PS01.103: THE UNUSUAL CAUSES OF ODYNOPHAGIA

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 78-78 ◽  
Author(s):  
Kheng Tian Lim
Keyword(s):  
Complete Resolution ◽  
Conflicts Of Interest ◽  
Fish Bone ◽  
Esophageal Injury ◽  
Mediastinal Infection ◽  
Inflammatory Processes ◽  
History Of ◽  
Fish Ingestion ◽  
The Right ◽  
Esophageal Ulcers

Abstract Background Odynophagia can be caused by infective and non-infective inflammatory processes, benign and malignant esophageal disorders such as achalasia, gastro-esophageal reflux disease and carcinoma. Methods We described two unusual cases of odynophagia and their individual management. Results Case 1 is a 21 year-old Indian man presented with 2 days history of odynophagia after taking doxycycline capsules indicated for acne. An esophagogastroduodenoscopy (OGD) was performed and showed multiple mid esophageal ulcers. Esophageal biopsy taken showed inflammatory ulcer slough with no fungal infection, dysplasia or malignancy. Doxycycline was stopped and patient recovered with complete resolution of odynophagia. Case 2 is a 55 year-old Chinese man presented with 1 day history of odynophagia and severe chest pain after eating a bowl of hot fish soup. A CT Thorax was performed which showed a localised perforation of the right wall of the esophagus with extraluminal gas posterior to the trachea. An urgent OGD was performed and an L-shaped fish bone was removed successfully and an endoclip was applied to close the puncture hole of esophagus. Patient made a full recovery without any mediastinal infection. Conclusion Odynophagia from mid esophageal ulcers secondary to doxycycline intake should be recognized and can be easily managed by stopping the antibiotics with complete resolution of the symptom. Fish ingestion leading to sharp bone induced penetrating esophageal injury can be safely managed by endoscopic removal and endoclip application. Disclosure All authors have declared no conflicts of interest.

Metabolic and Inflamatory Proteins Differently Expressed in Platelets From Deep Venous Thrombosis Patients

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 5256-5256
Author(s):  
Mariane Cristina Flores Nascimento ◽  
Karina Kleinfelder-Fontanesi ◽  
Fernanda Loureiro de Andrade Orsi ◽  
Steven H Seeholzer ◽  
Harry Ischiropoulos ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Conflicts Of Interest ◽  
Lower Limbs ◽  
Apolipoprotein A1 ◽  
Blood Samples ◽  
Orbitrap Mass Spectrometer ◽  
Inflammatory Processes ◽  
History Of

Abstract Abstract 5256 BACKGROUND: Deep venous thrombosis (DVT) is multi-causal disease associated to a high morbi-mortality due to complications as pulmonary embolism and post-flebitic syndrome. The incidence is about 20 to 30%, and 25% of the patients will present recurrence in 5 years. The identification of new risk factors is important in clinical practice to prevent new thrombotic events. The role of the platelets on DVT is still not well defined. AIM: The objective of this study was to analyze the hole proteins profile of platelets obtained from DVT patients and compare to the same matherial derived from healthy controls. PATIENTS: peripheral blood samples were collected from 3 spontaneous DVT patients and from 1 sibling and 1 neighbor for each patient in order to minimize the genetic and environmental interferences. These patients presented spontaneous and recurrent episodes of lower limbs proximal DVT and all of them mentioned a familiar history of coagulation disorders. METHODS: the platelets were washed, lysed, and the proteins were alkylated, reduced, precipitated with acetone and hydrolyzed by trypsin. 100mg of peptides were then separated by hydrophobicity using HPLC, and 8 fractions were obtained and directed to the LTQ-Orbitrap mass spectrometer. The proteins search was performed by Sorcerer-SEQUEST. RESULTS: We identified 5 proteins that were present on patients and absent in all the controls: Apolipoprotein A1 Binding-Protein, Coatomer (z1 sub-unit), Estradiol 11–17-b Dehydrogenase, Leucotriene A-4 Hydrolase and Sorbitol Dehydrogenase. Western-Blotting was performed with specific antibodies and validated the results. CONCLUSIONS: with this study it was possible to identify proteins up to date non-related to the physiopathology of DVT, that could be involved with metabolic and inflammatory processes. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Symptomatic Infundibulopelvic Dysgenesis in an Adolescent

