scholarly journals Early recognition of PIMS-TS: a single centre retrospective review

2021 ◽  
Vol 5 (1) ◽  
pp. e001011
Author(s):  
Roshni Mistry ◽  
Nicola Scanlon ◽  
James Hibberd ◽  
Fionnghuala Fuller
Keyword(s):  
Early Recognition ◽  
Febrile Illness ◽  
Final Diagnosis ◽  
University Hospital ◽  
Single Centre ◽  
Retrospective Case ◽  
Reactive Protein ◽  
Review Reports ◽  
Specific Symptoms

IntroductionResearch into paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) has focused on tertiary level management. This review reports on symptoms and investigations at presentation.MethodsSingle centre retrospective case note analysis of patients fulfilling PIMS-TS diagnostic criteria from March to May 2020 in a London district level university hospital.ResultsSix patients presented in the week prior to their final diagnosis with fever and non-specific symptoms. Raised C-reactive protein (CRP), lymphopenia and hyponatraemia were noted. Kawasaki-like symptoms were under-represented in all patients.InterpretationThe results suggest that a proportion of children with early PIMS-TS present with a non-specific febrile illness and abnormal blood results. Further research is needed to determine the most appropriate identification and follow-up of these children.

scholarly journals 755 Elective Surgery in the COVID-19 Pandemic: Outcomes of 100 Consecutive Cases

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
R Fisher ◽  
C Hadjittofi ◽  
Z Ali ◽  
P Antonas ◽  
K Parekh ◽  
...  
Keyword(s):  
Pain Management ◽  
Oral Surgery ◽  
Elective Surgery ◽  
University Hospital ◽  
Single Centre ◽  
Median Length ◽  
Microsoft Excel ◽  
Single Centre Study ◽  
Green Zone

Abstract Introduction The COVID-19 pandemic halted elective surgical activity. Basildon University Hospital established an elective Green Zone for COVID-19 swab negative patients who isolated for 14 days. This study reviewed the outcomes of the first 100 patients. Method A single-centre study was performed. Demographic and perioperative electronic data were supplemented with telephone follow-up for the first 100 Green Zone patients and analysed in Microsoft Excel. Results One hundred Green Zone patients underwent surgery between 21/05/2020 and 16/06/2020. The median age was 55 (14-88) years. 52% were female. Their operations were performed by General Surgery (39%), Gynaecology (17%), Vascular Surgery (14%), Oral Surgery (12%), ENT (9%), Urology (8%), and Pain Management (1%). Preoperatively, 100% had a negative SARS-CoV-2 swab and one had CT evidence of mild resolving COVID-19. Two patients had postoperative SARS-CoV-2 swabs, both negative. Median length of stay was 0 (0-7) days. 84% responded to telephone follow-up at a median 25 (13-54) postoperative days, 69% of whom were asymptomatic There were no 30-day major complications (>Clavien-Dindo IIIa) or 90-day mortality. Conclusions Elective surgery can be safe during the COVID-19 pandemic, with appropriate measures in place. This has significant implications in the context of an ever-expanding NHS waiting list during a pandemic of uncertain duration.

Caecal volvulus: untwisting the mystery

2021 ◽  
Vol 14 (3) ◽  
pp. e237165
Author(s):  
Martha Sara Kedrzycki ◽  
Jaya Roy Choudhury ◽  
Sherif Hakky
Keyword(s):  
Differential Diagnosis ◽  
Small Bowel ◽  
Closed Loop ◽  
Early Recognition ◽  
Case Series ◽  
University Hospital ◽  
Single Centre ◽  
Bowel Ischaemia ◽  
Prompt Treatment ◽  
Mobile Cecum

Caecal volvulus is an infrequent cause of acute surgical abdomen, where an abnormally mobile cecum twists on its own axis. It can lead to the development of closed-loop obstruction, small bowel ischaemia and perforation. Early recognition and prompt treatment is key; however, due to the rarity of this pathology, it is seldom listed as a differential diagnosis. Here, we present a single-centre case series of two patients presenting with caecal volvulus to an Emergency Surgery Unit at a University Hospital.

