scholarly journals Postpartum Spontaneous Subcapsular Hepatic Hematoma Related to Preeclampsia

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Dimitrios Anyfantakis ◽  
Miltiades Kastanakis ◽  
Georgios Fragiadakis ◽  
Paraskevi Karona ◽  
Nikolaos Katsougris ◽  
...  
Keyword(s):  
Epigastric Pain ◽  
Emergency Caesarean Section ◽  
Maternity Ward ◽  
Hepatic Hematoma ◽  
Pregnancy And Postpartum ◽  
Life Threatening ◽  
Clinical Phenomenon ◽  
Diagnostic Work ◽  
Work Up ◽  
Severe Epigastric Pain

Subcapsular hematoma of the liver represents an unusual clinical phenomenon in the pregnancy and postpartum period with serious complications in terms of fetal and maternal mortality. Here we report a case of a 32-year-old primiparous female at 36 weeks of gestation, admitted to a maternity ward of a private clinic for preeclampsia. The woman underwent an emergency caesarean section with the extraction of an alive foetus. A few hours after delivery, she was transferred to the emergency department of our institution complaining of severe epigastric pain. Diagnostic work-up was suggestive of a subcapsular right lob hepatic hematoma which was successfully managed conservatively. Timely diagnosis is necessary for the prevention of life-threatening events in mother and fetus. For this reason acute care physicians have to be vigilant of the condition and consider this in the differential diagnosis of epigastric pain during pregnancy and postpartum.

scholarly journals Death of unknown cause? Post-mortem diagnosis of fulminant course of an EBV-associated secondary hemophagocytic lymphohistiocytosis

2021 ◽  
Author(s):  
Josia Fauser ◽  
Stefan Köck ◽  
Eberhard Gunsilius ◽  
Andreas Chott ◽  
Andreas Peer ◽  
...  
Keyword(s):  
Immune Response ◽  
Case Report ◽  
Macrophage Activation ◽  
Post Mortem ◽  
Life Threatening ◽  
Appropriate Therapy ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up ◽  
Secondary Hemophagocytic Lymphohistiocytosis

SummaryHLH is a life-threatening disease, which is characterized by a dysregulated immune response with uncontrolled T cell and macrophage activation. The often fulminant course of the disease needs a fast diagnostic work-up to initiate as soon as possible the appropriate therapy. We present herein the case of a 71-year-old patient with rapidly progressive hyperinflammatory syndrome, which post mortem resulted in the diagnosis of EBV-associated HLH. With this case report, we intend to highlight the relevance of the HScore in the diagnosis of HLH, to create a greater awareness for EBV as a trigger of HLH, and to demonstrate the importance of treating EBV-associated HLH as early as possible.

scholarly journals Adrenal Insufficiency - Aetiology, Diagnosis and Treatment

2015 ◽  
Vol 3 (1) ◽  
pp. 36-47
Author(s):  
Nazma Akter ◽  
Nazmul Kabir Qureshi
Keyword(s):  
Quality Of Life ◽  
Adrenal Insufficiency ◽  
Presenting Symptoms ◽  
Life Saving ◽  
Life Threatening ◽  
Diagnostic Work ◽  
Work Up ◽  
Term Management

Adrenal insufficiency is caused by either primary adrenal failure or by hypothalamic-pituitary impairment of the corticotropic axis. Adrenal insufficiency, first codified in 1855 by Thomas Addison, remains relevant in 2014 because of its lethal nature. Though, it is a rare disease but is life threatening when overlooked. Main presenting symptoms such as fatigue, anorexia and weight loss are nonspecific, thus diagnosis is often delayed. The diagnostic work-up is well established but some pitfalls remain. The diagnosis is adequately established by the 250 ?g ACTH (adrenocorticotropic hormone) stimulation test in most cases. Glucocorticoids provide life saving treatment but long-term quality of life is impaired, perhaps because therapy is not given in a physiologic way. Dehydroepiandrosterone-replacement therapy has been introduced that could help to restore quality of life. It may be useful in pubertal girls, but not in adults. Monitoring of glucocorticoid-replacement is difficult due to lack of objective methods of assessment and is therefore largely based on clinical grounds. Thus, long-term management of patients with adrenal insufficiency remains a challenge, requiring an experienced specialist. DOI: http://dx.doi.org/10.3329/dmcj.v3i1.22238 Delta Med Col J. Jan 2015; 3(1): 36-47

