strangulation, ischaemia and necrosis. We present a case of gastric pneumatosis in a patient suffering with hiatus hernia and a history of recurrent gastric volvuli. Methods An 83-year-old man presented with a history of vomiting and abdominal pain. His background included a known hiatus hernia with previous episodes of gastric volvulus. A computer tomography (CT) showed a gastric volvulus with air in the gastric wall, in the intrahepatic biliary tree and porta hepatis. Conservative management was pursued with IV PPI and antibiotics, keeping the patient nil by mouth. He improved clinically and a repeat CT scan showed regression of the gastric pneumatosis, with resorption of gas in the porta hepatis and regression of the pneumobilia. He was discharged home 12 days after his initial presentation. Results Gastric pneumatosis (GP) is described as a rare finding that can occur in conditions such as gastric emphysema (GE) and emphysematous gastritis (EG). GE is described as a more benign condition, usually self-limiting which can be managed conservatively in most cases and rarely requires surgical interventions. EG is a more severe condition with a high mortality rate, and more aggressive treatment is advocated. The diagnostic process can be challenging but literature shows lactate, the presence of metabolic acidosis and peritonitis can help differentiating between the two clinical entities and choosing the appropriate management plan. Conclusions This case described a patient presenting with a gastric volvulus with the presence of gastric pneumatosis, pneumobilia and portal venous gas. These findings were diagnosed as gastric ischaemia secondary to volvulus. In this case the patient made a good recovery after being managed conservatively. GP is a rare CT entity which can be found in the presence of GE or EG. Differentiating between the two can be a challenging process, aided by clinical examination as well as blood test results. Achieving the right diagnosis is key as radical surgical intervention is not always needed to guarantee a good outcome.

Ketamine in the management of generalised cephalic tetanus

2007 ◽  
Vol 122 (12) ◽  
pp. 1389-1391 ◽  
Author(s):  
O Obanor ◽  
H O Osazuwa ◽  
J E O Amadasun
Keyword(s):  
Case Report ◽  
Mortality Rate ◽  
Airway Obstruction ◽  
High Mortality ◽  
Adjunctive Therapy ◽  
Anaesthetic Agent ◽  
Purulent Discharge ◽  
Clostridium Tetani ◽  
History Of ◽  
Cephalic Tetanus

AbstractBackground:Tetanus is a fatal infection caused by the neurotoxin tetanospasmin released by the vegetative spores of Clostridium tetani. The high mortality rate is related to frequent tetanic fits with laryngeal spasm and airway obstruction. Numerous anticonvulsants are in use, with varying efficacy in controlling fits. This case report highlights the use of ketamine as adjunctive therapy in the management of tetanus.Case report:A 20-year-old woman was admitted with a history of recurrent left ear pain, with bloody, purulent discharge, following a self-inflicted injury. She developed tetanic spasms 24 hours after admission. She had received no immunisations. A tracheostomy was established to relieve airway obstruction, and ketamine was added to the medication when breakthrough seizures were refractory to diazepam.Conclusion:Ketamine is of proven safety as an anaesthetic agent, especially in cases in which an anaesthetist is not readily available. Its effectiveness in this case, in combination with diazepam, warrants further evaluation.

scholarly journals 1417. Clinical Features and Outcomes of raoultella terrigena Infections. A Single-Center Experience from Karachi, Pakistan

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S715-S715
Author(s):  
Ishfaque Ahmed ◽  
Nosheen Nasir ◽  
Bushra Jamil Ali ◽  
Syed Faisal Mahmood
Keyword(s):  
Mortality Rate ◽  
Respiratory Tract ◽  
High Mortality ◽  
Cross Sectional Study ◽  
Drug Resistant ◽  
Sectional Study ◽  
Cross Sectional ◽  
History Of ◽  
Tract Infections ◽  
Raoultella Terrigena