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Daniel Pitts ◽  
David Chalmers ◽  
Brian Jumper
Keyword(s):  
Complete Resolution ◽  
Left Kidney ◽  
Rare Condition ◽  
Renal Calculi ◽  
Flank Pain ◽  
Pelvicalyceal System ◽  
Retrograde Pyelogram ◽  
History Of ◽  
The Right ◽  
Collecting System

Infundibulopelvic dysgenesis is a rare condition characterized by congenital malformation of the pelvicalyceal system. We present the case of an 18-year-old boy with chronic intermittent right flank pain and cystic dilation with parenchymal thinning on ultrasonography. The left kidney was normal. The patient denied dysuria, constipation, and history of UTIs or renal calculi. Cystoscopy with retrograde pyelogram showed marked stenosis of the right pelvicalyceal system and anatomy unfavorable to stenting. The patient’s symptoms were unresponsive to conservative management. Reconstruction of the right collecting system was unsuccessful and a simple nephrectomy was performed, which led to complete resolution of his symptoms.

scholarly journals P51 Is it injury or inflammation: teenage boy with back pain

Rheumatology ◽  
2019 ◽  
Vol 58 (Supplement_4) ◽  
Author(s):  
Samundeeswari Deepak ◽  
Tracey Dandy ◽  
Rachel Isles
Keyword(s):  
Back Pain ◽  
Ankylosing Spondylitis ◽  
Conflicts Of Interest ◽  
Lower Limbs ◽  
Creatinine Kinase ◽  
Foot Drop ◽  
Full Blood Count ◽  
Long Thoracic Nerve ◽  
History Of ◽  
The Right

Abstract Background A 14 year-old boy was referred by an orthopaedic colleague at the district hospital for evaluation of ankylosing spondylitis. The child was previously fit and well. His symptoms reported at the referral was back pain and also possibility of foot drop on the right ankle. His dad had ankylosing spondylitis and was on biologic treatment. Also, there was significant history of autoimmunity in other family members. Methods During the initial consultation, we revisited the history. The boy reported that main symptoms were recurrent popping sensation of his right side shoulder associated with pain and burning sensation on the shoulder which usually settles after an hour. He is sporty boy and plays regular rugby, football and used to throw discus. He denied any history of injury or illnesses preceding his symptoms. There was past history of fracture of right ankle on two occasions managed conservatively. There were no other systemic symptoms. On examination, the child was afebrile and systemically looked well. There was no lymphadenopathy, mouth ulcers or clubbing. His cardio respiratory examination was normal. Abdomen was soft with no organomegaly. He was noted to have winging of scapula on the right side and weakness of the abductor muscles on the right side shoulder. There was wasting of muscles around the right ankle. He was noticed to have bilateral cavovarus and high arched feet. There was scoliosis at the thoracic and lumbar level. His muscle tone, power and reflexes were all normal. Results With his clinical presentation of winging of scapula, long thoracic nerve palsy was considered and he was referred to local physiotherapy. MRI spine done at local hospital was reviewed in the MSK radiology meeting and this showed no evidence of ankylosing spondylitis and confirmed scoliosis. His blood tests showed normal full blood count, liver and kidney function, raised creatinine kinase of 358 and HLA B27 positive. The repeat creatinine kinase was normal (153).The nerve conduction study of both the upper and lower limbs were normal. He was also seen by the neurology team. Further discussion with sport medicine colleagues and advised to continue physiotherapy. On the review 3 months later, his symptoms were much improved. Conclusion The presentation of a teenage boy with back pain and family history of ankylosing spondylitis warrants further evaluation. Thorough history, examination and early referral to specialist centre is beneficial for appropriate management of complex situations like this. Conflicts of Interest The authors declare no conflicts of interest.

