scholarly journals Acquired tracheoesophageal fistula in a pregnant patient with COVID-19 pneumonia on prolonged invasive ventilation

2021 ◽  
Vol 14 (8) ◽  
pp. e244016
Author(s):  
Patricia Maria Gregoria Mina Cuaño ◽  
John Christopher Agsalud Pilapil ◽  
Ramon Jr Bagaporo Larrazabal ◽  
Ralph Elvi Villalobos
Keyword(s):  
Tracheoesophageal Fistula ◽  
Pregnant Patient ◽  
High Morbidity ◽  
Tracheal Injury ◽  
Tracheal Mucosa ◽  
Hypoxic Injury ◽  
Direct Injury ◽  
Extended Length ◽  
Definitive Repair ◽  
High Index Of Suspicion

A previously healthy pregnant woman was diagnosed with COVID-19 pneumonia and was subsequently intubated. Throughout the course of her illness, the patient was treated for recurrent bouts of pneumonia. A high-resolution chest and neck CT scan confirmed the presence of a tracheoesophageal fistula (TEF), which may have been caused by the presence of the overinflated endotracheal cuff, prolonged steroid use, hypoxic injury and possible direct injury of the tracheal mucosa from COVID-19 itself. A temporising procedure, involving tracheostomy with an extended-length tracheal tube, was performed. Unfortunately, the patient succumbed to infection prior to definitive repair. This case highlights the importance of keeping a high index of suspicion for tracheal injury in patients who experience prolonged periods of intubation. It also underlies the high morbidity and mortality rate associated with TEF, although being a rare disease.

scholarly journals Histopathologic Characteristics of Childhood Malignant Tumours in a Referral Medical Centre in Nigeria

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Usman Bello ◽  
Sanusi Muhammad Haruna ◽  
Ibrahim Hassan ◽  
Kabir Sulaiman ◽  
Kasimu Umar Adoke ◽  
...  
Keyword(s):  
Head And Neck ◽  
Early Stage ◽  
Neck Region ◽  
Medical Centre ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Malignant Tumours ◽  
Female Ratio ◽  
High Index Of Suspicion ◽  
Attending Physician

Background: Diseases of children in most developing countries revolve commonly around infectious disorders and malnutrition. However, other conditions including neoplastic diseases may be unassuming challenges to the attending physician. The objective of this study was to determine the epidemiological and histopathological pattern of malignant tumours among children in a northern Nigerian tertiary health institution. Materials and Methods: This is a retrospective study of malignant tumours in children aged fifteen years and below diagnosed over a ten year period (1st January 2011- 31st December 2020). Histopathology laboratory records at the Department of Pathology, Federal Medical Centre, Birnin Kebbi, Kebbi state, were reviewed and all diagnoses of malignant tumours were extracted. The findings were compared with similar studies elsewhere. Results: There were 36 children with confirmed cases of malignant tumours; 22 males and 14 females. The male to female ratio was 1.7:1. The peak age of incidence was 11-15years. The most common childhood malignant tumours were rhabdomyosarcoma, retinoblastoma, osteosarcoma, non-Hodgkin's lymphoma and squamous cell carcinoma. Head and neck region was the commonest area of affectation. Conclusion: The most common malignant tumours in children in our setting are sarcomas and small round blue cell tumours of childhood affecting predominantly older male children with head and neck regional predilections. Malignant tumours in children though not very common, are an important aspect of paediatric disorders to the attending physician due to their high morbidity and mortality. The diagnosis of such can be challenging to the pathologist, especially in resource constrain environments. High index of suspicion is therefore advocated to detect the tumour in its early stage that is associated with low morbidity and mortality.

scholarly journals Two Cases of Dyskeratosis Congenita with Clinically Distinct Presentations, Seen in National University Hospital, Singapore

2021 ◽  
pp. 1-4
Author(s):  
Lester Juay ◽  
Nisha Suyien Chandran
Keyword(s):  
Bone Marrow Failure ◽  
Young Patients ◽  
Dyskeratosis Congenita ◽  
University Hospital ◽  
Haematopoietic Stem Cell ◽  
High Morbidity ◽  
National University ◽  
Multisystemic Disease ◽  
Classical Triad ◽  
High Index Of Suspicion

