scholarly journals Secondary bacterial peritonitis and pelvic abscess due to Clostridium difficile

2018 ◽  
pp. bcr-2018-225252
Author(s):  
Michelle Herberts ◽  
Bradley Hicks ◽  
Muhammad Rizwan Sohail ◽  
Anil Jagtiani
Keyword(s):  
Hepatic Cirrhosis ◽  
Fluid Collection ◽  
Abdominal Ultrasound ◽  
Pelvic Abscess ◽  
Ct Guided ◽  
Bacterial Peritonitis ◽  
Fluid Analysis ◽  
Abdominal Ct Scan ◽  
History Of

A 70-year-old man with a history of hepatic cirrhosis presented with abdominal discomfort and distention. Physical examination revealed abdominal distention, positive fluid wave and abdominal tenderness. Due to concerns for spontaneous bacterial peritonitis (SBP), paracentesis was performed. Fluid analysis revealed 5371 total nucleated cells with 48% neutrophils. Ceftriaxone was then initiated for the treatment of SBP. Bacterial cultures of the fluid, however, grew Clostridium difficile. Therefore, metronidazole was added. An abdominal ultrasound revealed a pelvic fluid collection that was suspicious for an abscess on an abdominal CT scan. The patient underwent CT-guided drain placement into the pelvic fluid collection. The fluid aspirate was consistent with an abscess. However, cultures were negative in the setting of ongoing antibiotic therapy. The patient was treated with a 10-day course of ceftriaxone and metronidazole and was discharged home with outpatient follow-up.

scholarly journals No histology for diminutive duodenal neuroendocrine tumors: Is it safe?

2019 ◽  
Vol 07 (02) ◽  
pp. E308-E309
Author(s):  
Thomas Walter
Keyword(s):  
Natural History ◽  
Ct Scan ◽  
Neuroendocrine Tumors ◽  
Surgical Procedures ◽  
Abdominal Ct ◽  
Abdominal Ct Scan ◽  
Interesting Approach ◽  
History Of ◽  
Duodenal Neuroendocrine Tumors

AbstractFor the management of diminutive duodenal neuroendocrine tumors (d-NETs), Harshit et al. have proposed – in the work accompanying this editorial – an interesting approach, the endoscopic banding without resection (BWR) technique. Given the risks associated with classic endoscopic resections and surgical procedures, and the likely favorable natural history of diminutive d-NETs, BWR may be an option for these selected patients with a very low risk of LN + and recurrence. However, a close follow-up (endoscopic, EUS and thoraco-abdominal CT scan) is then required to guarantee the safety of this policy.

scholarly journals Osteochondritis dissecans of the hip

2003 ◽  
Vol 44 (1) ◽  
pp. 67-71 ◽  
Author(s):  
B. Lindén ◽  
K. Jonsson ◽  
I. Redlund-Johnell
Keyword(s):  
Osteochondritis Dissecans ◽  
Fluid Collection ◽  
Symptomatic Treatment ◽  
Plain Radiography ◽  
Hip Disease ◽  
History Of ◽  
Hip Arthrography ◽  
Weighted Sequences ◽  
Hip Rotation

Purpose: To investigate the clinical and radiological characteristics of osteochondritis dissecans (OD) of the hip and the Outcome of this condition after treatment. Material and Methods: Twelve male and 3 female patients with OD were retrospectively studied. Six patients had a history of Legg-Calvé-Perthes disease (LCPD) and among them 2 also had had a trauma to the hip. A further 5 had had trauma and 1 a developmental dislocation of the hip (DDH). The remaining 3 patients had no history of previous hip disease or trauma. All patients were examined with plain radiography, 7 with MR, 3 with CT and 2 with hip arthrography. Results: All OD lesions were detected at plain radiography, and most of them were located near the fovea. At MR the lesions had low signal intensity at T1-weighted sequences, and 6/7 had edema or fluid collection in or adjacent to the lesion on T2-weighted sequences. The early treatment in 7 patients was surgery, 2 had had conservative treatment and 6 no treatment. At follow-up 12 years after radiological diagnosis, 5 patients had hip arthrosis, 4 of whom were treated with arthroplasty. All but 3 had reduced hip rotation and all but 2 (with arthroplasty) had load pain. Three of the patients with earlier surgery had not developed arthrosis. Conclusions: OD lesions are usually well seen with plain radiography. There is a great risk of developing early arthrosis and it seems that early surgery is connected with arthrosis development. Thus only symptomatic treatment is recommended.

