scholarly journals Microgallbladder: Self-Remitting Acute Cholecystitis-Like Condition Unique to Patients with Cystic Fibrosis

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Mina S. Mousa ◽  
John C. Feldman ◽  
Paresh Mahajan
Keyword(s):  
Cystic Fibrosis ◽  
Acute Cholecystitis ◽  
Hospital Admissions ◽  
Surgical Intervention ◽  
Medical Condition ◽  
Imaging Finding ◽  
Chronic Abdominal Pain ◽  
Duct Obstruction ◽  
Water Efflux ◽  
History Of

Microgallbladder is a nonsurgical medical condition characterized by chronic inflammation and atrophy of the gallbladder, which is considered a highly specific imaging finding unique to patients with cystic fibrosis (CF), and has been incidentally reported on abdominal imaging in up to 45% of cases with CF. The impairment of exocrine water efflux in CF leads to the production of hyperviscous biliary secretions, cholestasis, and transient cystic duct obstruction of the microgallbladder causing microcholecystitis—interestingly a self-remitting acute cholecystitis-like condition without surgical intervention. We present a case report of a 22-year-old male patient with history of CF with multiple hospital admissions for unexplained chronic abdominal pain found to be caused by microgallbladder, which was managed conservatively.

scholarly journals Y Shaped Colonic Duplication Mimicking Intestinal Volvulus: A Case Report and Review of Literature

2021 ◽  
Author(s):  
Volkan Sarper Erikçi
Keyword(s):  
Abdominal Pain ◽  
Hospital Admissions ◽  
Surgical Intervention ◽  
Relevant Literature ◽  
Clinical Findings ◽  
Definitive Diagnosis ◽  
Chronic Abdominal Pain ◽  
Review Of Literature ◽  
Colonic Duplication ◽  
Intestinal Volvulus

Enteric duplications are rare congenital anomalies found anywhere from mouth to anus. Colonic duplications constitute about 13% of all enteric duplications. In this report a 6-year-old boy with chronic abdominal pain for a duration of last 2 years requiring intermittent hospital admissions was diagnosed as colonic duplication mimicking intestinal volvulus. Clinical findings are nonspecific and definitive diagnosis can only be made during surgical intervention and surgical treatment is advocated for all duplications. The topic is discussed under the light of relevant literature with a brief a brief literature review.

Factors Influencing the Need for Endoscopic Sinus Surgery in Adult Patients with Cystic Fibrosis

2017 ◽  
Vol 31 (1) ◽  
pp. 44-47 ◽  
Author(s):  
Christopher D. Brook ◽  
Alice Z. Maxfield ◽  
Hena Ahmed ◽  
Ahmad R. Sedaghat ◽  
Eric H. Holbrook ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Surgical Intervention ◽  
Hazard Analysis ◽  
Adult Patients ◽  
Sinus Surgery ◽  
Proportional Hazard ◽  
Cox Proportional Hazard ◽  
Severe Mutation ◽  
History Of ◽  
Snot 22

Background Risk factors in adult patients with cystic fibrosis (CF) associated with surgical intervention have not been delineated. Objective To identify characteristics of adult patients with CF and with chronic rhinosinusitis that predict surgical intervention with endoscopic sinus surgery (ESS). Methods Patients were identified in a tertiary sinus center by the International Classification of Diseases, Ninth Revision codes 277.00-277.03, which represent CF. Charts were reviewed for the CF transmembrane conductance regulator (CFTR) gene mutation, Lund-Mackay score (LMS), the 22-item Sino-Nasal Outcome Test (SNOT-22) score, previous ESS, and occurrence of ESS after presentation. The Fisher exact test was used to test frequency of events between the groups, and the Mann Whitney U test and the t-test were used to compare means among LMS, SNOT-22, and age. The Cox proportional hazard analysis was used to calculate hazard ratios (HR) for the impact of LMS, SNOT-22 score, previous ESS, and CFTR gene mutation status on the occurrence of ESS after presentation. Results One hundred and fifteen patients met the inclusion criteria for the study. Patients with a history of surgery more often underwent ESS after presentation (p ≤ 0.01). The LMS and the SNOT-22 score were not significantly different between the groups of previous ESS and no previous ESS (p = 0.23 and p = 0.28, respectively). A severe mutation genotype was predictive of ESS after presentation (p = 0.03). SNOT-22 scores did not differ between the severe and mild groups (36.0 and 32.4, respectively; p = 0.57), but the mean LMS was significantly higher in the severe mutation group (12.5 and 9.7; p ≤ 0.01). Univariate Cox proportional hazard analysis revealed an increased occurrence of ESS for patients with severe mutations (HR, 3.6; p ≤ 0.01) or a history of ESS (HR, 2.3; p ≤ 0.01). Conclusion The occurrence of ESS in adult patients with CF was predicted by previous ESS intervention as well as the severity of CFTR mutation.

