Acute exudative paraneoplastic polymorphous vitelliform maculopathy in a patient with thymoma, myasthenia gravis, and polymyositis

2021 ◽  
pp. 112067212199404
Author(s):  
He Yu ◽  
Xinyu Ma ◽  
Nianting Tong ◽  
Zhanyu Zhou ◽  
Yu Zhang
Keyword(s):  
Myasthenia Gravis ◽  
Medical Center ◽  
Postoperative Radiotherapy ◽  
Clinical Manifestations ◽  
Subretinal Fluid ◽  
Metastatic Tumor ◽  
The Body ◽  
Pleural Thickening ◽  
History Of ◽  
Clinically Significant

Importance: This is the first reported case of acute exudative paraneoplastic polymorphous vitelliform maculopathy (AEPPVM) in a patient with thymoma, accompanied by myasthenia gravis (MG) and polymyositis. Objective: To examine the pathogenesis of ocular disease in a patient with yolk-like fundus lesions and thymoma, MG, and polymyositis throughout the body based on clinical manifestations, diagnosis, differential diagnosis, and genetic testing to determine the appropriate treatment course. Design, setting, and participants: We describe a 63-year-old woman who presented to our tertiary medical center with a 3-month history of reduced visual acuity in both eyes. Concurrent fundoscopy revealed a 2.0 × 1.7-mm, unifocal, yellow, round vitelliform lesion in the macular region, surrounded by multifocal, shallow, yellow-white pockets of subretinal fluid. The patient’s medical history included thymoma with thymectomy treatment, combined with pericardiectomy and postoperative radiotherapy (20 years prior), followed by a diagnosis of MG with suspect thymic association (15 years prior). Three years prior, the patient had been diagnosed with polymyositis related to paraneoplastic syndrome; 1 year prior, she had been examined for pleural thickening due to suspected metastatic tumor. Results: On her most recent follow-up visit at 3 months after initial diagnosis, the patient was stable with no clinically significant progression in ocular or systemic conditions.

The Incidence and Nature of Adverse Reactions during Intravenous Acetylcysteine Therapy for Acetaminophen Overdose

2000 ◽  
Vol 16 (2) ◽  
pp. 47-49 ◽  
Author(s):  
Matitiahu Lifshitz ◽  
Perez Kornmehl ◽  
Haim Reuveni
Keyword(s):  
Adverse Drug Reactions ◽  
Adverse Reactions ◽  
Medical Center ◽  
Clinical Manifestations ◽  
Cost Benefit ◽  
Maculopapular Rash ◽  
Oral Formulation ◽  
Drug Reactions ◽  
Acetaminophen Overdose ◽  
History Of

Objective: To determine the incidence of adverse drug reactions in patients with acetaminophen overdose following administration of intravenous acetylcysteine, and to evaluate the cost-benefit ratio of intravenous compared with oral acetylcysteine therapy. Methods: The incidence of adverse drug reactions to intravenous acetylcysteine therapy was studied retrospectively in all patients with acetaminophen overdose who were admitted to Soroka University Medical Center, Beer-Sheva, Israel, from 1994 to 1998. Data were obtained from hospital records. All patients were treated with a 20-hour intravenous regimen according to the Prescott protocol. Special attention was paid to the clinical manifestations of adverse reactions, time of onset, and history of patient allergy and asthma. Cost of therapy (drug prices, hospital per diems) for intravenous versus oral acetylcysteine administration was evaluated in accordance with average rates prevailing in Israel in December 1998. Results: Ninety-two patients, 32 adolescents aged 12–18 years (mean ± SD 14.2 ± 1.9) and 60 adults aged 18–52 years (28.2 ± 3.2), were treated with intravenous acetylcysteine for acetaminophen overdose during the study period. Three patients (3.2%) developed adverse reactions: one adult presented with a maculopapular rash and pruritus, and two adolescents developed mild urticaria; no other adverse reactions were reported. All adverse reactions occurred during administration of the loading dose, 15–20 minutes after initiation of therapy. The reactions subsided a few hours after the acetylcysteine infusion was stopped and did not require antiallergy therapy. None of the three patients had a history of allergy. The 20-hour intravenous acetylcysteine protocol is approximately three times less expensive than the recommended oral regimen in terms of drug cost and length of hospitalization. Conclusions: Intravenous acetylcysteine is a relatively safe antidote for acetaminophen poisoning. The incidence rate of adverse reactions is low, and they are mild and easily controlled by termination of the infusion. We recommend intravenous acetylcysteine therapy, particularly for patients with vomiting caused by the acetaminophen overdose or by oral acetylcysteine therapy. The 20-hour intravenous acetylcysteine therapy has a cost-benefit advantage over oral therapy; however, the oral formulation is not approved by the FDA.