scholarly journals Shigella sonneiBacteremia Presenting with Profound Hepatic Dysfunction

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Oluwaseun Shogbesan ◽  
Andrew Rettew ◽  
Bilal Shaikh ◽  
Abdullateef Abdulkareem ◽  
Anthony Donato
Keyword(s):  
Laboratory Data ◽  
Abdominal Ultrasound ◽  
The United States ◽  
Shigella Sonnei ◽  
Public Health Issue ◽  
Watery Stool ◽  
Normal Limits ◽  
Significant Public Health ◽  
History Of

Worldwide, Shigellosis is a significant public health issue, associated with nearly one million deaths annually. About half a million cases ofShigellainfection are reported annually in the United States.Shigellabacteremia is uncommon and generally seen in children and immunocompromised adults. We present a case of aShigella sonneibacteremia with marked hepatic derangement in a 27-year-old previously healthy homosexual male with history of Roux-en-Y gastric bypass, who presented to the emergency room with a 4-day history of loose watery stool, abdominal cramps, nausea and vomiting, and yellow skin of 2-day duration. He reports similar diarrhea illness in two close contacts in preceding days. On examination, he was fully oriented but dehydrated, icteric, and febrile. Laboratory data revealed WBC of 2200/μL, elevated AST and ALT (201 IU/L, 73 IU/L resp.), normal alkaline phosphatase, elevated total and direct bilirubin of 8.2 mg/dL and 4.4 mg/dL, albumin of 3.2 g/dL, INR of 2.9, prothrombin time of 31.7, and platelet of 96,000/μL. Workup for infectious, autoimmune and medication-induced hepatitis, Wilson’s disease, and hemochromatosis was negative. Abdominal ultrasound and computed tomography of the abdomen showed hepatic steatosis and right-sided colitis. Stool and blood cultures were positive forShigella sonnei. He was treated with ciprofloxacin with improvement in liver function. Follow-up blood test 4 months later was within normal limits.

scholarly journals A Young Woman with Ischemic Stroke: Should We Pay More Attention to Varicella Zoster Infection

2016 ◽  
Vol 8 (2) ◽  
pp. 145-150 ◽  
Author(s):  
Cláudia Borbinha ◽  
João Pedro Marto ◽  
Sofia Calado ◽  
Miguel Viana-Baptista
Keyword(s):  
Ischemic Stroke ◽  
Hemorrhagic Transformation ◽  
Vascular Events ◽  
Varicella Zoster ◽  
Fluid Analysis ◽  
History Of ◽  
The Right ◽  
High Index Of Suspicion ◽  
Varicella Zoster Infection

Ischemic and hemorrhagic stroke are recognized complications of Varicella zoster virus (VZV) infections, although uncommon and poorly documented. The authors report the case of a 31-year-old woman admitted with acute ischemic stroke of the right posterior cerebral artery and a history of a thoracic rash 1 month before. Aspirin and simvastatin were prescribed, but the patient suffered a stepwise deterioration the following days, with new areas of infarction on brain imaging. Despite no evidence of cardiac or large vessel embolic sources, anticoagulation was started empirically 6 days after stroke onset. One week later, symptomatic hemorrhagic transformation occurred. The diagnosis of VZV vasculopathy was then considered, and treatment with acyclovir and prednisolone was started with no further vascular events. Cerebrospinal fluid analysis and digital subtraction angiography findings corroborated the diagnosis. The patient was discharged to the rehabilitation center with a modified Rankin scale (mRS) score of 4. On the 6-month follow-up, she presented only a slight disability (mRS score 2). In conclusion, VZV vasculopathy needs to be considered in young adults with stroke. A high index of suspicion and early treatment seem to be important to minimize morbidity and mortality. Anticoagulation should probably be avoided in stroke associated with VZV vasculopathy.