P-BN29 Laparoscopic cholecystectomy during the era of a Covid-19 pandemic; a cohort study

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Sian Davies ◽  
Nadar Ghassemi ◽  
Ning Yi Lo ◽  
Sneha Rathod ◽  
Alex Carney ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Length Of Stay ◽  
Acute Cholecystitis ◽  
Hospital Admissions ◽  
Surgical Intervention ◽  
Gallstone Disease ◽  
Good Practice ◽  
Control Group ◽  
Biliary Disease ◽  
Readmission Rates

Abstract Background The Covid-19 era has created a lot of uncertainty for management of common emergency and elective surgical conditions such as acute cholecystitis and other gallstone disease related emergency admissions. At our centre we continued to provide early operative intervention for patients presenting with biliary disease and acute cholecystitis throughout the Covid-19 era during both the 1st and the 2nd waves, despite a significant local surge in Covid-19 hospital admissions impacting on the available resources. Here we present the outcomes of our experience of managing such patients during the Covid-19 pandemic of 2020 of both 1st and 2nd waves. Methods A retrospective observational study was performed on all patients presenting with acute cholecystitis and biliary disease who underwent elective and emergency surgical intervention at UHNM (University Hospital of North Midlands) during the second wave of the Covid pandemic (2nd CW) between 14/10/2020 and 14/01/2021). These were then compared with patients who presented in the first Covid wave (1st CW) of 1/03/020 – 30/06/2020,) and a control group pre-covid (CG) 1/03/2019 – 30/06/2019, Patients were identified using ICD-10 codes K80 (Cholelithiasis) and K81 (Cholecystitis) and OPCS codes.J18.1 – J18.5. Primary endpoints were length of stay, 30 day readmission rates, mortality and morbidity. Results A total of 146 patients were identified who underwent laparoscopic cholecystectomy during the study time period (2ndCW). In comparison to 104 patients during the first covid wave cohort (1st CW) and the control group (CG) of 217 patients in the preceding non covid year. Length of stay (LOS) was significantly lower in the 2ndCW cohort in comparison to both the previous 1st CW cohort and the CG cohort (p < 0.0001), with readmissions also being statistically lower (5% vs 15% and 12% respectively p = 0.027). There was no statistical difference in outcomes for post-operative complications as per Clavien-Dindo classification. Conclusions Overall our study demonstrates that the recommended good practice of early surgical intervention in both emergency and elective gallstone disease can continue during the pandemic periods without any significant impact on patient care & outcomes. Also during this period length of stay was significantly shorted and lower 30 day readmission rates which are likely to be multifactorial but where lessons could be potentially learnt.

scholarly journals Medical Image of the Month: Perforated Gangrenous Cholecystitis

2021 ◽  
Vol 22 (5) ◽  
pp. 100-101
Author(s):  
Lauren Blackley ◽  
◽  
Madhav Chopra ◽  
Tammer El-Aini
Keyword(s):  
Acute Cholecystitis ◽  
Hospital Admissions ◽  
Open Cholecystectomy ◽  
Antibiotic Administration ◽  
Intravenous Contrast ◽  
Methamphetamine Use ◽  
Rebound Tenderness ◽  
Gangrenous Cholecystitis ◽  
History Of ◽  
Pericholecystic Abscess

No abstract available. Article truncated after 150 words. Clinical Scenario: A 47-year-old lady with a past medical history of hypertension, DVT on Xarelto, and methamphetamine use presented with a 3-day history of progressive right upper quadrant pain. Physical examination demonstrated marked right upper quadrant tenderness with palpation and significant rebound tenderness. A CT of the abdomen and pelvis without intravenous contrast demonstrated findings consistent with acute calculus cholecystitis with evidence of perforation and a pericholecystic abscess. The patient was taken emergently to the operating room where she underwent an open cholecystectomy which demonstrated perforated gangrenous cholecystitis with a large abscess in the gallbladder fossa. She was admitted to the ICU post-operatively due septic shock and did well with fluid resuscitation and antibiotic administration. Discussion: Acute cholecystitis is the most common acute complication of cholelithiasis and accounts for 3-9% of hospital admissions for acute abdominal pain. Eight to 95% of cases of acute cholecystitis are the result of a …

Omental Infarction: A Case Treated with Laparoscopic Surgery

2019 ◽  
pp. 1-3
Author(s):  
Bertrand Ng ◽  
Arafat Yasser
Keyword(s):  
Diabetes Mellitus ◽  
Laparoscopic Surgery ◽  
Hospital Stay ◽  
Acute Cholecystitis ◽  
Inflammatory Markers ◽  
Acute Onset ◽  
Laparoscopy Surgery ◽  
History Of ◽  
Background History ◽  
The Right

Omental infarct is a rare cause of an acute abdomen that arises from an interruption of blood supply to the omentum. Here, we present a case of omental infarct in a 67-year-old gentleman with background history of diabetes mellitus who present unusually with a severe acute onset right hypochondrium pain. Examination revealed that he was tender to touch at the right and was having localized guarding. His inflammatory markers were normal. He was successfully treated with laparoscopy surgery and he was subsequently discharged the following day. Omental infarct cases with right hypochondrium pain can sometimes mimicked acute cholecystitis and management includes laparoscopic surgery which can hasten symptoms resolution and reduces hospital stay, however recommendation for surgery has to be balanced with anesthetics risk and complication of the surgery itself.

