scholarly journals Resolution of group B streptococcal panspinal epidural abscess in a patient with diabetes after treatment with ceftriaxone and linezolid

2019 ◽  
Vol 12 (11) ◽  
pp. e232243
Author(s):  
David Wen ◽  
James Norman ◽  
Pooja Dassan ◽  
Gurjinder Sandhu
Keyword(s):  
Abdominal Pain ◽  
Back Pain ◽  
Urinary Retention ◽  
Conservative Management ◽  
Complete Resolution ◽  
Epidural Abscess ◽  
Radicular Pain ◽  
Group B ◽  
The Right ◽  
New Onset

Panspinal epidural abscesses are an extremely rare yet potentially fatal condition. Whether cases are best managed surgically or medically is currently controversial. A 63-year-old patient with diabetes presented initially with abdominal pain, back pain, urinary retention and constipation. He subsequently developed fevers, radicular pain and new-onset weakness in the right leg. MRI confirmed a panspinal epidural abscess extending from C7 to L5, with group B Streptococcus (GBS) cultured on sampling. Due to the significant risks of surgery he was managed conservatively, initially with ceftriaxone, and subsequently in combination with linezolid. Repeat MRI 3 months after presentation revealed complete resolution of the abscess. This case illustrates how conservative management is a valid option for patients with this condition, and supports the use of synergistic linezolid in this scenario. It also highlights how some cases may not initially present with the classically described triad of fever, back pain and loss of neurological function.

scholarly journals Concurrent Pulmonary, Intracranial, Intramedullary Tuberculoma, and Their Response to Conservative Management

2018 ◽  
Vol 4 (02) ◽  
pp. 088-090
Author(s):  
Sohael Khan ◽  
Suvarn Gupta ◽  
Shashank Jain ◽  
Shraddha Singhania
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Back Pain ◽  
Conservative Treatment ◽  
Pulmonary Tuberculosis ◽  
Conservative Management ◽  
Complete Resolution ◽  
Lower Extremities ◽  
The Central Nervous System ◽  
The Brain

AbstractTuberculomas of the central nervous system are common. However, the incidence of intraspinal intramedullary tuberculomas is very low, and a combination of intramedullary, intracranial, and pulmonary tuberculomas is extremely rare. We report a case of tuberculoma involving the brain and spine with pulmonary tuberculosis in a 46-year-old man initially presenting with back pain and weakness of both lower extremities. Conservative treatment with antituberculous medications resulted in complete resolution of his symptoms.

scholarly journals Acute Abdominal Pain Secondary to Chilaiditi Syndrome

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
David Kang ◽  
Andrew S. Pan ◽  
Michael A. Lopez ◽  
Jessica L. Buicko ◽  
Miguel Lopez-Viego
Keyword(s):  
Abdominal Pain ◽  
Bowel Obstruction ◽  
Conservative Management ◽  
Acute Abdominal Pain ◽  
Rare Condition ◽  
Symptomatic Treatment ◽  
Conservative Surgery ◽  
Chilaiditi Syndrome ◽  
Clinically Significant ◽  
The Right

Chilaiditi syndrome is a rare condition occurring in 0.025% to 0.28% of the population. In these patients, the colon is displaced and caught between the liver and the right hemidiaphragm. Patients' symptoms can range from asymptomatic to acute intermittent bowel obstruction. Diagnosis is best achieved with CT imaging. Identification of Chilaiditi syndrome is clinically significant as it can lead to many significant complications such as volvulus, perforation, and bowel obstruction. If the patient is symptomatic, treatment is usually conservative. Surgery is rarely indicated with indications including ischemia and failure of resolution with conservative management.

scholarly journals Role of Cholecystectomy in Symptomatic Hyperkinetic Gallbladder Patients

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
Jai P. Singh
Keyword(s):  
Abdominal Pain ◽  
Complete Resolution ◽  
Biliary Colic ◽  
Quadrant Pain ◽  
Gallbladder Ejection Fraction ◽  
Hida Scan ◽  
Upper Abdominal ◽  
The Right ◽  
Upper Abdomen

Introduction. Biliary dyskinesia is defined by a gallbladder ejection fraction (EF) of less than 35% on HIDA scan, and these patients have shown a good response to cholecystectomy. Management of patients with biliary colic symptoms who have a hyperkinetic gallbladder ( EF > 80 % ) is not clearly defined. Herein, I report three cases of the symptomatic hyperkinetic gallbladder that were successfully managed with cholecystectomy. Case Report. Patient 1was a 56-year-old female presented with pain in the right upper abdomen for one month. Her workup was unremarkable except for the gallbladder EF of 86%. Patient 2 was a 33-year-old female with similar symptoms and workup with gallbladder EF of 97%. Patient 3 was a 20-year-old female with right upper abdominal pain and gallbladder EF of 91%. Patients 1 and 3 had the normal US, normal CT scan, and normal EGD. Patient 2 had normal US and CT but did not undergo EGD. All three patients underwent laparoscopic cholecystectomy and had complete resolution of their symptoms. Conclusion. The hyperkinetic gallbladder is a rare phenomenon, which can cause debilitating right upper quadrant pain. All three patients had an excellent response to cholecystectomy. Therefore, it is concluded that the patients with biliary colic and gallbladder EF of 80% or higher should be strongly considered for surgery.

