scholarly journals Cystic Artery Pseudoaneurysm: Current Review of Aetiology, Presentation, and Management

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Seyed Mohammad Javad Taghavi ◽  
Mahendra Jaya kumar ◽  
Ramesh Damodaran Prabha ◽  
Harald Puhalla ◽  
Craig Sommerville
Keyword(s):  
Biliary Obstruction ◽  
Clinical Presentation ◽  
Case Reports ◽  
Open Cholecystectomy ◽  
Cystic Artery ◽  
High Index ◽  
Delayed Presentation ◽  
Management Options ◽  
Artery Pseudoaneurysm ◽  
High Index Of Suspicion

Background. Cystic artery pseudoaneurysms are rare. Most commonly, they occur secondary to acute cholecystitis or after a cholecystectomy. Complications include haemobilia, biliary obstruction, and haemorrhage. Given the rarity and associated morbidity, a high index of suspicion is required. This article reviews the current literature on cystic artery pseudoaneurysms to investigate its aetiology, clinical presentation, and management options. Methods. A broad search of the Medline and PubMed databases was carried through. All peer reviewed literatures published in the English language between 1991 and 2020 with keywords “cystic” and “artery” and “pseudoaneurysm” in the title were selected for review. No further exclusion criteria; all studies yielded from the search were included in the results of this review. Additionally, we present a case of cystic artery pseudoaneurysm treated at our centre and included this in our analysis. Results. Sixty-seven case reports were found between 1991 and 2020. Aetiologies: Aetiology of cystic artery pseudoaneurysm was found to be cholecystitis in 41 instances (61.2%), cholecystectomy in 18 instances (26.8%), idiopathic in 6 instances (8.9%) cholelithiasis in 1 instance (1.5%), and pancreatitis in 1 instance (1.5%). Complications: Fifty-two cases were complicated by haemobilia (77.6%), 36 by anaemia (53.7%), 25 by biliary obstruction (37.3%), 13 by haemodynamic shock (19.4%), 9 by haemoperitoneum (13.4%), and 6 by contained rupture (8.9%). Most commonly, patients had two or more of these complications. Management: Forty-four patients were managed with endovascular embolisation (65.7%), 21 with endoscopic intervention (31.3%), 18 with open cholecystectomy (26.9%), 13 with laparoscopic cholecystectomy (19.4%), and 6 with pseudoaneurysm ligation (9%). Delayed presentation postcholecystectomy ranged from 8 days to 3 years. Conclusions. Cystic artery pseudoaneurysms are rare complications of a common operation. The most common clinical presentation is haemobilia, which can be difficult to diagnose clinically. A high index of suspicion and prompt investigation with targeted imaging and intervention is required. This is especially pertinent in gastrointestinal bleeding postlaparoscopic cholecystectomy as a missed diagnosis could cause significant morbidity.

Recently Recognized Cases of Ophthalmofilariasis in Hungary

2009 ◽  
Vol 19 (4) ◽  
pp. 675-678 ◽  
Author(s):  
Eszter Fodor ◽  
Éva Fok ◽  
Erika Maka ◽  
Olga Lukáts ◽  
Jeanette Tóth*
Keyword(s):  
Clinical Presentation ◽  
High Index ◽  
Dirofilaria Repens ◽  
The Other ◽  
Slit Lamp ◽  
The Past ◽  
Red Eye ◽  
High Index Of Suspicion ◽  
Slit Lamp Biomicroscopy

Purpose To report four cases of zoonotic ophthalmodirofilariasis infection caused by Dirofilaria repens in Hungary. Methods Four cases of ophthalmofilariasis have been treated at our department during the last 14 months. A subconjunctival moving worm was observed by slit lamp biomicroscopy in two cases. In one of these a living filaria was surgically removed, but the other disappeared. Red eye and migrating edema were the presenting signs in two cases. A biopsy taken from the subcutaneous masses disclosed D repens. Results Histopathologic or parasitologic examination identified a female D repens in every case. Laboratory alterations were not found. Symptoms subsided after treatment. Conclusions The clinical presentation of filariasis is not always straightforward, and a high index of suspicion is necessary in cases presenting with orbital or periorbital inflammation. During the past 10 years the identification of locally acquired infections by D repens has increased in Hungary.