scholarly journals Editorial

2005 ◽  
Vol 22 (2) ◽  
pp. i-iv
Author(s):  
Katherine Bullock
Keyword(s):  
Arab World ◽  
Medical Center ◽  
Knowledge Society ◽  
The Body ◽  
Modern World ◽  
Ibn Sina ◽  
Muslim Countries ◽  
The Face ◽  
History Of ◽  
Independent Thought

As Mehmet Mahfuz Söylemez documents in his “The Jundishapur School:Its History, Structure, and Functions,” Southwest Asia has long been a sitefor a cross-fertilization of ideas that have led to productive societies.Although Jundishapur’s excellence as a medical center predates the comingof Islam, it nevertheless played a key role in transmitting knowledge toMuslim physicians as well as contributing to Baghdad’s development as anup-and-coming center of excellence. In an open and welcoming climate,the scholars and physicians of Jundishapur and Baghdad fostered a learningenvironment that allowed Muslim civilizations to flourish.Today’s Muslims often look back to such “golden ages” with wistfulness,admiration, and frustration. Given the constant defeats and subjugationfaced by Muslim countries since western colonization, this wistfulness is notsurprising. In order to bolster their identity to defend themselves against thiscontinuing subjugation, Muslims often offer this glorious past to anIslamophobic world: “We are not barbarians! See what Muslim civilizationwas capable of!” And in the face of Eurocentric curricula that largely denyany role to a non-European civilization in the history of ideas since Plato,such reminders are crucial.But as Dieter Weiss’ “Paths toward an Arab Knowledge Society” inadvertentlyhighlights, such wistfulness is underscored by an ignorance of justwhat it takes to produce a golden age. For a society to flourish, it must createthe conditions that enable its inhabitants to engage in knowledge creation:the freedom to think, debate, and discuss. While he focuses only onthe Arab world, one would have to be blind to reality not to realize that thesame deplorable situation can be found in most Muslim countries today.Imagine what kind of Muslim cultural and political society must haveexisted for Ibn Sina, who produced great medical and philosophical workswhile denying the resurrection of the body. Compare that with the assassinations,death threats, and the like facing contemporary writers who engagein independent thought about Islam and the modern world. Think of the roleof caliph Ma’mun’s bayt al-hikmah (House of Wisdom), where Christians,Muslims, and scholars who followed other religions worked side-by-side to ...

Clinically significant mind–body interactions: evolutionary history of the scientific basis

2017 ◽  
Author(s):  
Mira Lal
Keyword(s):  
Psychosomatic Medicine ◽  
Historical Context ◽  
Scientific Basis ◽  
The Body ◽  
Clinical Practices ◽  
History Of ◽  
Clinically Significant ◽  
Key Aspects ◽  
William Osler

Mind-body interactions enshrined in the psychosomatic approach, encompass the psyche (mind) and the soma (body). They can result in obstetric and gynaecological disease conditions with clinically significant morbidity. Relevant psychosomatic understanding facilitates appropriate management. Chapter 1 discusses the anatomical, physiological, and pathological basis of clinical psychosomatic obstetrics and gynaecology, explores ancient medical practices throughout Asia and Europe, the change in approaches since the seventeenth century, and the future of psychosomatic medicine. Tracing medical history from ancient times shows the importance of time-tested methods of physical and mental assessments of patients by using good clinical observation, and appropriate knowledge for treating illnesses. Records of the clinical practices of Hippocrates, Soranus, and William Osler retell the medical philosophy, and ethics behind promoting healing of the body that could also involve restoring a healthy mind. By analysing the historical context of psychosomatic medicine, Chapter 1 brings into focus the rationale behind developing psychosomatic awareness in healthcare, and the fundamentals and basis of related healthcare. It introduces key aspects of psychosomatic medicine that feature in current practice, such as understanding the neuroendrocrinological milieu, which regulates the physiological changes from puberty to the menopause, and generates emotions, behaviour patterns or pain either generalised or specific, as when in labour. Psychosomatic issues will challenge futuristic clinicians' managing women's diseases.

scholarly journals Congenital Anomalies of the Kidney and Urinary Tract in Children with Congenital Heart Defects

2020 ◽  
Vol 45 (2) ◽  
pp. 307-313
Author(s):  
Dapeng Jiang ◽  
Qi Wang ◽  
Zhengzhou Shi ◽  
Jie Sun
Keyword(s):  
Urinary Tract ◽  
Congenital Heart Defects ◽  
Congenital Anomalies ◽  
Congenital Heart ◽  
Medical Center ◽  
Heart Defects ◽  
Clinical Manifestations ◽  
Number Of Patients ◽  
Significant Difference ◽  
History Of

