Case 31

2020 ◽  
pp. 211-217
Author(s):  
Andrew Woodhouse
Keyword(s):  
Unknown Origin ◽  
Modern Medicine ◽  
Initial Evaluation ◽  
Substantial Proportion ◽  
Diagnostic Challenge ◽  
Specific Patient ◽  
Pyrexia Of Unknown Origin ◽  
Patient Groups ◽  
Definition Of ◽  
Targeted Approach

Fever for which there is no obvious cause after initial evaluation and which persists remains a diagnostic challenge even for modern medicine with its plethora of investigative tools. The classical definition of pyrexia of unknown origin (PUO) is still useful but more recent modifications take into account specific patient groups and the changes in the way in which patients are evaluated, with less emphasis on in-patient investigation. While infection remains an important underlying cause of PUO, a substantial proportion of patients have other conditions, particularly malignancy and inflammatory and autoimmune diseases. Approaching a patient with PUO in a systematic way and gathering information from history, examination, and initial investigations allow a targeted approach to investigations which will reveal a diagnosis in a majority of patients.

scholarly journals Pyrexia of Unknown Origin: An Atypical Presentation of Hepatic Hemangioma

2020 ◽  
Vol 06 (04) ◽  
pp. e180-e184
Author(s):  
Gunjan Desai ◽  
Dattaraj Budkule ◽  
Prasad Pande ◽  
Prasad Wagle
Keyword(s):  
Unknown Origin ◽  
Uneventful Recovery ◽  
Hepatic Hemangioma ◽  
Diagnostic Challenge ◽  
Abdominal Ultrasonography ◽  
Algorithmic Approach ◽  
Pyrexia Of Unknown Origin ◽  
Right Lobe ◽  
Sudden Decrease ◽  
Vague Abdominal Pain

AbstractPyrexia of unknown origin (PUO) has been a diagnostic challenge for decades. Hepatic hemangioma (HH) is not a common differential diagnosis of PUO. It is the most common benign hepatic tumor, commonly asymptomatic and incidentally detected, or can present with vague abdominal pain. PUO is a rare presenting feature. We describe a case of 38-year-old lady presenting with PUO. With no other identifiable source of fever despite exhaustive investigations, a giant hemangioma in right lobe of liver detected on abdominal ultrasonography was deemed to be the cause of PUO. The patient had sudden decrease in hemoglobin while undergoing workup, which on imaging showed a bleeding hemangioma and right hepatectomy was performed. Patient had an uneventful recovery and her PUO also resolved after surgery. HH should be considered a rare diagnosis of exclusion for PUO after a standard algorithmic approach does not reveal any other cause.

scholarly journals Non-medical risk factors associated with postponing elective surgery: a prospective observational study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Julia Becker ◽  
Gerald Huschak ◽  
Hannes-Caspar Petzold ◽  
Volker Thieme ◽  
Sebastian Stehr ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Low Socioeconomic Status ◽  
Elective Surgery ◽  
Nursing Home Residents ◽  
Hospital Staff ◽  
Data Management System ◽  
Electronic Patient Records ◽  
Specific Patient ◽  
Emergency Procedures ◽  
Patient Groups

Abstract Background Operation room (OR) planning is a complex process, especially in large hospitals with high rates of unplanned emergency procedures. Postponing elective surgery in order to provide capacity for emergency operations is inevitable at times. Elderly patients, residents of nursing homes, women, patients with low socioeconomic status and ethnic minorities are at risk for undertreatment in other contexts, as suggested by reports in the medical literature. We hypothesized that specific patient groups could be at higher risk for having their elective surgery rescheduled for non-medical reasons. Methods In this single center, prospective observational trial, we analysed 2519 patients undergoing elective surgery from October 2018 to May 2019. A 14-item questionnaire was handed out to illicit patient details. Additional characteristics were collected using electronic patient records. Information on the timely performance of the scheduled surgery was obtained using the OR’s patient data management system. 6.45% of all planned procedures analysed were postponed. Association of specific variables with postponement rates were analysed using the Mann–Whitney U test and Fisher's exact test/χ2-test. Results Significantly higher rates of postponing elective surgery were found in elderly patients. No significant differences in postponing rates were found for the variables gender, nationality (Germany, EU, non-EU), native language, professional medical background and level of education. Significantly lower rescheduling rates were found in patients with ties to hospital staff and in patients with a private health insurer. Conclusions Elderly patients, retirees and nursing home residents seem to be at higher risk for having their elective surgery rescheduled. However, owing to the study design, causality could not be proven. Our findings raise concern about possible undertreatment of these patient groups and provide data on short-term postponement of elective surgery. Trial registration DRKS00015836. Retrospectively registered.