scholarly journals Successfully Treated Intra-Abdominal Abscess Caused by Fish Bone With Perforation of Ascending Colon: A Case Report

2015 ◽  
Vol 100 (3) ◽  
pp. 428-430 ◽  
Author(s):  
Mami Yamamoto ◽  
Kentaroh Yamamoto ◽  
Takamitsu Sasaki ◽  
Daisuke Fukumori ◽  
Fumio Yamamoto ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Foreign Body ◽  
Laboratory Data ◽  
Fish Bone ◽  
Abdominal Abscess ◽  
Ascending Colon ◽  
Hospital Visit ◽  
History Of ◽  
Upper Abdominal ◽  
The Right

Ingestion of a foreign body is not uncommon, but rarely results in perforation of the gastrointestinal tract. The most common sites of perforation are reportedly the narrowest parts of the bowel, and perforation of the right side of the colon is rare. We report herein the case of a 69-year-old man who presented with an 8-week history of right upper abdominal pain. Laboratory data revealed inflammation at the first hospital visit. Computed tomography revealed a hypodense lesion containing a hyperdense foreign body in the abdomen. Intra-abdominal abscess caused by foreign body perforation was diagnosed. After administering antibiotics for 2 weeks, surgery was performed. Symptoms had resulted from perforation of the ascending colon by a fish bone.

Spontaneous Cholecystocutaneous Fistula in a Dog

2012 ◽  
Vol 48 (1) ◽  
pp. 43-49 ◽  
Author(s):  
Shelly A. Marquardt ◽  
Mark C. Rochat ◽  
Jennifer L. Johnson-Neitman
Keyword(s):  
Chest Wall ◽  
Complete Resolution ◽  
Fistulous Tract ◽  
Gallbladder Disease ◽  
Fibrous Tissue ◽  
Exploratory Laparotomy ◽  
Thoracic Wall ◽  
Liver Lobe ◽  
History Of ◽  
The Right

The purpose of this case report was to describe the surgical correction of a cholecystocutaneous fistula in a dog. A 6 yr old vizsla presented with a 2 mo history of a chronic draining wound on the right ventral thorax. Diagnostics revealed numerous fistulous tracts opening at a single site on the right ventrolateral chest wall, extending caudodorsally through the chest wall and diaphragm to the region of the right medial liver lobe. Exploratory laparotomy revealed the apex of the gallbladder adhered to the diaphragm with a tract of fibrous tissue extending along the diaphragm laterally to the right thoracic wall. Cholecystectomy was performed. The fistulous tract was incised to expose the lumen of the fistula, and the fistula was omentalized. Twenty-eight months after surgery, the dog had had no recurrence of the fistulous tract. Exploratory laparotomy allowed excellent visualization of the intra-abdominal path of the fistula and facilitated the ease of resection of the source. Cholecystectomy resulted in rapid and complete resolution of the fistula without the need for excision of the fistula. Although rare, gallbladder disease should be a differential for chronic fistulous tracts.

scholarly journals 47. Claudication, Cerebral infarct and Cyclophosphamide

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Jeeu Teck Sze
Keyword(s):  
Adverse Events ◽  
Ischaemic Stroke ◽  
Conflicts Of Interest ◽  
Temporal Artery ◽  
Left Vertebral Artery ◽  
Intravenous Cyclophosphamide ◽  
Complete Occlusion ◽  
History Of ◽  
Intracranial Arteries ◽  
The Right