Abstract Background Raoultella terrigena (formerly Klebsiella terrigena) is an environmental gram-negative rod, occasionally causing infections in humans, especially in elderly, immunosuppressed patients. Moreover, this organism tends to be multi-drug resistant, limiting treatment options. Evidence on clinical presentation and outcomes of this infection is limited; we conducted a cross-sectional study to get a better insight into these infections. Methods We conducted a cross-sectional study on all adult patients with clinical specimen positive for Raoultella terrigena at a 700-bedded tertiary care hospital in Karachi, Pakistan, between January 2013 to December 2018. Results A total of 58 patients with R. terrigena were identified. The median age was 61.5 years, and the male to female ratio was (60.9% vs. 39.1%). The most common site of infection was respiratory tract 28.3%, followed by urinary tract infections 26%, and central line-associated infections 15.2%. In 12 patients 22.6%, R. terrigena was a colonizer. Amongst infected cases, 23.6% were in shock, and of which 18.1% required vasopressors. 29.2% had respiratory failure requiring non-invasive ventilation in 13.9%, and mechanical ventilation in 15.3%. The previous history of multidrug-resistant organisms was present in 67.4% cases and the history of prior antibiotics use within the last six months was present in 78.3%. 91.3% of isolates were resistant to piperacillin-tazobactam and meropenem, 65.2% were resistant to colistimethate. However, tigecycline susceptibility maintained in 30.4% checked in n=31, 67.4% and fosfomycin sensitivity in 15.2% cases, checked in n=29, 63% cases. Eight patients lost to follow up. Majority of patients were treated with combination therapy n=31, 81.6% and meropenem plus colistemethate was the most commonly used combination n=11, 44%. The overall mortality rate was 44.7%. Among all recorded co-morbid conditions, chronic kidney disease was strongly associated with mortality (p= .029), as also the use of vasopressors (p= .005).Persons who had high (greater or equal to three) Charlson comorbidity index had high mortality (p=0.002). Conclusion R.terrigena is a highly drug-resistant organism with high mortality rate, and causes hospital-acquired respiratory tract infections in majority of patients. Disclosures All Authors: No reported disclosures

scholarly journals Notes on typhus fevers in Kenya

1939 ◽  
Vol 39 (4) ◽  
pp. 345-354 ◽  
Author(s):  
J. I. Roberts
Keyword(s):  
Mortality Rate ◽  
High Mortality ◽  
Guinea Pigs ◽  
Rattus Rattus ◽  
Human Case ◽  
The Other ◽  
Post Mortem ◽  
History Of ◽  
Intraperitoneal Inoculation

1. The history of a typical sanguineus-borne human case of typhus is given, together with the results of intraperitoneal inoculation of material from the initial lesion into guinea-pigs.2. This material in the earlier inoculations caused a high mortality rate among guinea-pigs, and is characterized from the other material obtained from rats and fleas by the swing of temperatures between morning and evening.3. Three cases of non-lesion typhus occurred in a brewery heavily infested with rats and fleas, the patients affirming they had been bitten only by fleas.A high rat infestation was noted and a Xenopsylla index of 15·0 per rat.4. Inoculation into guinea-pigs of emulsified brain and testicle material from Rattus rattus trapped at this typhus focus, and of emulsified fleas from the rats, resulted in the establishment of a strain of virus which produced a typhus-like syndrome in guinea-pigs.5. Infection of guinea-pigs with strains of virus from rats, ticks and fleas, has been secured without any difficulty in Kenya, and it has not been found necessary to keep guinea-pigs on vitamin-deficient diets.6. Typical scrotal reaction has been observed in the majority of guinea-pigs inoculated. The onset is generally sudden and coincides with the rise in temperature. Subsidence of the swelling and inflammation is gradual over about 3 days.7. Loss in weight is not a marked feature of the forms of virus encountered in Kenya.8. Post-mortem appearances in the rat-and flea-forms differ from those of the tick-type mainly in less ascites and slight enlargement of the spleen.

scholarly journals Suppurative gastritis in a HIV-positive patient: A case report

2020 ◽  
Vol 77 (7) ◽  
pp. 751-753
Author(s):  
Dragomir Damjanov ◽  
Tomislav Preveden ◽  
Snezana Brkic ◽  
Daniela Maric ◽  
Mirjana Zivojinov ◽  
...  
Keyword(s):  
Case Report ◽  
Mortality Rate ◽  
High Mortality ◽  
Epigastric Pain ◽  
Gastric Wall ◽  
Gastric Aspirate ◽  
Excessive Alcohol Consumption ◽  
Blood Tests ◽  
Enterococcus Spp ◽  
Excessive Alcohol

