scholarly journals Delayed chylothorax in the absence of radiological evidence of rib or vertebral body fractures following blunt trauma

2021 ◽  
Vol 2021 (4) ◽  
Author(s):  
Khurum Mazhar ◽  
Saifullah Mohamed ◽  
Akshay Jatin Patel ◽  
Sarah Berger-Veith ◽  
Qamar Abid ◽  
...  
Keyword(s):  
Blunt Trauma ◽  
Medium Chain Triglyceride ◽  
Chest Discomfort ◽  
Invasive Procedures ◽  
Chest Drainage ◽  
Effective Implementation ◽  
Vertebral Body Fractures ◽  
Traumatic Chylothorax ◽  
History Of ◽  
Medium Chain Triglyceride Diet

Abstract Our case report illustrates effective implementation of conservative measures without the need for more invasive procedures, which can be required in refractory cases. Our patient was a 42-year-old female who fell from a horse and presented with a 1-week history of dyspnoea. Investigations revealed her to have a large right chylothorax, which was treated conservatively with chest drainage and octreotide. The patient remained in hospital for a total of 3 days prior to being discharged home without further complications. Blunt traumatic chylothorax should be considered as part of the differential diagnosis in patients who present with ongoing dyspnoea or chest discomfort within a 2-week preceding history of blunt trauma. Radiological imaging should be mandatory and the absence of posterior thoracic fractures does not exclude the diagnosis. Conservative management with pleural drainage, medium-chain triglyceride diet and octreotide yielded excellent results in our case.

Refractory primary intestinal lymphangiectasia effectively managed with subcutaneous octreotide

2021 ◽  
Vol 14 (4) ◽  
pp. e238457
Author(s):  
Amir Halim ◽  
Philippa Youd ◽  
Jill Thorpe ◽  
Irfan Halim
Keyword(s):  
Case Report ◽  
Gastrointestinal Symptoms ◽  
Medium Chain Triglyceride ◽  
Well Being ◽  
Intestinal Lymphangiectasia ◽  
Curative Therapy ◽  
Medium Chain ◽  
History Of ◽  
Medium Chain Triglyceride Diet ◽  
Conventional Medium

This case report describes a young man with a history of lymphoedema and long-standing gastrointestinal symptoms since childhood. After undergoing extensive investigations, he was diagnosed with primary intestinal lymphangiectasia (IL). The patient’s condition was refractory to conventional medium-chain triglyceride diet but responded well to treatment with subcutaneous octreotide. We have shown octreotide to be effective in improving the pathological effects of primary IL, associated with improved clinical well-being and serology, but it is not a curative therapy.

scholarly journals A141 SPONTANEOUS ESOPHAGEAL PERFORATION: AN UNREPORTED COMPLICATION OF LYMPHOCYTIC ESOPHAGITIS

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 128-129
Author(s):  
A LAGROTTERIA ◽  
A W Collins ◽  
A Someili ◽  
N Narula
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Case Report ◽  
Proton Pump Inhibitor ◽  
Proton Pump ◽  
Esophageal Perforation ◽  
Distal Esophagus ◽  
Chest Discomfort ◽  
History Of ◽  
Lymphocytic Esophagitis

Abstract Background Lymphocytic esophagitis is a new and rare clinicopathological entity. It is a histological pattern characterized by lymphocytic infiltrate without granulocytes. Its etiology and clinical significance remains unclear. The clinical manifestations are typically mild, with reflux and dysphagia the most commonly reported symptoms. Aims We describe a case report of spontaneous esophageal perforation associated with lymphocytic esophagitis. Methods Case report Results A previously well 31-year-old male presented to the emergency department with acute food impaction. His antecedent symptoms were acute chest discomfort and continuous odynophagia following his most recent meal, with persistent globus sensation. The patient had no reported history of allergies, atopy, rhinitis, or asthma. A previous history of non-progressive dysphagia was noted after resuscitation. Emergent endoscopy revealed no food bolus, but a deep 6 cm mucosal tear in the upper-mid esophagus extending 24 to 30 cm from the incisors. Chest computed tomography observed small volume pneumoperitoneum consistent with esophageal perforation. The patient’s recovery was uneventful; he was managed conservatively with broad-spectrum antibiotics, proton pump inhibitor therapy, and a soft-textured diet. Endoscopy was repeated 48 hours later and revealed considerable healing with only a residual 3-4cm linear laceration. Histology of biopsies taken from the mid and distal esophagus demonstrated marked infiltration of intraepithelial lymphocytes. There were no eosinophils or neutrophils identified, consistent with a diagnosis of lymphocytic esophagitis. Autoimmune indices including anti-nuclear antibodies and immunoglobulins were normal, ruling out a contributory autoimmune or connective tissue process. The patient was maintained on a proton pump inhibitor (pantoprazole 40 mg once daily) following discharge. Nearly six months following his presentation, the patient had a recurrence of symptoms prompting representation to the emergency department. He described acute onset chest discomfort while eating turkey. Computed tomography of the chest redemonstrated circumferential intramural gas in the distal esophagus and proximal stomach. Conclusions Esophageal perforation is a potentially life-threatening manifestation of what had been considered and described as a relatively benign condition. From isolated dysphagia to transmural perforation, this case significantly expands our current understanding of the clinical spectrum of lymphocytic esophagitis. Funding Agencies None