Current Treatment Recommendations for Leishmaniasis

1992 ◽  
Vol 26 (11) ◽  
pp. 1452-1455 ◽  
Author(s):  
Jeffrey T. Moss ◽  
James P. Wilson
Keyword(s):  
English Language ◽  
Clinical Presentation ◽  
Case Reports ◽  
Data Extraction ◽  
Treatment Options ◽  
Medical Personnel ◽  
Current Treatment ◽  
Treatment Modalities ◽  
Management Options ◽  
Governmental Institutions

OBJECTIVE: To review the epidemiology, clinical presentation, risk factors for transmission, and pathogenesis of leishmaniasis, as well as current treatment options for this disease. DATA SOURCES/DATA SELECTION: We reviewed unclassified medical-threat briefing material, subject-matter reviews, and case reports from the world's infectious disease literature. We concentrated on literature pertaining to the pathogenesis and management of leishmaniasis indigenous to Southwest Asia. DATA EXTRACTION: Data from subject reviews published in the English language were evaluated. Case reports and clinical trials provided supplemental data on evolving theories and management options. DATA SYNTHESIS: The clinical presentation of leishmaniasis is highly variable. Management relies heavily upon the use of parenteral antimonial drugs. Although these agents are effective in most cases, toxicity and the emergence of resistance limit the usefulness of standard therapies. Alternative treatment modalities include heat, surgical curettage, ketoconazole, metronidazole, pentamidine, rifampin, amphotericin B, aminoglycosides, allopurinol, and immunotherapy. CONCLUSIONS: Although the number of reported cases of leishmaniasis in the US has generally been low, there is a possibility that more cases may be reported in the future because of the large number of military personnel returning to this country from endemic areas. Medical personnel, particularly those working in governmental institutions, should be familiar with the pathogenesis of this unusual infection as well as potential treatment options.

Disseminated blastomycosis presenting as a neck mass

2000 ◽  
Vol 122 (2) ◽  
pp. 270-271 ◽  
Author(s):  
Kenneth R. Bergman ◽  
Peter Sorensen ◽  
Christopher Sinha
Keyword(s):  
United States ◽  
Clinical Presentation ◽  
Neck Mass ◽  
High Index ◽  
Blastomyces Dermatitidis ◽  
Dimorphic Fungus ◽  
Central United States ◽  
Uncommon Disease ◽  
High Index Of Suspicion

Blastomycosis is an uncommon disease caused by the dimorphic fungus Blastomyces dermatitidis. It is endemic to the central United States, especially the watersheds of the Mississippi, Missouri, and Ohio rivers. The clinical presentation of this disease often mimics that of malignancy, so a high index of suspicion must be present to avoid misdiagnosis. 1

scholarly journals Scrotal Ulcer is a Rare Presentationof TB Epididymis in Young Male

2021 ◽  
pp. 146-149
Author(s):  
Rekadi Srinivasa Rao ◽  
Senthil Kumar ◽  
R. Anantharamakrishnan ◽  
P. Varadaraju
Keyword(s):  
Case Report ◽  
Early Diagnosis ◽  
Clinical Presentation ◽  
Young Male ◽  
High Index ◽  
History Of ◽  
Scrotal Swelling ◽  
High Index Of Suspicion

Introduction: Scrotal tuberculosis (TB) is rare and may present as painful scrotal swelling with ulceration and discharging sinus. Case Report: A 28 years male with 2 months history of swelling and pain over left scrotum. Developed ulcer over the scrotal region with multiple sinus associated with pus discharge. Conclusion: The clinical presentation of TB scrotal ulcer can be atypical and a high index of suspicion is required for early diagnosis. Diagnosis is by using ultrasonography, microbiology, and biopsy. Treatment requires prolonged ATT for 6 months.

scholarly journals Clozapine-induced liver injury and pleural effusion

2014 ◽  
Vol 6 (2) ◽  
pp. 36-37
Author(s):  
Joseph P.M. Kane ◽  
Francis A. O'Neill
Keyword(s):  
Pleural Effusion ◽  
Liver Injury ◽  
Liver Enzymes ◽  
Clinical Symptoms ◽  
Acute Liver Injury ◽  
Case Reports ◽  
High Index ◽  
Documented Case ◽  
High Index Of Suspicion ◽  
Symptoms And Signs

Clozapine, whilst associated commonly with a transient and benign increase in liver enzymes, has also been associated with varying presentations of hepatitis in existing case reports. This report describes what we believe to be the first documented case of acute liver injury and pleural effusion associated with clozapine, resolving after cessation of the agent. The case supports existing literature in advocating a high index of suspicion, particularly in the 4-5 weeks following clozapine initiation, when considering nonspecific clinical symptoms and signs.