Introduction. Suppurative gastritis (SG) is a rare disease characterized by a bacterial infection of the stomach wall. This condition has high mortality rate, especially in patients with predisposing factors such as alcoholism, immunodeficiency and previous endoscopic gastric procedures. Case report. A 41 year old male was hospitalized with epigastric pain, fever and vomiting. The symptoms started a few days after esophagogastroduodenoscopy (EGD). His personal medical history included periodical excessive alcohol consumption. Based on initial blood tests the patient was diagnosed with sepsis and was promptly started a treatment with antibiotics. In the first few days of hospitalization there was an improvement in inflammation marker levels, but the patient was still febrile and with the referred epigastric pain. A computed tomography scan showed marked thickening of the gastric wall and EGD revealed deep ulcers in the stomach with fibrinopurulent exudate. Histological examination of gastric biopsies showed necrosis and abscesses. Blood cultures were positive for Stenotrophomonas maltophilia and Pseudomonas aeruginosa with subsequent change in antibiotics. The repeated blood tests showed leucopenia and the patient tested positive for human immunodeficiency virus (HIV). A second EGD showed pus in the stomach, with a gastric aspirate culture positive for Enterococcus spp. The treatment was modified and a third EGD showed healed gastric mucosa confirmed by histopathological evaluation. Conclusion. Taking in consideration the high mortality rate of SG, it is necessary to make an early diagnosis and start the treatment against specific pathogens, since it can be crucial for a better outcome of this clinical condition.

scholarly journals Extensive gastric necrosis in an infant

2021 ◽  
Vol 8 (9) ◽  
pp. 2816
Author(s):  
Suraj R. Gandhi ◽  
Neha S. Shenoy ◽  
Vini Joseph ◽  
Apoorva P. Makan ◽  
Syamantak Basu ◽  
...  
Keyword(s):  
Gastric Wall ◽  
Fatal Outcome ◽  
Gastric Volvulus ◽  
Rare Condition ◽  
Abdominal Distension ◽  
Feeding Tube ◽  
Gastric Necrosis ◽  
History Of ◽  
Anterior Gastric Wall ◽  
Upper Abdominal

Gastric necrosis is a rare condition, more so in children and can be potentially fatal. The sloughing of the necrosed wall results in perforations or large defects in the gastric wall.  We report a rare case of extensive gastric necrosis in a 2 months old female infant, managed successfully. Child presented with non-bilious vomiting and excessive cry. There was history of recurrent upper abdominal distension. X-ray of abdomen showed massive pneumoperitoneum. Intra operatively, posterior gastric wall was sloughed off and lower end of feeding tube was lying in the peritoneal cavity. Necrotic wall was debrided and stomach tube was created from remaining anterior gastric wall. Gastrostomy and jejunostomy was done. Post-operative period was uneventful. Dye study at three months showed good gastric capacity. Stomach being a well vascularised organ, necrosis is rare. There is varied etiology of gastric necrosis, volvulus being one of them. Gastric volvulus might be associated with other congenital anomalies like eventration, asplenia, wandering spleen. The incidence of perforation in gastric volvulus with necrosis is 5-28% and a mortality of 50% is reported with such perforations. Vigilant clinical observation in pediatric patients with upper abdominal distension and pain can point the diagnosis and prevent fatal outcome.

scholarly journals Tetanus in horses: an overview of 70 cases

2018 ◽  
Vol 38 (2) ◽  
pp. 285-293 ◽  
Author(s):  
Márcio G. Ribeiro ◽  
Geraldo de Nardi Júnior ◽  
Jane Megid ◽  
Marília M.J. Franco ◽  
Simony T. Guerra ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Clinical Outcomes ◽  
Surgical Procedures ◽  
High Mortality ◽  
Clinical Signs ◽  
Specific Treatment ◽  
Case Series ◽  
Clinical Aspects ◽  
History Of ◽  
Length Of Hospitalization

ABSTRACT: Tetanus is characterized by high case fatality rates in horses. Comprehensive case series studies involving equine tetanus from different geographic areas enable the evaluation of prognosis, efficacy of treatment, and control measures. We retrospectively investigated some selected epidemiological data (breed, age, gender, use of the horses, history of vaccination, seasonality, presence of wound/history of surgical procedures, clinical outcomes) and main clinical aspects (clinical signs, incubation period, length of hospitalization, and period between onset signs and hospitalization) in 70 cases of equine tetanus over 1990-2015, with emphasis in the association between these data and the clinical outcomes. High mortality rate (72.9%) was observed in this study. Forty (57.1%) horses presented history of wounds or surgical procedures related with tetanus, represented mainly by lesions in the hind limbs (42.5%), front limbs (15.0%), umbilical infections (7.1%), castration (4.3%), and face wounds (4.3%). Hyperesthesia, limb spasticity, cervical stiffness, tetanic spasms, and restriction of jaw movement were the main consistent clinical signs. Besides no statistical association, all the horses with umbilical infections, wounds in face, prolonged recumbency, sweating, dysphagia/aphagia died, and together with delay between onset of first clinical signs and prompt veterinary assistance (< 5 days) were considered indicative of poor prognosis; whereas there was a significant association (p=0.001) between survival and length of hospitalization > 7 days, seemed as an evidence of good prognosis. The high mortality rate of tetanus, even in horses under specific treatment, highlight the need for early diagnosis, prompt veterinary assistance, and establishment of prophylatic measures in equine farms.