Status Epilepticus—Work-Up and Management in Children

2020 ◽  
Vol 40 (06) ◽  
pp. 661-674
Author(s):  
Cristina Barcia Aguilar ◽  
Iván Sánchez Fernández ◽  
Tobias Loddenkemper
Keyword(s):  
Status Epilepticus ◽  
Medical Emergency ◽  
First Line ◽  
Timely Manner ◽  
Treatment Protocols ◽  
Efficacious Treatment ◽  
Life Threatening ◽  
Diagnostic Work ◽  
Work Up ◽  
Medication Choice

AbstractStatus epilepticus (SE) is one of the most common neurological emergencies in children and has a mortality of 2 to 4%. Admissions for SE are very resource-consuming, especially in refractory and super-refractory SE. An increasing understanding of the pathophysiology of SE leaves room for improving SE treatment protocols, including medication choice and timing. Selecting the most efficacious medications and giving them in a timely manner may improve outcomes. Benzodiazepines are commonly used as first line and they can be used in the prehospital setting, where most SE episodes begin. The diagnostic work-up should start simultaneously to initial treatment, or as soon as possible, to detect potentially treatable causes of SE. Although most etiologies are recognized after the first evaluation, the detection of more unusual causes may become challenging in selected cases. SE is a life-threatening medical emergency in which prompt and efficacious treatment may improve outcomes. We provide a summary of existing evidence to guide clinical decisions regarding the work-up and treatment of SE in pediatric patients.

Erectile dysfunction

2017 ◽  
Author(s):  
Antonino Saccà ◽  
Andrea Salonia
Keyword(s):  
Erectile Dysfunction ◽  
Accurate Diagnosis ◽  
Sexual History ◽  
Basic Work ◽  
Life Threatening ◽  
Seeking Help ◽  
Common Risk Factors ◽  
Diagnostic Work ◽  
Work Up ◽  
Significant Opportunity

Erectile dysfunction (ED) has progressively emerged as an important sentinel marker of cardiovascular and overall health among men. A timely and accurate diagnosis of ED may thus represent a significant opportunity not only to diagnose the dysfunction per se, but also to comprehensively identify co-morbid and potentially life-threatening conditions. Basic work-up for a man seeking help for ED should start considering that ED may share several modifiable and unmodifiable common risk factors with cardiovascular disorders and other potential life-threatening conditions. Overall, most patients with ED can be adequately managed with a basic diagnostic work-up; this includes a comprehensive medical and sexual history, along with a physical examination and some laboratory tests. Conversely, only some selected patients may also need specific diagnostic tests.

Problem solving in clinical practice: the sick infant with low sodium and high potassium

2020 ◽  
pp. edpract-2019-317756
Author(s):  
Yincent Tse ◽  
Nidhi Singhal ◽  
Leigh McDonald ◽  
Milan Gopal ◽  
Anupam Lall ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Problem Solving ◽  
High Potassium ◽  
Initial Management ◽  
Low Sodium ◽  
Life Threatening ◽  
Diagnostic Work ◽  
Work Up ◽  
Term Management ◽  
Diagnostic Work Up

Many paediatricians will be faced with a sick infant who on investigation is found to have hyponatraemia and hyperkalaemia at some time in their career. The focus of initial management includes the treatment of potentially life-threatening hyperkalaemia with concurrent investigation aiming to elucidate whether the underlying cause reflects a primarily renal or endocrine pathology. We describe the presentation of two infants who each presented with one of the more common underlying diagnoses that led to this biochemical disturbance and discuss the approach to immediate treatment, diagnostic work-up and longer term management.