Surgery in autoimmune pancreatitis

2021 ◽  
Author(s):  
Sara Nikolic ◽  
Poya Ghorbani ◽  
Raffaella Pozzi Mucelli ◽  
Sam Ghazi ◽  
Francisco Baldaque- Silva ◽  
...  
Keyword(s):  
Autoimmune Pancreatitis ◽  
University Hospital ◽  
Premalignant Lesions ◽  
Single Centre ◽  
Age At Surgery ◽  
Diagnostic Work ◽  
Work Up

Introduction: Autoimmune pancreatitis (AIP) is a disease that may mimic malignant pancreatic lesions both in terms of symptomatology and imaging appearance. The aim of the present study is to analyse experiences of surgery in patients with AIP in one of the largest European cohorts. Methods: We performed a single-centre retrospective study of patients diagnosed with AIP at the Department of Abdominal Diseases at Karolinska University Hospital in Stockholm, Sweden, between January 2001 and October 2020. Results: There were 159 patients diagnosed with AIP, and among them 35 (22.0%) patients had surgery: 20 (57.1%) males and 15 (42.9%) females; average age at surgery was 59 years (range 37-81). Follow-up period after surgery was 67 months (range 1-235). AIP type 1 was diagnosed in 28 (80%) patients and AIP type 2 in 7 (20%) patients. Malignant and premalignant lesions were diagnosed in 8 (22.9%) patients for whom AIP was not the primary differential diagnosis but, in all cases, it was described as a simultaneous finding and recorded in retrospective analysis in histological reports of surgical specimens. Conclusions: Diagnosis of AIP is not always straightforward, and, in some cases, it is not easy to differentiate it from the malignancy. Surgery is generally not indicated for AIP but might be considered in patients when suspicion of malignant/premalignant lesions cannot be excluded after complete diagnostic work-up.

scholarly journals Calcifying odontogenic cyst: a report of two clinical cases

2019 ◽  
Vol 25 (4) ◽  
pp. 36
Author(s):  
Xavier Lagarde ◽  
Julie Sturque ◽  
Mathilde Fenelon ◽  
Jean Marie Marteau ◽  
Jean Christophe Fricain ◽  
...  
Keyword(s):  
Local Anesthesia ◽  
Final Diagnosis ◽  
Odontogenic Cyst ◽  
University Hospital ◽  
Complete Excision ◽  
Cystic Form ◽  
Anterior Aspect ◽  
Calcifying Odontogenic Cyst ◽  
First Case

Introduction: Cystic maxillary lesions are common. In 1962, Gorlin described a rare cystic form termed the calcifying odontogenic cyst (COC) or Gorlin's cyst. Two cases of this form were treated at Bordeaux University Hospital. Observation: The first case was a 17-year-old patient with mandibular odontoma, which had developed over the previous 6 months. Excision was performed under local anesthesia, and the diagnosis of COC was made following pathological analysis. A 6-month follow-up was planned. The second case was a 62-year-old patient with a post-extraction mandibular lesion, which had been evolving for 1 year. Enucleation under local anesthesia led to the diagnosis of COC. No recurrence was observed after 5 years of follow-up. Discussion: COCs are rare lesions affecting mainly the anterior aspect of the mandible. COCs are usually discovered in unforeseen circumstances, and they can be observed as a clinically painless and well-defined oral deformation. Radiological examination often reveals radiolucent and uniloculated lesions, sometimes associated with radiopaque lesions. Pathological analyses are required for final diagnosis. Management is based on complete excision, more or less associated with marsupialization, and requires an annual clinical radiographic monitoring over the next 5 years. Conclusion: COC are rare lesions, usually asymptomatic, whose treatment is based on complete excision. Clinical and radiological follow-up is necessary until complete reossification is achieved.

scholarly journals Dysmorphic Short Stature: Radiological Diagnosis of Trichorhinophalangeal Syndrome

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Corina Ramona Nicolescu ◽  
Laura Kasongo ◽  
Léon Rausin
Keyword(s):  
Short Stature ◽  
Early Recognition ◽  
Final Diagnosis ◽  
Biological Evaluation ◽  
Facial Features ◽  
Radiological Findings ◽  
Trichorhinophalangeal Syndrome ◽  
Precise Diagnosis ◽  
Sparse Hair

Trichorhinophalangeal syndrome (TRPS), a type of skeletal dysplasia, is characterized by a triad of dysmorphic (bulbous nose and large ears); ectodermal (thin and sparse hair); and skeletal (short stature and cone-shaped epiphyses) findings, and this combination is helpful for early diagnosis and appropriate follow-up. A 14-year-old boy presented with short stature and distinctive facial features, and following the first clinical and biological evaluation, no precise diagnosis was reached. Progressive bilateral development of noninflammatory and painless deformity of his second finger required a radiological exam that highlighted the key elements (cone-shaped epiphyses) for final diagnosis. This case illustrates the difficulties to early recognition of TRPS when the clinical presentation is not complete and radiological findings are missing.