Incidence of cholelithiasis after laparoscopic sleeve gastrectomy

2020 ◽  
Vol 2 (2) ◽  
pp. 63-69
Author(s):  
Iea Alabbasi ◽  
Issam Merdan ◽  
Falih Al-Gazgooz
Keyword(s):  
Sleeve Gastrectomy ◽  
Laparoscopic Sleeve Gastrectomy ◽  
Weight Reduction ◽  
Gallstone Formation ◽  
Abdominal Ultrasound ◽  
Gallbladder Polyps ◽  
Concomitant Cholecystectomy ◽  
History Of ◽  
Age Range

Background: Laparoscopic sleeve gastrectomy is a well-known method for weight reduction. Post-operative weight loss is a major risk factor for gallstone formation. Objective: To determine whether prophylactic concomitant laparoscopic cholecystectomy should be performed on all patients at the time of laparoscopic sleeve gastrostomy or not. Patients and Methods: A retrospective and prospective study on 540 patients with morbid obesity who underwent laparoscopic sleeve gastrectomy; their BMI range was between 38 and 53, their age range was 18 to 63 years, and 335 of them were females. The exclusion criteria were patients with a history of cholecystectomy, gallstone patients or gallbladder polyps more than 1 cm in preoperative abdominal ultrasound, and those who failed to follow-up. All patients were followed up with every 6–12 months, including those who had cholecystectomy by other surgeons. Results: During the study period, from the total 540 patients who had laparoscopic sleeve gastrectomy, 167 patients (30.92%) had cholecystectomy, out of which 20 patients (3.7%) had achieved 45% weight reduction during the first six months; while in another 6 months, 147 patients (27.22%) had cholecystectomy, achieving additional 30% weight reduction. Conclusions: The incidence of gallstones after laparoscopic sleeve gastrostomy is about 30.92%, indicating that 69.08% will not have gallstones in the postoperative follow-up period, so it would be unwise to do prophylactic concomitant cholecystectomy for all patients. Keywords: Bariatric procedures, cholecystectomy, incidence

scholarly journals Liver Segmentectomy by Intrahepatic Lithiasis

2021 ◽  
pp. 305-311
Author(s):  
Fadi Rayya ◽  
Ehab Alhasan
Keyword(s):  
Hepatic Duct ◽  
Preoperative Evaluation ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Abdominal Ultrasound ◽  
Biliary Pancreatitis ◽  
Liver Segment ◽  
Intrahepatic Lithiasis ◽  
History Of ◽  
Normal Gallbladder

Intrahepatic cholelithiasis, which is defined as stones proximal to the confluence of the hepatic ducts, is considered endemic in Southeast Asia. Its pathogenesis is not completely understood yet. A 19-year-old female was admitted to the hospital with a history of recurrent biliary pancreatitis. Abdominal ultrasound detected normal gallbladder while magnetic resonance cholangiopancreatography revealed lithiasis at the hepatic duct of liver segment V. After preoperative evaluation a typical segmentectomy was done. The postoperative period was uneventful and the patient was well at 6-month follow-up.

Delayed forebrain syndrome due to presumptive traumatic intranasal meningoencephalocele in a cat

2019 ◽  
Vol 7 (3) ◽  
pp. e000910
Author(s):  
Theophanes Liatis ◽  
Alberta De Stefani ◽  
Panagiotis Mantis ◽  
Giunio Bruto Cherubini
Keyword(s):  
Epileptic Seizures ◽  
Final Diagnosis ◽  
Neurological Signs ◽  
Fluid Analysis ◽  
Cerebral Mri ◽  
Long Term Follow Up ◽  
Postural Reaction ◽  
History Of ◽  
The Right

A 3-year-old male neutered domestic shorthair cat was referred with 1-month history of three generalised tonic-clonic epileptic seizures and left-sided thoracic limb knuckling. Nine months previously, the cat was bitten on the right upper palpebral region without manifesting neurological signs. On admission, physical and neurological examination revealed left-sided postural reaction deficits and absent menace response. Thus, a right-forebrain neurolocalisation was reached. Haematology, biochemistry, bile acid stimulation test, infectious diseases serology and cerebrospinal fluid analysis were unremarkable. Cerebral MRI revealed extension of brain and meninges into the right frontal sinus. Final diagnosis of a right-sided traumatic frontoethmoidal meningoencephalocele was made. The cat remained seizure free under phenobarbital treatment with residual left-sided postural reaction deficits at 9 months follow-up. This is the first report of presumptive traumatic meningoencephalocele in a cat, which emphasises the importance of complete neurological investigation and regular long-term follow-up checks in patients with historical head trauma despite the absence of initial neurological signs.