Rickets and a medium chain triglyceride diet

1973 ◽  
Vol 8 (3) ◽  
pp. 439-440 ◽  
Author(s):  
James P. Keating ◽  
Donald B. Strominger ◽  
John Poulos
Keyword(s):  
Medium Chain Triglyceride ◽  
Medium Chain ◽  
Medium Chain Triglyceride Diet

A lesson in history: the evolution of endoscopic third ventriculostomy

2012 ◽  
Vol 33 (2) ◽  
pp. E11 ◽  
Author(s):  
Paul J. Schmitt ◽  
John A. Jane
Keyword(s):  
Patient Selection ◽  
Endoscopic Third Ventriculostomy ◽  
Lessons Learned ◽  
New Technique ◽  
Third Ventriculostomy ◽  
Evidence Based ◽  
Success Rates ◽  
Effective Implementation ◽  
Remarkable Improvement ◽  
History Of

The history of endoscopic third ventriculostomy (ETV) demonstrates the importance of studying neurosurgery's history. A story that began with numerous technological advancements started to fizzle as neurosurgeons were stymied by problems encountered during the infancy of the technology they were still developing. The new technique, although sound in theory, failed to deliver a realistic solution for managing hydrocephalus; it lost the battle to the valved shunt. Over the last 15–20 years, a clearer understanding of pathophysiological mechanisms underlying various forms of hydrocephalus, along with effective implementation of evidence-based practice, has allowed for optimization of patient selection and a remarkable improvement in ETV success rates. Neurosurgeons would be wise to take the lessons learned in modernizing the ETV procedure and reassure themselves that these lessons do not apply to other methods that are tempting to dismiss as antiquated or archaic.

Invasive pulmonary aspergillosis/pseudomonas

2021 ◽  
Vol 14 (7) ◽  
pp. e236887
Author(s):  
Menaka Mahendran ◽  
Daniel Urbine
Keyword(s):  
Antifungal Therapy ◽  
High Mortality ◽  
Surgical Intervention ◽  
Main Pulmonary Artery ◽  
Invasive Pulmonary Aspergillosis ◽  
Chest Discomfort ◽  
Pulmonary Aspergillosis ◽  
Extensive Disease ◽  
Massive Haemoptysis ◽  
History Of

A 47-year-old Caucasian man on long-standing antifungal therapy for chronic necrotising aspergillosis and a history of recurrent pseudomonas pneumonias presented to the outpatient pulmonary clinic with dyspnoea and chest discomfort for 3 days. A CT angiography of the chest demonstrated angioinvasion from the previously noted left upper lobe cavitary lesion into the left main pulmonary artery, along with new consolidating lesions. Due to the high risk for massive haemoptysis, he was evaluated by thoracic surgery and underwent a successful left pneumonectomy. As invasive pulmonary aspergillosis is associated with high mortality, surgical intervention should always be considered, especially in those who develop extensive disease, despite being on aggressive antifungal therapy. Though minimally described in literature, invasive pulmonary pseudomonas also carries a high mortality risk. In our patient, cultures from the resected lung only demonstrated Pseudomonas aeruginosa.

scholarly journals A toe that pointed the wrong way: An unusual presentation of tetanus

2016 ◽  
Vol 7 (01) ◽  
pp. 150-152
Author(s):  
Krishnarpan Chatterjee ◽  
Anirban Ghosh ◽  
Rimi Som Sengupta
Keyword(s):  
Blunt Trauma ◽  
Clinical Features ◽  
Antimicrobial Therapy ◽  
Passive Immunization ◽  
Complete Recovery ◽  
Unusual Presentation ◽  
History Of

ABSTRACTWe report the case of a 15-year-old girl who was initially diagnosed to have a striatal toe. Her condition progressed and she later developed clinical features consistent with tetanus. History of blunt trauma to nose was elicited retrospectively. Antimicrobial therapy with metronidazole and both active and passive immunization was started immediately. The patient went on to make a complete recovery.

scholarly journals Anterior Mediastinal Mass Causing Intermittent Atrial Fibrillation

2021 ◽  
Author(s):  
Adam M Spanier ◽  
Garrett R Evans ◽  
Hugh M Hiller
Keyword(s):  
Atrial Fibrillation ◽  
Emergency Department ◽  
Mediastinal Mass ◽  
Mass Effect ◽  
Metabolic Effects ◽  
Anterior Mediastinal Mass ◽  
Chest Discomfort ◽  
Rare Finding ◽  
Ventricular Response ◽  
History Of

ABSTRACT Mediastinal masses are a rare finding in the emergency department and typically present with vague chest complaints such as chest discomfort, chest pain, or dyspnea. Rarely do these tumors present with dysrhythmias, and when dysrhythmias are present, they typically arise secondary to endocrine or metabolic effects exerted by the tumor. Here we report a case of a patient who presented to the emergency department with atrial fibrillation with rapid ventricular response, concomitant with a history of recurrent palpitations that were previously aborted with self-induced vagal maneuvers. Upon further investigation, the patient had an anterior mediastinal mass, diagnosed as a thymoma, suspected to be contributing to his presenting dysrhythmia through mass effect.

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