Dyskeratosis congenita (DKC) is a genodermatosis of variable inheritance and is often characterised by the classical triad of nail dysplasia, reticulate hyperpigmentation of upper chest and neck, and oral leukoplakia. We report 2 cases of DKC from National University Hospital, Singapore, whose clinical presentations differed greatly from each other. Dermatologists should hold a high index of suspicion for DKC in young patients who present without the classical triad of features, as early dermatological care can be instituted through reinforcement of rigorous sun protection and regular surveillance for skin cancers. Early diagnosis also offers physicians the time to organise haematopoietic stem cell transplantation if necessary, as bone marrow failure is often inevitable. As a multisystemic disease with high morbidity and mortality particularly from haematological complications if left undetected and untreated in the early stages, the role of the dermatologist in diagnosing DKC is a crucial one.

scholarly journals Foreign bodies in aero-digestive tract in children: spectrum of presentation and management

2017 ◽  
Vol 4 (6) ◽  
pp. 1889
Author(s):  
Rajashekhar T. Patil ◽  
Advait Prakash
Keyword(s):  
Foreign Body ◽  
Digestive Tract ◽  
Bronchial Tree ◽  
Anatomical Location ◽  
High Morbidity ◽  
Radiographic Findings ◽  
Delay In Diagnosis ◽  
Threatening Condition ◽  
High Index Of Suspicion ◽  
A Prospective Study

Background: Foreign body (FB) ingestion and aspiration is quite common in children. It can be a life-threatening condition. Early diagnosis of foreign body aspiration is essential as delay in its recognition and treatment results in high morbidity and mortality. Symptoms seem to mostly depend on the anatomical location. The absence of specific symptoms indicating the occurrence of FB injury can lead to delay in diagnosis, thereby increasing the risk of complications.Methods: This is a prospective study which comprised of 50 patients with between 8 months and 4.5 years. FB involving different parts of the aero-digestive tract were included in the study. The site, side, symptoms and radiographic findings were recorded for each patient. Different procedures were used for retrieval of various FB at different locations. Majority of these procedures were performed under anaesthesia.Results: Most of the FB were organic in nature. Right side bronchus was more commonly involved. A combination of different procedures was used according to the site involved. All the FB were removed successfully and smoothly. There was minimum morbidity with no mortality and the overall outcome was excellent. Hospital stay varied according to the site of involvement.Conclusions: The symptoms of FB change with the site involved and many patients are even asymptomatic. A differential diagnosis of foreign body should always be made in an acute or chronic presentation of respiratory cases. Aspiration of foreign body should be suspected in all cases of broncho-pulmonary infection with atypical course. High index of suspicion is the cornerstone of diagnosis. Bronchoscopy is the best diagnostic and therapeutic method in all suspicions of foreign body of tracheo-bronchial tree. Proper and timely intervention optimizes the outcome.

DOZ047.110: Recurrent tracheoesophageal fistula tracheoscopic chemocauterization with trichloroacetic acid

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
D P R Lara ◽  
L V M Riveros ◽  
L R S Pineda ◽  
P O Padilla ◽  
I C Cañón ◽  
...  
Keyword(s):  
Trichloroacetic Acid ◽  
Tracheoesophageal Fistula ◽  
Primary Repair ◽  
Endoscopic Management ◽  
High Morbidity ◽  
Medical Reason ◽  
Endoscopic Techniques ◽  
Number Of Patients ◽  
The Mean

Abstract Objective The aim of this study was to report the experience of two centers in the treatment of recurrent tracheoesophageal fistula (RTEF), by tracheoscopic chemocauterization with trichloroacetic acid (TCA). A surgical approach to RTEF has high morbidity and mortality. Some endoscopic techniques have been developed but nevertheless, optimal treatment is still not determined because of the low number of patients, short term of follow-up, and different techniques. Materials and Methods From January 2016 to March 2019, 12 patients with RTEF were selected for endoscopic management in two centers. Eleven had RTEF after primary repair of esophageal atresia/TEF and one had a second fistula with misdiagnosis, all of them by a thoracotomy approach. In all cases the diagnosis was confirmed by clinical evaluation, esophagram, and bronchoscopy. Under general anesthesia, a rigid pediatric bronchoscope with a 0° rod lens telescope telemonitoring was used to localize and refresh the fistula with a small endoscopy brush of 2–3 mm. Cotton soaked with 50% TCA was applied on the fistula for 30 seconds. The procedure had to be repeated two times. Results Fistulae were closed in 10 patients. The closure was confirmed by esophagram or bronchoscopy after 2 months of the procedure. It remains completely obliterated and the patients are asymptomatic. There were only two patients with progressive decrease in the diameter of the fistula; one patient died for some other medical reason and another patient is being treated. The mean number of procedures in each patient was 1.3, and the follow-up was 12 months on average (2–36). Two patients had bronchospasms as postoperative complication. Conclusion The tracheoscopic chemocauterization of RTEF with the use of 50% TCA is a minimally invasive, safe, and effective technique. It has fewer complications and avoids the morbidity of open surgery.