scholarly journals Clinical characteristics and prognosis of idiopathic pulmonary hemosiderosis in pediatric patients

2018 ◽  
Vol 47 (1) ◽  
pp. 293-302 ◽  
Author(s):  
Yajun Zhang ◽  
Fenglan Luo ◽  
Nini Wang ◽  
Yue Song ◽  
Yuhong Tao
Keyword(s):  
Clinical Characteristics ◽  
Bronchoalveolar Lavage Fluid ◽  
Early Recognition ◽  
Gastric Lavage ◽  
Lavage Fluid ◽  
University Hospital ◽  
West China ◽  
Pulmonary Hemosiderosis ◽  
Idiopathic Pulmonary Hemosiderosis

Objective This study aimed to analyze the clinical characteristics and prognosis of pediatric idiopathic pulmonary hemosiderosis (IPH). Methods Pediatric IPH cases that were diagnosed at West China Second University Hospital, Sichuan University between 1996 and 2017 were reviewed. Follow-up data from 34 patients were collected. Results A total of 107 patients were included (42 boys and 65 girls). The median age was 6 years at diagnosis. The main manifestations of the patients were as follows: anemia (n = 100, 93.45%), cough (n = 68, 63.55%), hemoptysis (n = 61, 57%), fever (n = 23, 21.5%), and dyspnea (n = 23, 21.5%). There were relatively few pulmonary signs. The positive rates of hemosiderin-laden macrophages in sputum, gastric lavage fluid, and bronchoalveolar lavage fluid were 91.66%, 98.21%, and 100%, respectively. Seventy-nine patients were misdiagnosed. A total of 105 patients were initially treated with glucocorticoids, among whom 102 survived and three died. Among the followed up patients, two died and 32 survived, among whom 10 presented with recurrent episodes. Conclusions The classic triad of pediatric IPH is not always present. The rates of misdiagnosis and recurrence of IPH are high. Early recognition and adequate immunosuppressive therapy are imperative for improving prognosis of IPH.

Longitudinal Follow up of Primary Insomnia Patients in a Psychiatric Clinic

2007 ◽  
Vol 41 (7) ◽  
pp. 611-617 ◽  
Author(s):  
Samson Yat-yuk Fong ◽  
Yun Kwok Wing
Keyword(s):  
Risk Factor ◽  
Psychiatric Disorder ◽  
Psychiatric Disorders ◽  
Primary Insomnia ◽  
University Hospital ◽  
Physical Disorder ◽  
Psychiatric Clinic ◽  
Retrospective Case ◽  
Diagnostic Stability

Objective: Insomnia could be a symptom of underlying psychiatric or physical disorder, a risk factor for other psychiatric disorder, or a discrete psychiatric disorder per se. In order to determine the nosological status of primary insomnia, an outcome study was carried out to investigate its diagnostic stability and its relationship to subsequent psychiatric disorders. Methods: Fifty-three primary insomnia patients in a university hospital psychiatric outpatient clinic were assessed by retrospective case note review, followed by a 6 month prospective follow up with Structured Clinical Interview Schedule for DSM-IV In-patient (SCID-I/P, version 2.0, and a sleep questionnaire. Results: The majority of patients (n =44, 83%) did not develop other psychiatric disorders after 13.4±1.2 years from the onset of insomnia. Nine patients (17%) developed mood disorder (n =6), anxiety disorder (n =2) and somatoform disorder (n =1) at 6.3±2.3 years after the onset of insomnia. Subjective deterioration of insomnia and a shorter duration of sleep symptoms at the first consultation were associated with the development of secondary psychiatric disorders. Approximately one-third (n =17, 32%) reported symptoms improvement and six (13.2%) were free from medications. Better education was the only factor that predicted improvement in symptoms. Conclusions: There existed a longitudinal diagnostic stability of primary insomnia in a majority of clinical patients. However, in a proportion of patients, it might either be a risk factor or a prodrome of mood or anxiety disorders.