scholarly journals Dyspnea, Tachycardia, and New Onset Seizure as a Presentation of Wilms Tumor: A Case Report

2014 ◽  
Vol 2014 ◽  
pp. 1-3
Author(s):  
Linda Li ◽  
Jennifer Light ◽  
Michael Marchick ◽  
Robyn Hoelle
Keyword(s):  
Pulmonary Embolism ◽  
Abdominal Pain ◽  
Wilms Tumor ◽  
Abdominal Mass ◽  
Onset Seizure ◽  
Care Givers ◽  
First Case ◽  
The Right ◽  
Vague Abdominal Pain ◽  
New Onset

Wilms tumor is found in 1 in 10,000 children and most commonly presents in asymptomatic toddlers whose care givers notice a nontender abdominal mass in the right upper quadrant. This case of Wilms tumor presented as a critically ill eleven-year old with significant tachypnea, dyspnea, vague abdominal pain, intermittent emesis, new onset seizure, metabolic acidosis, and hypoxemia. This is the first case in the literature of Wilms Tumor with cavoatrial involvement and seizure and pulmonary embolism resulting in aggressive resuscitation and treatment. Treatment included anticoagulation, chemotherapy, nephrectomy, and surgical resection of thrombi, followed by adjunctive chemotherapy with pulmonary radiation.

scholarly journals Acute idiopathic omental infarction as an unusual cause of left iliac fossa pain: a case report

2018 ◽  
Vol 5 (2) ◽  
pp. 743
Author(s):  
Shanavas Cholakkal ◽  
Rajesh Nambiar ◽  
Sajeesh Sahadevan ◽  
Rohit Ravindran
Keyword(s):  
Abdominal Pain ◽  
Conservative Management ◽  
Medical Literature ◽  
Surgical Intervention ◽  
Iliac Fossa ◽  
Left Iliac Fossa ◽  
Omental Infarction ◽  
Pediatric Age Group ◽  
Contrast Enhanced Ct ◽  
The Right

Acute idiopathic omental infarction is an uncommon cause of abdominal pain. Only about 300 cases have been reported in the medical literature so far.15% of cases occur in the pediatric age group. Omental infarctions are common on the right side and present as right iliac fossa pain. Clinical presentation usually mimics acute appendicitis and leads to unnecessary surgical intervention in majority of the cases. Acute idiopathic omental infarction presenting as left iliac fossa pain has not been reported till now in medical literature. Controversy exist regarding the management of acute omental infarction. While a few authors recommend surgical resection of the infarcted omentum, most authors recommend conservative management. Here we report a case 36 years old lady with acute idiopathic omental infarction presenting as the left sided abdominal pain. Diagnosis was made on contrast enhanced CT imaging. She was managed conservatively with NSAIDs and antibiotics. She was discharged after 2 days of in hospital. She improved clinically on outpatient follow up at 1 week, 1 month and 6 months. In short, acute idiopathic omental infarction is an unusual cause of left iliac fossa pain. Patients may benefit from conservative management, once the diagnosis is confirmed based on imaging. Further studies are necessary to devise a correct guideline on surgical intervention and conservative management in omental infarction.

Acute abdomen in pregnancy: a retrospective study of pregnant patients hospitalised for abdominal pain

2020 ◽  
Vol 99 (3) ◽  
pp. 131-135
Keyword(s):  
Abdominal Pain ◽  
Clinical Signs ◽  
University Hospital ◽  
Diagnostic Process ◽  
Abdominal Emergency ◽  
Lower Abdominal Quadrant ◽  
Abdominal Emergencies ◽  
The Right ◽  
Abdominal Quadrant ◽  
In Pregnancy

Introduction: Abdominal emergencies occur in pregnant women with the rate of 1:500−635 pregnancies. Such conditions usually develop from full health and worsen rapidly. Symptoms are often similar to those in physiological pregnancy (abdominal pain, vomiting, constipation). The diagnostic process is thus difficult and both the mother and her child are at risk. Our aim was to evaluate the frequency of abdominal emergencies in the Department of Surgery, University Hospital in Pilsen and to consider their impact on pregnancy and on the newborn. Methods: We acquired a set of patients by retrograde collection of data. We searched for pregnant patients suspected of developing an abdominal emergency admitted to the Department of Surgery, Faculty of Medicine, Pilsen between 2004 and 2015. We evaluated a number of clinical signs to statistically describe the set. Results: The set included 121 patients; 42 of the patients underwent a surgical procedure and 79 received conservative treatment. 38 patients underwent appendectomy; 6 appendixes were with no pathologies. McBurney’s incision was an approach of choice in most cases. The most frequent symptom was pain in the right lower abdominal quadrant. The foetus has been lost in none of the cases. Conclusion: Acute appendicitis was the most frequent abdominal emergency in our set and also the most frequent reason for surgical intervention. The most specific sign was pain in the right lower abdominal quadrant. No impact of appendicitis or appendectomy on the health of the newborn has been observed. Even though abdominal emergencies in pregnancy are relatively rare, the results of the department are very good.