scholarly journals A Rare Case of Intracardiac Extension of Hepatocellular Carcinoma in a Child

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Abdulrahman Al Jassmi ◽  
Hani Humad ◽  
Said Abou Eida
Keyword(s):  
Hepatocellular Carcinoma ◽  
Mortality Rate ◽  
Hepatitis B ◽  
High Mortality ◽  
Rare Case ◽  
Advanced Stage ◽  
Hepatitis B Infection ◽  
History Of ◽  
Intracardiac Extension ◽  
Common Malignancy

Hepatocellular carcinoma (HCC) is the fifth most common malignancy found in men and ninth most common in women, out of which 72.5% reported cases are from Asia. In children, it accounts for <2% cases worldwide with even rarer incidence of 1.2% involving intracardial extension. However, it presents with a high mortality rate with mean survival ranging from 1 to 4 months. The present case is an extremely rare case of intracardiac extension of HCC in a 3.5-year-old Asian girl with no history of hepatitis B infection presented at an advanced stage of HCC who succumbed within one month of presentation to the hospital.

scholarly journals A RARE CASE OF SCRUB TYPHUS MASQUERADING AS BREAST ABSCESS

2014 ◽  
Vol 04 (04) ◽  
pp. 107-109
Author(s):  
Venkata Pothukuchi Krishna ◽  
Venkata Ravikumar Chepuri ◽  
Sudhakar Kanumuri ◽  
Raghavareddy Yarram ◽  
Sailaja Yadalla
Keyword(s):  
Pregnant Woman ◽  
Mortality Rate ◽  
High Mortality ◽  
Rare Case ◽  
Scrub Typhus ◽  
Breast Abscess ◽  
History Of ◽  
High Index Of Suspicion ◽  
Timely Treatment ◽  
In Pregnancy

AbstractWe are presenting a case of scrub typhus masquerading as breast abscess in a pregnant woman who attended to hospital with history of fever and breast tenderness. A high index of suspicion is necessary as it is rarely seen but easily treatable and without proper and timely treatment, serious complications may arise which carries high mortality rate. Scrub typhus during pregnancy is quite rare. The line of treatment of scrub typhus in pregnancy is also analysed.

Emamectin benzoate is a safe and effective anthelmintic against coelomic nematode Philometra rubra in striped bass Morone saxatilis

2020 ◽  
Vol 142 ◽  
pp. 47-53
Author(s):  
K Béland ◽  
G Séguin ◽  
S Lair
Keyword(s):  
Mortality Rate ◽  
Striped Bass ◽  
High Mortality ◽  
Morone Saxatilis ◽  
Treatment Results ◽  
Emamectin Benzoate ◽  
Once Daily ◽  
Fish Hatchery ◽  
Parasitic Burden

An unusually high mortality rate due to verminous (Philometra rubra) coelomitis was documented in wild-hatched striped bass Morone saxatilis raised in a fish hatchery as part of a stock restoration program. To decrease the parasitic burden and therefore potentially minimize mortality, the effectiveness of 2 different anthelmintics was evaluated. Two trials were conducted on wild-collected fingerlings naturally infected by P. rubra. In 2006, 144 yearling fish were randomly assigned to 4 experimental groups: (1) levamisole (Levasol®) at 2 mg l-1 via immersion for 8 h once weekly for 3 wk; (2) levamisole at a dose of 2.5 mg kg-1 biomass via feed once daily for 7 d; (3) emamectin benzoate (Slice®) at a dose of 0.05 mg kg-1 biomass via feed once daily for 7 d; and (4) control. Emamectin successfully eliminated live nematodes in 84.9% of the fish, whereas the administration of levamisole, either via immersion or feed, was not successful in significantly reducing the number of live P. rubra. In 2007, the administration of the same dosage of emamectin to approximately 1000 naturally infected yearling striped bass was associated with a 100% mortality rate of P. rubra in the 30 fish randomly examined 5 wk after the beginning of the treatment. Results of these trials indicate that, at the dosage used, the administration of emamectin at the end of the summer is safe for striped bass yearlings and considerably reduces the prevalence and intensity of the infection by this parasite.

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