Abstract Introduction We present a severe and rare case of GCA involving the right middle cerebral artery (MCA) resulting in an ischaemic stroke.  Our patient presented in 2017, before tocilizumab was approved as a treatment option in refractory GCA. Intravenous cyclophosphamide was used as a glucocorticoid-sparing agent in this patient with good response. This case contributes to our current limited evidence base in the treatment and prognosis of intracranial GCA. Case description The patient was 75 years old when referred by his GP with a four-month history of left temporal headache, jaw claudication and weight loss in August 2017. He had type 2 diabetes and hypertension. He also had a stroke in 2015 and was subsequently found to have paroxysmal atrial fibrillation so was commenced on rivaroxaban.  His bloods showed ESR of 66 and CRP 18. ESR had been persistently raised for two months. Ophthalmology assessment revealed bilateral cataracts only. A clinical diagnosis of GCA was made and he was commenced on prednisolone 60mg daily.  A biopsy of his left temporal artery was performed six days later and the histology showed transmural inflammation with multinucleated giant cells. His headache and jaw claudication improved with prednisolone but he was still experiencing localised temporal artery tenderness.  In the last week of September 2017, he presented to the Emergency Department with a two-day history of incoordination and left arm weakness. MRI of his head showed small foci of infarcts in the right MCA territory. He had suffered an ischaemic stroke likely secondary to GCA despite being treated with high dose oral glucocorticoid. He was given three pulses of intravenous methylprednisolone followed by intravenous cyclophosphamide. Subsequent CT angiogram (CTA) confirmed the involvement of intracranial arteries – circumferential thickening of the right internal carotid artery with near complete occlusion of right cavernous and intracranial segments. There was also mural thickening involving the left vertebral artery.  He went on to have five more cycles of cyclophosphamide and responded well to treatment. Oral methotrexate 15mg weekly was added in two weeks after the last course of cyclophosphamide. During his last clinic visit, he was taking prednisolone 2mg daily and the plan was to taper the dose down to zero over eight weeks. Discussion Though uncommon, GCA can affect vertebrobasilar arteries causing strokes. The involvement of intracranial arteries, on the other hand, is thought to be extremely uncommon in GCA due to their increased wall thickness. There is only a limited number of intracranial GCA cases reported in the medical literature. A review of nearly 500 patients with a diagnosis of central nervous system vasculitis at the Mayo Clinic identified only two patients with convincing evidence of intracranial GCA. Our patient’s MRI and CTA were reviewed in the neuroradiology multidisciplinary meeting and the consensus was that there was a near complete occlusion of the right MCA due to a vasculitic process.  Importantly, his GCA went into remission and he has not had any relapses thus far (21 months since his initial presentation). He has also improved from the stroke point of view. We have been able to reduce his prednisolone dose to a minimal level. The use of oral or intravenous cyclophosphamide in the treatment of refractory GCA have been reported. It was found to be effective in inducing a sustained remission in a majority of patients in a series of 35 patients in Germany. However, significant adverse events were reported in one third of the patients. Our patient tolerated intravenous cyclophosphamide therapy well. He was given fluconazole and co-trimoxazole as prophylactics. He did not report any major infections or adverse events during the four-month period when he was on cyclophosphamide. Key learning points This case represents a severe variant of GCA. Our patient was only referred to secondary care after being unwell for several months. It illustrates the importance of promptly initiating investigations and treatment when GCA is suspected.  This case demonstrates the importance of following up with patients closely as well as working closely with the multispecialty team in managing patients with GCA.  Conflicts of interest The authors have declared no conflicts of interest.