Acute heart failure: diagnosis

ESC CardioMed ◽  
2018 ◽  
pp. 1911-1917 ◽  
Author(s):  
Adriaan A. Voors ◽  
Piotr Ponikowski
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Medical Condition ◽  
Specific Treatment ◽  
Length Of Hospital Stay ◽  
Clinical History ◽  
Life Threatening ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

Acute heart failure is a life-threatening medical condition typically leading to urgent hospital admission. Early diagnosis is of great importance, since it will lead to earlier and better targeted treatment, leading to a decrease in length of hospital stay, and most importantly to improved clinical outcome. The initial diagnostic work-up includes a clinical history, evaluation of symptoms and signs, an electrocardiogram, chest X-ray, natriuretic peptide levels, echocardiography and perhaps lung ultrasound. After the initial work-up, a clinical classification according to blood pressure, congestion, and peripheral perfusion should be performed, since it will guide treatment. During the diagnostic work-up, treatable and life-threatening conditions always need to be considered since they need immediate and case-specific treatment.

scholarly journals Retrograde Jejunogastric Intussusception: A Case Report

1970 ◽  
Vol 5 (1) ◽  
pp. 32-34
Author(s):  
SS Pervin ◽  
SK Biswas ◽  
S Ahmed ◽  
D Khandokar
Keyword(s):  
Epigastric Pain ◽  
Rare Condition ◽  
Gastric Surgery ◽  
Type Ii ◽  
Jejunogastric Intussusception ◽  
Life Threatening ◽  
Peristaltic Movement ◽  
Life Threatening Complication ◽  
Operative Recovery ◽  
Severe Epigastric Pain

Jejunogastric Intussusceptions is a rare but potentially life threatening complication of a previous gastrectomy or gastrojejunostomy. A 70 years old man presented with severe epigastric pain followed by haematemesis, 8 years after truncal vagotomy and gastrojejunostomy for pyloric stenosis. Ultrasonography revealed dilated stomach with a large intragastric mass which has minimal peristaltic movement. Endoscopy of upper GIT revealed prolapsed segment of jejunal loops through the gastrojejunostomy stoma. Laparotomy disclosed a retrograde type II jejunogastric intussusception and was managed by reduction of jejunogastric intussusception, resection of gangrenous segment and end to end anastomosis. Post operative recovery was uneventful. Retrograde jejunogastric intussusceptions is a rare condition and around 200 cases has been reported since its first description in 1914. Urgent recognition and surgical treatment is mandatory to reduce the mortality rate from this complication. Key words: Retrograde Jejunogastric Intussusception; gastrojejunostomy; gastric surgery. DOI: 10.3329/fmcj.v5i1.6812Faridpur Med. Coll. J. 2010;5(1):32-34

scholarly journals Transthyretin Amyloidosis with Gastrointestinal Manifestation: a Case Report

2019 ◽  
Vol 28 (3) ◽  
pp. 359-361 ◽  
Author(s):  
Radislav Nakov ◽  
Stayko Sarafov ◽  
Ventsislav Nakov ◽  
Mariana Gospodinova ◽  
Tihomir Todorov ◽  
...  
Keyword(s):  
Diagnostic Challenge ◽  
Transthyretin Amyloidosis ◽  
Gi Symptoms ◽  
Peripheral Polyneuropathy ◽  
Life Threatening ◽  
Gastrointestinal Manifestation ◽  
Diagnostic Work ◽  
Biochemical Imaging ◽  
Work Up ◽  
Diarrhea Syndrome

Transthyretin amyloidosis (ATTR) is a rare, progressive, life-threatening, hereditary disorder caused by mutations in the transthyretin gene. Due to the phenotypic heterogeneity, ATTR is difficult to recognize and it is often diagnosed very late. In ATTR gastrointestinal (GI) disorders play an important role in the patients’ morbidity and mortality. In some cases, GI symptoms are present even before the onset of the peripheral polyneuropathy. However, the complaints are various and it is really difficult to differentiate them from other GI disorders. We present a 61-year old male referred for diarrhea, unintentional weight loss and early satiety. He had hypotension after longstanding hypertension, numbness and tingling in the feet. We considered a broad differential diagnosis spectrum of chronic diarrhea syndrome and performed numerous laboratory, biochemical, imaging, endoscopic, histological and genetic tests. Transthyretin amyloidosis with a Glu89Gln mutation was diagnosed. Transthyretin amyloidosis is frequently misdiagnosed, representing a diagnostic challenge in GI practice. The presence of certain clinical combinations could help gastroenterologists to include ATTR in their diagnostic work-up.