Severe Headache

2018 ◽  
pp. 107-112
Author(s):  
Aman Shah
Keyword(s):  
Computed Tomography ◽  
Blood Pressure ◽  
Emergency Department ◽  
Pressure Control ◽  
Acute Onset ◽  
Severe Headache ◽  
High Morbidity ◽  
Common Cause ◽  
Aneurysmal Rupture ◽  
High Index Of Suspicion

This case highlights the clinical presentation and diagnostic workup of a subarachnoid hemorrhage (SAH) in an emergency department setting. Given the high morbidity and mortality associated with this diagnosis, clinicians must have a high index of suspicion when patients present with an acute onset, severe headache. While computed tomography of the head is the best initial diagnostic test, lumbar puncture should be performed if the imaging is equivocal or negative and the clinical concern for SAH persists. After SAH is diagnosed, prompt consultation and co-management with neurosurgery should occur, in addition to strict blood pressure control and efforts to reduce intracranial pressure. Trauma is the most common cause of SAH while aneurysmal rupture is the leading cause of atraumatic SAH.

scholarly journals Tracheal Basement Membrane Thickening in Rhesus Monkeys

1974 ◽  
Vol 11 (3) ◽  
pp. 278-288 ◽  
Author(s):  
G. A. Splitter ◽  
W. I. Butcher ◽  
M. D. Stevens
Keyword(s):  
Electron Microscopy ◽  
Mast Cells ◽  
Rhesus Monkeys ◽  
Respiratory Diseases ◽  
Nonhuman Primates ◽  
Fluorescent Microscopy ◽  
Tracheal Injury ◽  
Tracheal Mucosa ◽  
Basement Membrane Thickening ◽  
Respiratory Conditions

Thickened hyaline tracheal membrane similar to that which occurs with several respiratory conditions in man was seen in Rhesus monkeys. The membrane was eosinophilic and up to 50.4 μm thick. Frequently eosinophils and mast cells were seen in the tracheal mucosa and submucosa. Using fluorescent microscopy, IgG, B1C, B1A and albumin were identified in the membrane. Electron microscopy showed that the membrane was composed of 18.8-nm collagen-like fibrils with occasional periodicity. The cause of the thickened hyaline tracheal membrane could not be determined. The changes probably represent a response to mild repeated or continuous tracheal injury owing to a variety of causes. Delineation of the cause of this process in nonhuman primates may help in the understanding of respiratory diseases in man.

scholarly journals Chronic Rhinosinusitis in Children

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Hassan H. Ramadan
Keyword(s):  
Mortality Rate ◽  
Medical Treatment ◽  
Common Cold ◽  
Surgical Intervention ◽  
Common Disease ◽  
Nasal Discharge ◽  
High Morbidity ◽  
The Us ◽  
The Common ◽  
High Index Of Suspicion

Rhinosinusitis is a very common disease worldwide and specifically in the US population. It is a common disease in children but may be underdiagnosed. Several reasons may account to the disease being missed in children. The symptoms in children are limited and can be very similar to the common cold or allergic symptoms. Cough and nasal discharge may be the only symptoms present in children. A high index of suspicion is necessary to make the diagnosis of rhinosinusitis in these children. The majority of those children are treated medically. Only a few number will require surgical intervention when medical treatment fails. Complications of rhinosinusitis, even though rare, can carry a high morbidity and mortality rate.