Rhinosinusitis in the Pediatric Patient with Cystic Fibrosis

2014 ◽  
Vol 10 (3) ◽  
pp. 198-201 ◽  
Author(s):  
Christopher Fundakowski ◽  
Rosemary Ojo ◽  
Ramzi Younis
Keyword(s):  
Cystic Fibrosis ◽  
Autosomal Recessive ◽  
Pediatric Patients ◽  
Surgical Intervention ◽  
Chronic Sinusitis ◽  
Genetic Disorder ◽  
Symptomatic Relief ◽  
Recurrence Rates ◽  
Polyp Recurrence ◽  
Sinonasal Polyposis

Cystic fibrosis (CF) is a common autosomal recessive genetic disorder where a deletion mutation and subsequent downstream alteration in transmembrane regulator proteins results in increased mucus viscosity. CF manifests clinically with chronic multisystem inflammation and recurrent infections. Nearly all children with CF have chronic sinusitis, and a large majority will have concurrent sinonasal polyposis. Chronic sinusitis and sinonasal polyposis in pediatric patients with CF can be managed conservatively initially, though most will fail medical management and require surgical intervention. Unfortunately, symptom resolution is marginal and polyp recurrence rates are high. Currently, no cure exists for CF and the mainstay of treatment is to provide symptomatic relief, and minimize disease morbidity.

scholarly journals Clinical Profile of Acute Poisoning in Children at a Teaching Hospital in Lalitpur

2014 ◽  
Vol 34 (2) ◽  
pp. 100-103 ◽  
Author(s):  
Ajaya Kumar Dhakal ◽  
D Shrestha ◽  
A Shakya ◽  
SC Shah ◽  
H Shakya
Keyword(s):  
Teaching Hospital ◽  
Hospital Admissions ◽  
Acute Poisoning ◽  
Childhood Mortality ◽  
Age Group ◽  
Common Cause ◽  
Mortality And Morbidity ◽  
History Of ◽  
The Common ◽  
Poisoning In Children

Introduction: Acute poisonings are one of the common cause of emergency visits and hospital admissions and is potentially preventable cause of childhood mortality and morbidity. The objectives of this study were to identify the common type of poisoning in children, to determine types of poisoning according to age and to find out the common age group in which the incidence of poisoning was high.Materials and Methods: It was a descriptive observational study done in a teaching hospital in Lalitpur, Nepal in patients aged 1 month to 18 years who visited the emergency department and were admitted to hospital with history of alleged poisoning from 2009 July to 2014 January.Results: Fifty patients were included. Drugs, kerosene and organophosphorus were most common cause of poisoning. Drugs and kerosene below 10 years of age and organophosphorus and drugs above 10 years of age were common types of poisoning. Maximum numbers (50%) of children with poisoning cases were below five year of age. Mean duration of hospital stay was 2.1days and mean age of poisoning was 7.8 years with a male(54%) predominance. Majority of poisoning occurred at home (84%) and 68% of patients were symptomatic at presentation to hospital with 84% of patients presenting to hospital within six hours.Conclusion: This study showed that drugs, kerosene and organophosphorus were most common forms of poisoning. Young children were most vulnerable for acute poisoning.DOI: http://dx.doi.org/10.3126/jnps.v34i2.10139J Nepal Paediatr Soc 2014;34(2):100-103 

scholarly journals Association between severity of prenatally diagnosed hydronephrosis and receipt of surgical intervention postnatally among patients seen at a fetal-maternal center

BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zoë G. Baker ◽  
Arthi Hannallah ◽  
Melissa Trabold ◽  
Danielle Estell ◽  
Cherry Deng ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Renal Scarring ◽  
Tertiary Care ◽  
Rank Test ◽  
Kaplan Meier ◽  
Hazard Ratios ◽  
Age At Surgery ◽  
History Of ◽  
Pediatric Urologist ◽  
Tract Infections