Ectopic Pregnancy - A 1 Year Clinical Study in King George Hospital, Visakhapatnam

2021 ◽  
Vol 8 (27) ◽  
pp. 2457-2461
Author(s):  
Vamsi Mudadla ◽  
Shyamala Kaitala ◽  
Satyavani Nandigama
Keyword(s):  
Risk Factors ◽  
Early Diagnosis ◽  
Ectopic Pregnancy ◽  
Clinical Presentation ◽  
Tertiary Care ◽  
High Index ◽  
Diagnostic Methods ◽  
Obstetric Emergency ◽  
King George Hospital ◽  
High Index Of Suspicion

BACKGROUND Ruptured ectopic is a life threatening obstetric emergency. Obstetrician must have a high index of suspicion for ectopic pregnancy and should be aware of importance of early diagnosis and early intervention. The present study was undertaken to evaluate the incidence, clinical presentation, risk factors, treatment and morbidity associated with ectopic pregnancy. METHODS Retrospective analysis of ectopic pregnancy was done in King George Hospital, Visakhapatnam from January 2020 to December 2020 in the department of OBG. The following parameters: Age, risk factors, clinical presentation, site of ectopic, diagnostic methods, mode of treatment were noted. RESULTS A total of 63 cases were reported during this time frame. It is a tertiary care centre getting referrals from nearby districts and other hospitals. Incidence of ectopic pregnancy in the present study is 0.89 %. 41.26 % of patients belonged to age group between 26 to 30 years. Out of 63 cases 49.20 % were multigravida. 28 % of the cases were associated with previous H/O abortions and 23 % of the cases were associated with PID and in 17.4 % of the cases there was no predisposing factors. 96.82 % the patients presented with pain abdomen. Shock in 34.92 % of the cases. Ampulla is the most common site of ectopic. In 76 % of the cases there was hemoperitoneum > 500 ml. Salpingectomy was done in 79.3 % cases. 84 % of cases required blood transfusion > 1 unit. There was no mortality. CONCLUSIONS Ectopic pregnancy is one of the obstetric emergency with significant morbidity and mortality. PID and post abortal sepsis are one of the important risk factors for ectopic pregnancy. As many patients may not have recognizable risk factors, a high index of suspicion is critical for early diagnosis. Early USG diagnosis of ectopic pregnancies reduces mortality and enables us to offer the patient conservative medical and surgical treatment. KEYWORDS Ectopic Pregnancy, TVS, Ampulla, Salpingectomy

scholarly journals COVID-19 Myocarditis Clinical Presentation, Diagnosis and Management: A Narrative Review

2021 ◽  
Vol 1 (1) ◽  
pp. 135-150
Author(s):  
Elie Al Zaghrini ◽  
Nancy Emmanuel ◽  
Victor Zibara ◽  
Wael Terro ◽  
Samia Hanna
Keyword(s):  
Cardiovascular System ◽  
Clinical Presentation ◽  
Treatment Guidelines ◽  
Case Reports ◽  
Narrative Review ◽  
Current Understanding ◽  
Medical Community ◽  
Management Options ◽  
Diagnosis And Management ◽  
Novel Coronavirus