Abstract 15102: Benign Cardiac Neoplasms in the United States - A Thirteen-year Review

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Neiberg Lima ◽  
Kristina Byers-Spencer ◽  
Kamil Cwikla ◽  
Cuyler Huffman ◽  
Mireya Diaz ◽  
...  
Keyword(s):  
Sinus Node ◽  
Small Body ◽  
Arterial Embolization ◽  
The United States ◽  
Epidemiologic Studies ◽  
High Morbidity ◽  
Cardiac Neoplasms ◽  
The Us ◽  
Low Incidence ◽  
High Index Of Suspicion

Introduction: Benign cardiac neoplasms (BCN) are rare; with varying reported incidence and a paucity of epidemiologic studies. The purpose of our review was to add to the small body of literature describing the characteristics and trends of BCN in the US. Methods: This study is a retrospective review of data from the HCUP-NIS Database from 2002-2014. Inclusion criteria consisted of the presence of indication for BCN. Additionally, we queried the database for BCN-associated comorbidities. SAS studio was utilized for analysis. Results: The data consisted of 482,872,274 weighted discharges. There were 45,568 weighted discharges that had BCN. Sixty four percent were women. Median cost per admission was 51,799 USD, five times higher than the national average. A total of 1,267 (2.78%) patients died during the admission. Stroke and arterial embolization were reported in 6730 (14.76%) and 573 (1.26%) weighted discharges. Weight loss, fever and endocarditis were reported in 311 (0.68%), 383 (0.84%) and 869 (1.91%) patients, respectively. Pulmonary hypertension co-occurred in 3440 (7.55%) patients. Episodes of atrial tachyarrhythmias, ventricular arrhythmias, syncope and cardiac arrest were reported in 13,184 (28.93%), 1,471 (3.23%), 1,055 (2.32%) and 393 (0.86%) cases. Sinus node dysfunction, severe AV nodal block co-occurred in 1,005 (2.21%) and 930 (2.04%) patients. Conclusions: We identified a low incidence of BCN in the US over the 13-year study period. Since the prevalence for BCN is low, clinicians must maintain a high index of suspicion due to the high morbidity and mortality.

Retroperitoneal Leakage as a Cause of Acute Ultrafiltration Failure: Its Associated Risk Factors in Peritoneal Dialysis

2009 ◽  
Vol 29 (5) ◽  
pp. 542-547 ◽  
Author(s):  
Man Fai Lam ◽  
Wai Kei Lo ◽  
Kai Chung Tse ◽  
Terrence P.S. Yip ◽  
Sing Leung Lui ◽  
...  
Keyword(s):  
Risk Factors ◽  
Peritoneal Dialysis ◽  
Clinical Problem ◽  
High Morbidity ◽  
Peritoneal Catheter ◽  
Pleuroperitoneal Communication ◽  
Ultrafiltration Failure ◽  
History Of ◽  
Associated Risk Factors ◽  
High Index Of Suspicion

Background Ultrafiltration failure is an important clinical problem in patients on maintenance peritoneal dialysis (PD) and is associated with high morbidity and mortality. Acute ultrafiltration failure (AUFF) is usually secondary to mechanical problems with the peritoneal catheter or peritoneal leakage. Retroperitoneal leakage (RPL) is an important cause of AUFF and often poses diagnostic difficulty. Herein we analyze the incidence of AUFF secondary to RPL in our centers and study its associated risk factors. Methods After excluding causes due to mechanical problems with the peritoneal catheter, patients complicated by AUFF underwent computerized tomographic peritoneography (CTP) or magnetic resonance imaging of the peritoneal cavity (MRP) to determine any RPL. Other patients on maintenance PD without RPL served as controls for comparison of risk factors. Demographic and peritoneal membrane characteristics, including history of hernia and pleuroperitoneal leakage, were analyzed. Results During the 5-year study period, 36 patients in a cohort of 743 patients on maintenance PD developed AUFF. 23 of these 36 patients were found to have RPL, which was confirmed by either CTP ( n = 16) or MRP ( n = 7). The duration of PD at the time of RPL and the dialysate-to-plasma ratio of creatinine at 4 hours were 49.3 ± 24.5 (range 0.5 – 87.9) months and 0.70 ± 0.09 respectively. Incidences of hernia (52.2%) and pleuroperitoneal communication (34.8%) were significantly higher than in PD patients without RPL (13% and 7% respectively, p = 0.001). Logistic regression analysis identified hernia and pleuroperitoneal communication as the risk factors for RPL. The odds ratios for RPL with hernia and pleuroperitoneal communication were 6.62 [95% confidence interval (CI) 2.35 – 18.69, p < 0.001] and 6.23 (95% CI 1.83 – 21.19, p = 0.003) respectively. Conclusion RPL was not uncommon in patients with AUFF. A high index of suspicion for RPL is needed in the management of patients with history of hernia or pleuroperitoneal communication presenting with AUFF.

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