Abstract Background Hydronephrosis (HN) is the most common abnormality detected on prenatal ultrasound. This study sought to stratify outcomes of patients by severity of prenatal HN with postnatal outcomes. Methods This was a retrospective review of patients referred to a tertiary care fetal-maternal clinic with diagnosis of prenatal HN from 2004 to 2019. HN severity was categorized as mild, moderate, or severe. Data were analyzed to determine the association between HN severity and surgical intervention. Decision for surgery was based on factors including history of multiple urinary tract infections, evidence of renal scarring, and/or reduced renal function. Surgery-free survival time was represented by the Kaplan–Meier method, and hazard ratios were calculated using the log-rank test. Results 131 kidneys among 101 infants were prenatally diagnosed with hydronephrosis; 35.9% had mild HN, 29.0% had moderate HN, and 35.1% had severe HN. 8.5% of patients with mild HN, 26.3% of patients with moderate HN, and 65.2% of patients with severe HN required surgery. Patients with severe HN were 12.2 (95% CI 6.1–24.4; p < 0.001) times more likely to undergo surgery for HN than patients with mild HN and 2.9 (95% CI 1.5–5.3; p = 0.003) times more likely to undergo surgery than patients with moderate HN. Patients with moderate HN were 4.3 times more likely to require surgery than patients with mild HN (95% CI 1.5–12.9; p = 0.01). Median age at surgery was 11.8 months among patients with mild HN (IQR 11.7–14.1 months), 6.6 months among patients with moderate HN (IQR 4.2–16.4 months), and 5.4 months among patients with severe HN (3.7–12.4 months). Conclusion Among this cohort of referrals from a fetal-maternal clinic, severity of HN correlated with increased likelihood of surgical intervention. Continued assessment of patients with prenatal HN should be evaluated to best determine the role of the pediatric urologist in cases of prenatal HN.

scholarly journals Posterior Fossa Arachnoid Cyst Masking a Delayed Diagnosis of Hyperparathyroidism in a Child

2012 ◽  
Vol 2012 ◽  
pp. 1-4
Author(s):  
B. Dhamija ◽  
D. Kombogiorgas ◽  
I. Hussain ◽  
G. A. Solanki
Keyword(s):  
Differential Diagnosis ◽  
Primary Hyperparathyroidism ◽  
Posterior Fossa ◽  
Arachnoid Cyst ◽  
Hospital Admissions ◽  
Delayed Diagnosis ◽  
Visual Disturbance ◽  
Organ Damage ◽  
Presenting Symptoms ◽  
History Of

Background. Primary hyperparathyroidism in childhood is a very rare entity, often being diagnosed late after the onset of its presenting symptoms. It most commonly affects patients in their fourth decade of life and beyond. The inclusion of primary hyperparathyroidism in the differential diagnosis is necessary when evaluating patients presenting with nonspecific symptoms such as polyuria, fatigue, weight loss, abdominal pain, nausea, and vomiting.Methods. We report the case of an eleven-year-old girl presenting with three years history of headaches, visual disturbance, along with episodes of emotional lability. Neuroimaging confirmed a large posterior fossa arachnoid cyst. It was decided to manage this lesion conservatively with surveillance. Only after further hospital admissions with recurrent loss of consciousness, dizziness, and nausea to add to her already existing symptoms, a full biochemical and endocrine assessment was performed to look for more specific causes for her presentation. These pointed to a diagnosis of primary hyperparathyroidism.Conclusions. The inclusion of primary hyperparathyroidism in the differential diagnosis should be considered when evaluating paediatric patients presenting with nonspecific (neurological, gastrointestinal, and renal) symptoms in order to establish a prompt diagnosis of the disorder and to avoid severe complications of prolonged hypercalcaemia and end-organ damage.

Significance of Positive and Negative Syndromes in Chronic Schizophrenia

1986 ◽  
Vol 149 (4) ◽  
pp. 439-448 ◽  
Author(s):  
S. R. Kay ◽  
L. A. Opler ◽  
A. Fiszbein
Keyword(s):  
Hospital Admissions ◽  
Chronic Schizophrenia ◽  
Strongly Correlated ◽  
General Psychopathology ◽  
Developmental Impairment ◽  
Schizophrenic Patients ◽  
History Of ◽  
Patient Stay ◽  
Negative Syndrome

Positive and negative syndromes were studied in relation to demographic, historical, genealogical, clinical, psychometric, extrapyramidal, and follow-up measures of 101 chronic schizophrenic patients. The criterion scales proved to be reliable, normally distributed, and strongly correlated with general psychopathology, but otherwise inversely related to one another. Multiple regression analysis identified sets of 4–6 independent variables that explained 74%-81 % of the scales' variance. A positive syndrome was associated chiefly with productive features, family history of sociopathy, more previous hospital admissions, and longer in-patient stay during the 30-month follow-up period. A negative syndrome correlated with deficits in cognitive, affective, social, and motor spheres, higher incidence of major psychiatric illness but less affective disorder among relatives, lower education, and greater cognitive developmental impairment. The results underscore the importance of genetic and biodevelopmental variables for understanding schizophrenic syndromes.

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