Objective: The purpose of this article is to review the cases of myocarditis in COVID-19 patients and synthesize the current understanding regarding the presentation, diagnosis, and management of myocarditis in the setting of COVID-19 disease. Background: The novel coronavirus disease has shown serious implications for the cardiovascular system, including acute myocardial injury, arrhythmias, venous thromboembolism, and myocarditis. Several cases of myocarditis in COVID-19 patients have been reported since the disease's emergence at the end of 2019. The diagnostic approach and management have been variable. The purpose of this narrative review is to gather the most reliable published material regarding myocarditis in COVID-19 and present it as an overview to simplify the current understanding we have of this disease. Methods: We screened PubMed, Scopus, and Embase. We then selected peer-reviewed and pre-print articles published in English that were related to the involvement of the cardiovascular system in COVID-19, with a focus on myocarditis. We included case reports describing myocarditis in COVID-19 patients and summarized their clinical presentation, diagnosis, and management. References of the selected articles were also screened, and some were included when relevant. Discussion: This article is subdivided into sections that discuss the clinical presentation of COVID-19 myocarditis and move on to various diagnostic approaches and management options. Each subsection presents a brief literature review followed by a summary and interpretation of what was found in the reported cases. Conclusion: After noticing the involvement of the cardiovascular system in COVID-19 patients, specifically through myocarditis, we present this narrative review to provide the medical community with a unified article regarding the current understanding of myocarditis in COVID-19 patients. This article further stresses the necessity of establishing proper treatment guidelines for COVID-19 myocarditis.

scholarly journals Chronic umbilical abscess secondary to a patent urachus in a 30 years male: a case report

2021 ◽  
Vol 8 (9) ◽  
pp. 2845
Author(s):  
Akula Nynasindhu ◽  
Swetana Palavalasa
Keyword(s):  
Case Report ◽  
Urinary Bladder ◽  
Ct Scan ◽  
Regional Anaesthesia ◽  
Clinical Presentation ◽  
Adult Population ◽  
High Index ◽  
Patent Urachus ◽  
Urachal Sinus ◽  
High Index Of Suspicion

Urachus is epithelialized, fibromuscular remnant part connecting urinary bladder with umbilicus. Urachal anomalies present and progress differently in paediatric and adult population. They remain largely asymptomatic until infected. Clinical presentation may vary from simple discharge from umbilicus to intrabdominal abscess and peritonitis. We present a case of urachal sinus presenting as recurrent umbilical abscess. 30 years male presented with complaints of umbilical mass with pus discharge. He was evaluated clinically and radiologically. Ultrasound revealed a localized collection near umbilicus whereas CT scan revealed connection of that collection to a fibrous strand like structure approximately 10 cm extending from umbilicus to urinary bladder. An open exploration was done under regional anaesthesia and 20 ml of abscess drained with excision of tract by ligating near the bladder end. Local debridement was done near the umbilical area. Wound closed in layers. Post-op period was uneventful without any recurrence. urachal anamolies need a high index of suspicion in adults to intervene early and get better outcomes with less morbidity.

Impact of HIV-1 infection on the clinical presentation of syphilis in men who have sex with men

Sexual Health ◽  
2015 ◽  
Vol 12 (2) ◽  
pp. 110 ◽  
Author(s):  
Craig Tipple
Keyword(s):  
At Risk ◽  
Clinical Features ◽  
Clinical Presentation ◽  
High Index ◽  
Sexually Transmissible Infections ◽  
Sex With Men ◽  
High Index Of Suspicion ◽  
Hiv 1

Men who have sex with men (MSM), especially those with HIV-1 infection, are disproportionately affected by syphilis in higher income countries. The course, and some of the clinical features of the disease, especially the development of neurosyphilis, can be affected by HIV-1 co-infection. This review documents potential differences in the clinical features of syphilis in HIV-1 infected and uninfected MSM and highlights the importance of a thorough examination and high index of suspicion when seeing and treating MSM at risk of sexually transmissible infections.

Palmar Dislocations of the 5th Carpometacarpal Joint: Case Report of a Rare Injury and Review of Published Cases

2020 ◽  
Vol 25 (03) ◽  
pp. 368-372
Author(s):  
Zhixue Lim ◽  
Sandeep Jacob Sebastin
Keyword(s):  
Case Report ◽  
Closed Reduction ◽  
Case Reports ◽  
High Index ◽  
Carpometacarpal Joint ◽  
Rare Injury ◽  
Delay In Diagnosis ◽  
High Index Of Suspicion

Isolated palmar dislocation of the 5th carpometacarpal joint (CMCJ) is a rare injury that can be easily missed and requires a high index of suspicion to detect. We report a case of an initially missed isolated ulnopalmar dislocation of the 5th CMCJ and a summary of other published case reports comparing methods of fixation and outcomes. We conclude that a delay in diagnosis will significantly reduce the chances of successfully managing this injury via closed reduction.

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