Z-line degradation and phagocytosis of sarcomeric fragments in myonecrosis

1983 ◽  
Vol 41 ◽  
pp. 790-791
Author(s):  
Melinda L. Estes ◽  
Samuel M. Chou
Keyword(s):  
Vastus Lateralis ◽  
Inflammatory Myopathy ◽  
Muscle Disease ◽  
White Female ◽  
Inflammatory Cell Infiltrate ◽  
Limb Weakness ◽  
Muscle Diseases ◽  
History Of ◽  
The Right ◽  
Mononuclear Inflammatory Cell

Many muscle diseases show common pathological features although their etiology is different. In primary muscle diseases a characteristic finding is myofiber necrosis. The mechanism of myonecrosis is unknown. Polymyositis is a primary muscle disease characterized by acute and subacute degeneration as well as regeneration of muscle fibers coupled with an inflammatory infiltrate. We present a case of polymyositis with unusual ultrastructural features indicative of the basic pathogenetic process involved in myonecrosis.The patient is a 63-year-old white female with a one history of proximal limb weakness, weight loss and fatigue. Examination revealed mild proximal weakness and diminished deep tendon reflexes. Her creatine kinase was 1800 mU/ml (normal < 140 mU/ml) and electromyography was consistent with an inflammatory myopathy which was verified by light microscopy on biopsy muscle. Ultrastructural study of necrotizing myofiber, from the right vastus lateralis, showed: (1) degradation of the Z-lines with preservation of the adjacent Abands including M-lines and H-bands, (Fig. 1), (2) fracture of the sarcomeres at the I-bands with disappearance of the Z-lines, (Fig. 2), (3) fragmented sarcomeres without I-bands, engulfed by invading phagocytes, (Fig. 3, a & b ), and (4) mononuclear inflammatory cell infiltrate in the endomysium.

Popliteal artery thrombosis secondary to a tibial osteochondroma

VASA ◽  
2011 ◽  
Vol 40 (3) ◽  
pp. 251-255 ◽  
Author(s):  
Gruber-Szydlo ◽  
Poreba ◽  
Belowska-Bien ◽  
Derkacz ◽  
Badowski ◽  
...  
Keyword(s):  
Case Report ◽  
Magnetic Resonance Angiography ◽  
Popliteal Artery ◽  
Doppler Ultrasonography ◽  
Histopathological Examination ◽  
Previous History ◽  
Plain Radiography ◽  
Artery Thrombosis ◽  
History Of ◽  
The Right

Popliteal artery thrombosis may present as a complication of an osteochondroma located in the vicinity of the knee joint. This is a case report of a 26-year-old man with symptoms of the right lower extremity ischaemia without a previous history of vascular disease or trauma. Plain radiography, magnetic resonance angiography and Doppler ultrasonography documented the presence of an osteochondrous structure of the proximal tibial metaphysis, which displaced and compressed the popliteal artery, causing its occlusion due to intraluminal thrombosis..The patient was operated and histopathological examination confirmed the diagnosis of osteochondroma.

COMMONWEALTH Forum: The Politics of Science or the Science of Politics

Commonwealth ◽  
2017 ◽  
Vol 19 (1) ◽  
Author(s):  
John Arway
Keyword(s):  
Public Policy ◽  
Natural Resource ◽  
Factual Information ◽  
The Past ◽  
Difference Of Opinion ◽  
History Of ◽  
The Right ◽  
Scientific Facts ◽  
Environmental Agency ◽  
Laws And Regulations

The challenges of including factual information in public policy and political discussions are many. The difficulties of including scientific facts in these debates can often be frustrating for scientists, politicians and policymakers alike. At times it seems that discussions involve different languages or dialects such that it becomes a challenge to even understand one another’s position. Oftentimes difference of opinion leads to laws and regulations that are tilted to the left or the right. The collaborative balancing to insure public and natural resource interests are protected ends up being accomplished through extensive litigation in the courts. In this article, the author discusses the history of environmental balancing during the past three decades from the perspective of a field biologist who has used the strength of our policies, laws and regulations to fight for the protection of our Commonwealth’s aquatic resources. For the past 7 years, the author has taken over the reins of “the most powerful environmental agency in Pennsylvania” and charted a course using science to properly represent natural resource interests in public policy and political deliberations.

Sign in / Sign up

Export Citation Format

Share Document