DeVega versus ring annuloplasty in severe functional tricuspid insufficiency and their impact on the right ventricle

2019 ◽  
Vol 1 (4) ◽  
pp. 133-139
Author(s):  
Yasser Hamdy ◽  
Mohammed Mahmoud Mostafa ◽  
Ahmed Elminshawy
Keyword(s):  
Right Ventricular ◽  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Early Postoperative Period ◽  
Tricuspid Valve Repair ◽  
Ring Annuloplasty ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
The Right

Background: Functional tricuspid valve regurgitation secondary to left-sided valve disease is common. DeVega repair is simple, but residual regurgitation with subsequent impairment of the right ventricular function is a concern. This study aims to compare tricuspid valve repair using DeVega vs. ring annuloplasty and their impact on the right ventricle in the early postoperative period and after six months. Methods: This is a prospective cohort study of 51 patients with rheumatic heart disease who underwent tricuspid valve repair for secondary severe tricuspid regurgitation. Patients were divided into two groups: group A; DeVega repair (n=34) and group B; ring annuloplasty repair (n=17). Patients were assessed clinically and by echocardiography before discharge and after six months for the degree of tricuspid regurgitation, right ventricular diameter and tricuspid annular plane systolic excursion (TAPSE). Results: Preoperative echocardiographic assessment showed no difference in left ventricular end-systolic diameter, end-diastolic diameter, ejection fraction and right ventricular diameter, however; group A had significantly better preoperative right ventricular function measured by TAPSE (1.96 ± 0.27 vs1.75 ± 0.31 cm; p=0.02). Group B had significantly longer cardiopulmonary bypass time (127.65 ± 13.56 vs. 111.74 ± 18.74 minutes; p= 0.003) and ischemic time (99.06 ± 11.80 vs. 87.15 ± 16.01 minutes; p= 0.009). Pre-discharge, there was no statistically significant difference in the degree of tricuspid regurgitation, but the right ventricular diameter was significantly lower in group B (2.66 ± 0.41 and 2.40 ± 0.48 cm; p=0.049). After six months of follow up, the degree of tricuspid regurgitation (p= 0.029) and the right ventricular diameter were significantly lower in the ring annuloplasty group (2.56 ± 0.39 and 2.29 ± 0.44 cm; p=0.029). Although there was a statistically significant difference in preoperative TAPSE, this difference disappeared after six months. Conclusion: Both DeVega and ring annuloplasty techniques were effective in the early postoperative period, ring annuloplasty was associated with lesser residual regurgitation and better right ventricular remodeling in severe functional tricuspid regurgitation than DeVega procedure after 6-months of follow up.

The effect of Gokshura Churna over Tilanalakshara Yoga in the management of Mutrashmari - A Randomized Comparative Clinical Study

2018 ◽  
Vol 3 (5) ◽  
Author(s):  
Dr. Anil M. Sanshi ◽  
Dr.Pallavi A. Hegde
Keyword(s):  
Abdominal Pain ◽  
Renal Calculi ◽  
Renal Calculus ◽  
P Value ◽  
Standard Group ◽  
Standard Drug ◽  
Female Ratio ◽  
Comparative Clinical Study ◽  
Group B ◽  
Trial Drug

Background: Mutrashmari is a stone like structure anywhere in the Mutravaha Srothas which can be compared with renal calculi and one among the Astamahagada, clinical features as renal angle pain, haematuria, pyuria and dysuria. Peak age is 3rd to 5th decade while majority of patients report regarding onset of disease in 2nd decade of life and male to female ratio is 3:1. Objectives: To compare the effect of Gokshura Churna over Tilanalakshara Yoga in the management of Mutrashmari with special reference to Renal calculi. Materials and Methods: 30 patients were selected on the basis of inclusion criteria and divided into 2 groups with 15 patients in each group by chit method. Group A was treated with standard drug Tilanalakshara Yoga and Group B was traeted with trial drug Gokshura Churna. Results: It was found that standard group reduced the abdominal pain by 85.1%, dysuria by 89.4%, renal angle tenderness 88.4%, haematuria 100%, pyuria 100%, size of renal calculus 41.9% by 21st day of treatment. In study group it was observed that abdominal pain reduced by 92%, dysuria 96.1%, renal angle tenderness 91.6%, haematuria 100%, pyuria 100% and size of renal calculus 48.5% by 21st day of treatment. Conclusion: This assessment showed Gokshura Churna had significant result over Tilanala Kshara Yoga in both subjective and objective parameters with P value less than 0.0001.

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