scholarly journals Predictive Factors in Sacral Neuromodulation: A Systematic Review

2021 ◽  
pp. 1-21
Author(s):  
Ranjana Jairam ◽  
Jamie Drossaerts ◽  
Tom Marcelissen ◽  
Gommert van Koeveringe ◽  
Desiree Vrijens ◽  
...  
Keyword(s):  
Systematic Review ◽  
Predictive Factors ◽  
Sacral Neuromodulation ◽  
Level Of Evidence ◽  
Specific Patient ◽  
Detrusor Contractility ◽  
Affective Symptoms ◽  
Lower Success Rate ◽  
Patient Groups ◽  
Based Medicine

<b><i>Introduction:</i></b> Sacral neuromodulation (SNM) is an effective treatment in patients with overactive bladder syndrome or nonobstructive urinary retention when conservative treatment fails. Several factors that could impact outcome with SNM have been studied. This systematic review investigated these predictive factors and their relevance for clinical practice. <b><i>Methods:</i></b> Systematic review according to the PRISMA guidelines was conducted. This review is registered in the PROSPERO register (CRD42015016256). <b><i>Results:</i></b> Seventy-eight studies (of which 11 abstracts) were included. Females, younger patients, and a tined lead procedure tend to be predictive in successful SNM outcome. Factors that did not influence SNM outcome were prior back surgery, surgery for stress urinary incontinence, affective symptoms, and duration of complaints. Reduced detrusor contractility is associated with a lower success rate. The level of evidence of most studies (graded according to the Centre for Evidence-Based Medicine) was 3b. <b><i>Conclusion:</i></b> Even though this systematic review investigated predictive factors (gender, age, type of procedure, type of lead, and detrusor contractility), no general consensus on predictive factors could be made. Most studies are small, retrospective, and involve a heterogeneous population. Therefore, prospective research in larger specific patient groups remains necessary to find predictors of SNM outcome.

scholarly journals High diagnostic yield of splenic core biopsy in patients with pyrexia of unknown origin

2021 ◽  
Author(s):  
Yee Ting Nicole Yim ◽  
Gabriel Wallis ◽  
Jawad Saeed ◽  
Stefan Voo ◽  
Irfan Kayani ◽  
...  
Keyword(s):  
Core Biopsy ◽  
Diagnostic Yield ◽  
Unknown Origin ◽  
Pyrexia Of Unknown Origin ◽  
High Diagnostic Yield

scholarly journals Leptospirosis presenting as severe cardiogenic shock: A case report

2018 ◽  
Vol 19 (4) ◽  
pp. 351-353
Author(s):  
E Forbat ◽  
MJ Rouhani ◽  
C Pavitt ◽  
S Patel ◽  
R Handslip ◽  
...  
Keyword(s):  
Case Report ◽  
Cardiogenic Shock ◽  
Social History ◽  
Rare Case ◽  
Clinical Course ◽  
Unknown Origin ◽  
Case Presentation ◽  
Pyrexia Of Unknown Origin ◽  
Severe Cardiogenic Shock ◽  
Infectious Illness

Background Leptospirosis is a rare infectious illness caused by the Spirochaete Leptospira. It has a wide-varying spectrum of presentation. We present a rare case of severe cardiogenic shock secondary to leptospirosis, in the absence of its common clinical features. Case presentation A 36-year-old woman presented to our unit with severe cardiogenic shock and subsequent multi-organ failure. Her clinical course was characterised by ongoing pyrexia of unknown origin with concurrent cardiac failure. She was initially managed with broad-spectrum antibiotics and inotropes. Percutaneous cardiac biopsy excluded major causes of myocarditis. On day 21 after presentation, she was found to be IgM-positive for leptospirosis. Conclusions This is a rare case of severe cardiogenic shock secondary to leptospirosis infection. The case also highlights the importance of obtaining a thorough social history when assessing a patient with an unusual presentation, as clues can often be missed.

scholarly journals Gallium-67 scanning in pyrexia of unknown origin.

BMJ ◽  
1979 ◽  
Vol 2 (6201) ◽  
pp. 1330-1331 ◽  
Author(s):  
A J Hilson ◽  
M N Maisey
Keyword(s):  
Unknown Origin ◽  
Pyrexia Of Unknown Origin ◽  
Gallium 67

Pyrexia of Unknown Origin

2002 ◽  
pp. 263-264
Author(s):  
Catherine Wykes ◽  
Kate Grady
Keyword(s):  
Unknown Origin ◽  
Pyrexia Of Unknown Origin
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