scholarly journals Phenotypical variability of post-partum reversible cerebral vasoconstriction syndrome

2010 ◽  
Vol 2 (2) ◽  
pp. 16 ◽  
Author(s):  
Benjamin Matosevic ◽  
Martin Furtner ◽  
Michael Knoflach ◽  
Christoph Schmidauer ◽  
Georg Wille ◽  
...  
Keyword(s):  
Post Partum ◽  
Treatment Strategies ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Potential Treatment ◽  
Cerebral Vasoconstriction ◽  
Life Threatening ◽  
Diagnostic Work ◽  
Work Up ◽  
Phenotypical Variability ◽  
Diagnostic Work Up

Reversible cerebral vasoconstriction syndrome is recognized increasingly as a complication of the postpartum period. Our series of four cases illustrates its phenotypical variability, summarizes the diagnostic work-up, and outlines potential treatment strategies for this usually benign but sometimes disabling and life-threatening disease.

scholarly journals THE MANAGEMENT OF VENOUS THROMBOEMBOLIC DISORDERS

2013 ◽  
Vol 3 (3) ◽  
Author(s):  
Diana S. Purwanto
Keyword(s):  
Venous Thromboembolism ◽  
Thrombotic Event ◽  
Venous Stasis ◽  
Initial Management ◽  
Clinical Probability ◽  
Venous Thromboembolic ◽  
Life Threatening ◽  
Diagnostic Work ◽  
Work Up ◽  
D Dimer

Abstrak: Tromboemboli vena (VTE) mengacu pada semua bentuk trombosis patologis yang terjadi di sirkulasi vena, yang paling umum adalah trombosis vena dalam (DVT) pada ekstremitas bawah, namun manifestasi VTE yang paling mengancam nyawa adalah embolisasi trombi vena dalam ke sirkulasi paru, yang disebut emboli paru (PE). Banyak faktor baik yang diturunkan atau didapat, bisa menyebabkan VTE karena faktor-faktor tersebut mempengaruhi stasis vena, kerusakan pembuluh dan hiperkoagulabilitas, sebagai pemicu peristiwa trombotik. Sebuah kombinasi dari tes D-dimer dan probabilitas klinis diperkenalkan oleh Wells sebagai langkah pertama dalam diagnosis. Agen antikoagulan biasanya UFH atau LMWH, harus diberikan untuk menghindari pembentukan bekuan lebih lanjut ketika gangguan VTE dikonfirmasi. Pada saat efek antitrombotik yang memadai dicapai dengan heparin, antikoagulan oral seperti warfarin digunakan untuk mengurangi kemungkinan VTE berulang. Kata kunci: Tromboemboli vena, DVT, PE, D-dimer, antikoagulan.     Abstract: Venous thromboembolism (VTE) refers to all forms of pathologic thrombosis occurring on the venous side of the circulation, the most common of which is deep venous thrombosis (DVT) of the lower extremities. The most life-threatening manifestation of VTE is embolization of venous thrombi to the pulmonary circulation, called pulmonary embolism (PE). Many factors, either inherited or acquired, can cause VTE, since these factors influence the venous stasis, vessel damage and hypercoagulability, as the trigger of thrombotic event.   A combination of a D-dimer assay and clinical probability as a first step in diagnostic work-up was introduced by Wells et al. An initial management of anticoagulant agents usually UFH or LMWH, should be administered to avoid further clot formation when VTE disorder is confirmed. At some point an adequate antithrombotic effect is achieved with heparin, oral anticoagulant such as warfarin is started to reduce the probability of recurrent VTE. Keywords: Venous thromboembolism, DVT, PE, D-dimer, anticoagulant.

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