TP1-1 Endovascular versus surgical management of pericallosal artery aneurysms, single centre experience

2019 ◽  
Vol 90 (3) ◽  
pp. e10.2-e10
Author(s):  
MS Draz ◽  
AK Toma ◽  
S Bezouich ◽  
P Grover
Keyword(s):  
Surgical Intervention ◽  
Case Series ◽  
Artery Aneurysm ◽  
Endovascular Management ◽  
Single Centre ◽  
Retrospective Case ◽  
Surgical Clipping ◽  
Pericallosal Artery ◽  
Single Centre Experience

ObjectivesComparing surgical versus endovascular management of pericallosal artery aneurysm.DesignRetrospective case series.SubjectsPatients managed in our unit for pericallosal artery aneurysms.MethodsPatients medical and radiological records were reviewed collecting data about presentation, management, complications. Clinical outcome was assessed by mRS at 3,6 and 12 months. Imaging were reviewed to report aneurysm size and treatment outcome.ResultsAverage follow up period 3.3 years SD ±3.5. 38 patients had SAH and 19 were incidentally discovered. Initial CT showed SAH in 21 patients, IVH in 3,ICH in 3 IVH and ICH in 9. 33 patients treated using endovascularly, 13 patients conservatively and 2 by surgical clipping. 33% of endovascular group had stroke caused by approach related complications. 41.3% of the patients had mRS (0–2) at 3 months period. Increased to 46.5% at 12 months. Average imaging follow up was 1.5 years (SD ±1.6). 36.3% of endovascular group showed aneurysm remnant filling or recurrence.ConclusionsPericallosal artery aneurysms are complex in nature and both management modalities are challenging. Complications were high in endovascular group. Surgical intervention should be considered in selected patients where complex intervention is required.

scholarly journals AB0543 CHARACTERISTICS AND TREATMENT CHANGES IN PATIENTS WITH PSORIATIC ARTHRITIS SEEN IN A COMBINED DERMATOLOGY-RHEUMATOLOGY CLINIC

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1304.1-1304
Author(s):  
K. Klavdianou ◽  
M. Stavropoulou ◽  
P. Panagakis ◽  
M. Papoutsaki ◽  
A. Panagiotopoulos ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Systemic Therapy ◽  
Patient Characteristics ◽  
Final Diagnosis ◽  
University Hospital ◽  
Research Grants ◽  
Pasi Score ◽  
Synthetic Agents ◽  
Treatment Changes

Background:Data on patients with Psoriasis (PSO) referred to a combined Dermatology-Rheumatology outpatient Clinic (Derm-Rheum) with suspected psoriatic arthritis (PsA) are limited.Objectives:To assess patient characteristics and treatment changes in PsA patients referred to a Derm-Rheum Clinic.Methods:Prospective study of PSO patients referred to a combined Derm - Rheum Clinic from February 2018 to June 2020 in a Tertiary University Hospital.Results:Among 151 patients with PSO referred to the Clinic, 129 (85%) with a final diagnosis of PsA were included. In 73% of patients (n=94) PsA was diagnosed there for the 1st time. 56% were females with a mean age of 55 years and a median disease duration of 14.2 years. At initial evaluation, 95% had peripheral arthritis, 45% nail involvement, 23% axial involvement, 12% enthesitis and 6% dactylitis with a median DAPSA score of 20.5 and PASI score of 1.6, respectively. 31% of the patients were not receiving any systemic treatment, 45% were on biologics (30% as monotherapy, 15% in combination with non-biologics), 29% were on non-biologics (14% as monotherapy, 15% in combination with biologics or targeted synthetic agents] and 10% were on targeted synthetic (ts) agents. At last visit (median follow-up: 15 months) only 8% did not receive any systemic therapy (p<0.001 compared to 1st visit), 62% were on biologics (39% monotherapy – 23% in combination with non-biologics, p=0.009), 46% were on non-biologics (20% as monotherapy – 26% in combination with biologics or ts agents, p=0.01) and 10% of the patients were on apremilast. The median DAPSA and PASI scores at last visit were 5.3 and 0, respectively.Conclusion:About 2/3 of patients with PSO referred to a combined Derm - Rheum Clinic with suspicious musculoskeletal complaints were diagnosed for the 1st time as PsA. During follow-up the percentage of PsA patients who started or continued systemic therapy significantly increased with significant improvement of disease activity indices. These data emphasize the value of combined Derm - Rheum Clinics for earlier diagnosis and more efficacious treatment of PsA patients.Acknowledgements:This work was supported by research grants from the Special Account for Research Grants (S.A.R.G.), National and Kapodistrian University of Athens, Athens, Greece.Disclosure of Interests:None declared.

Sign in / Sign up

Export Citation Format

Share Document