scholarly journals Pyogenic renal abscess mimicking as Malignancy

2013 ◽  
Vol 12 (3) ◽  
pp. 339-340
Author(s):  
Mayank Baid ◽  
Manoranjan Kar ◽  
Utpal De ◽  
Sayak Roy ◽  
Someshubhra Datta Roy
Keyword(s):  
Fluid Collection ◽  
Medical Science ◽  
Needle Aspiration ◽  
Ct Guided ◽  
Single Episode ◽  
Loss Of Weight ◽  
Male Farmer ◽  
Enhanced Ct ◽  
Culture Sensitivity ◽  
History Of

A 64 years male farmer presented with history of painless gross hematuria for 1 month and severe loss of weight and appetite for 2 months. There was a history of single episode of fever for 1 day without chills and rigors, about 1 month ago. There was no history of tuberculosis. On examination patient had severe pallor, no raised temperature and no tenderness at renal angle. His hemoglobin on admission was 5.7gm%. Enhanced CT scan showed right kidney having irregular low density lesion at the lower pole with perirenal fluid collection. Urine for culture sensitivity showed growth of Escherichia coli sensitive to norfloxacin and so patient was put on oral norfloxacin for 14 days. A CT guided fine needle aspiration biopsy was planned for the patient for a definite diagnosis. But a repeat ultasonography before the procedure, showed both kidneys to be normal. The lesion had vanished!Bangladesh Journal of Medical Science Vol. 12 No. 03 July ’13 Page 339-340 DOI: http://dx.doi.org/10.3329/bjms.v12i3.11793

scholarly journals Rare, post-periodontitis spondylodiscitis caused by Fusobacterium nucleatum in a patient with multiple sclerosis: challenge of diagnosis and treatment

2021 ◽  
Vol 14 (3) ◽  
pp. e239664
Author(s):  
Dritan Pasku ◽  
Siddharth Shah ◽  
Ahmed Aly ◽  
Nasir A Quraishi
Keyword(s):  
Multiple Sclerosis ◽  
Fusobacterium Nucleatum ◽  
Mri Scan ◽  
Surgical Biopsy ◽  
Ct Guided ◽  
Commensal Flora ◽  
Immunsuppressive Therapy ◽  
Ct Guided Biopsy ◽  
History Of

Fusobacterium nucleatum is part of the commensal flora of the oral cavity, frequently associated with periodontal infections. We describe the case of a 49-year-old woman, on immunsuppressive therapy for multiple sclerosis, who presented with a 3-month history of debilitating back pain. She had a recent episode of periodontitis, and was under regular dental review. Her MRI scan demonstrated findings suggestive of L2–L3 spondylodiscitis. Her CT-guided biopsy yielded negative cultures and the patient failed two courses of empirical antibiotic treatment. With clinical and radiological disease progression, she underwent a percutaneous disc washout and biopsy, which subsequently grew F. nucleatum. Treatment with clindamycin and metronidazole was commenced orally for 6 weeks. She improved gradually, and at 1 year follow-up was asymptomatic. The diagnosis of spondylodiscitis caused by F. nucleatum is challenging. The perseverance on identification by surgical biopsy, minimally invasive washout and targeted antibiotics are the mainstay of effective treatment.

Computed tomographic and sonographic findings in a dog with duplex kidney, ureter duplex and ectopic ureterocele

2020 ◽  
Vol 48 (01) ◽  
pp. 44-48
Author(s):  
Katharina I. Kopp ◽  
Sebastian Schaub ◽  
Christine Peppler ◽  
Alexander Acker ◽  
Kerstin von Pueckler
Keyword(s):  
Abdominal Ultrasound ◽  
Duplex Kidney ◽  
Ectopic Ureterocele ◽  
Computed Tomographic ◽  
Contrast Enhanced ◽  
History Of ◽  
Enhanced Computed Tomography ◽  
French Bulldog ◽  
Contrast Enhanced Computed Tomography

AbstractA 5-month-old, male French bulldog was presented with a history of urinary incontinence. Abdominal ultrasound showed changes compatible with a ureterocele and a bilobed right kidney. Excretory computed tomographic urography was consistent with right-sided duplex kidney, ureter duplex and ectopic ureterocele. To the authors’ knowledge, this is the first description of a duplex kidney with an ectopic ureterocele diagnosed with ultrasound and contrast enhanced computed tomography in a dog. After the imaging diagnosis, a neoureterocystostomy was performed. In the follow-up examination the dog presented with mild incontinence which was treated medically using phenylpropanolamine.

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