Background/Aims: To investigate the incidence and clinical characteristics of congenital anomalies of the kidney and urinary tract (CAKUT) in children with congenital heart defects (CHD). Methods: We retrospectively analyzed the clinical data of children with CHD with CAKUT admitted to the Shanghai Children’s Medical Center affiliated with the Shanghai Jiao Tong University School of Medicine between September 2018 and March 2019. Patients underwent routine examinations for liver, kidney, and coagulation function, and urinary tract ultrasonography, and we summarized patients’ clinical manifestations and imaging abnormalities. Results: A total of 1,410 children with CHD were diagnosed and treated in our hospital. The total number of patients with abnormal urogenital systems was 104, and hydronephrosis was the most common abnormality, followed by vesicoureteral reflux and duplication of the kidney and ureter. The overall prevalence of CAKUT was 7.4%. There was no statistically significant difference for maternal age, sex, parity, gestational age, and history of medication during pregnancy between the patients with CAKUT and those without CAKUT. Conclusion: The incidence of CAKUT in our patients with CHD was significantly higher than that in the general population. We recommend urinary ultrasonography as a routine examination for children with CHD for early detection of CAKUT, to avoid missed diagnoses, and to initiate appropriate treatment.

scholarly journals Epidemiological aspects of centipede (Scolopendromorphae: Chilopoda) bites registered in Greater S. Paulo, SP, Brazil

1998 ◽  
Vol 32 (6) ◽  
pp. 514-518 ◽  
Author(s):  
Irene Knysak ◽  
Rosana Martins ◽  
Carlos R. Bertim
Keyword(s):  
Urban Areas ◽  
Rainy Season ◽  
Medical Center ◽  
Clinical Manifestations ◽  
Signs And Symptoms ◽  
Reproductive Period ◽  
The Body ◽  
Basic Knowledge ◽  
Venomous Animals ◽  
Hands And Feet

INTRODUCTION: The lack of basic knowledge on venomous arthropods and the benignity of the clinical manifestations contribute to the centipede bite victims' not being taken to a treatment reference center, leading to underestimation of the number of cases and minimizing the possibility of a broader epidemiological view. An inventory of the centipede bite occurrences in Greater S. Paulo, Brazil, and the therapeutic methods employed, by the main Brazilian medical center for the notification of poisoning by venomous animals, is presented. METHOD: All patient cards of the period 1980-1989 have been checked as to place, month and time of occurrence; sex, age, affected part of the body, signs and symptoms have been observed, as well as the therapeutic methods employed. The centipedes that caused the accidents were identified at the Arthropods Laboratory. RESULTS: It was registered 216 accidents, with a 69% predominance of the Greater S. Paulo and in only 63% of the cases (136) was the agent brought in by the victim for identification. The genera most frequently represented were Cryptops (58%), Otostigmus (33%) and Scolopendra (4%). Of the 136 cases, 87% showed erythema, edema, hemorrhage, burns, cephalalgia, and intense pain. There was a predominance of accidents in the warm rainy season, in the morning and for females between 21 and 60 years of age. Hands and feet were the parts of the body most affected. The benign evolution of the clinical picture (54%) made therapeutical treatment unnecessary. Only the victims of Scolopendra and Otostigmus (46%) were medicated with anesthetics (51%), analgesics (25%), antihistamines and cortisone (24%). CONCLUSION: The reproductive period of the centipedes, associated with their sinanthropic habits, contributes to the greater incidence of accidents in urban areas in the warm rainy season. Only patients bitten by Scolopendra and Otostigmus require therapeutical treatment.

scholarly journals Radiographic characteristics and early clinical manifestations of family clustered coronavirus disease 2019 (COVID-19)

2020 ◽  
Vol 48 (8) ◽  
pp. 030006052094589
Author(s):  
Bingyan Zhan ◽  
Shujuan Lan ◽  
Zhoucuomao La ◽  
Deting Li ◽  
Xinmei Wang ◽  
...  
Keyword(s):  
Clinical Manifestations ◽  
Influenza Virus Infection ◽  
Chest Ct ◽  
The Body ◽  
Qinghai Province ◽  
Infected Case ◽  
Elderly Female ◽  
History Of ◽  
Sporadic Cases ◽  
Bilateral Lung

Object To study chest computed tomography (CT) findings in family clusters of coronavirus disease 2019 (COVID-19). Methods Twenty-one patients with confirmed COVID-19 were enrolled at the West District Qingdao Municipal Hospital, the Fifth People's Hospital of Qinghai Province and Jiaozhou Central Hospital. Eleven were family clustered cases and 10 were sporadic cases not associated with family gatherings. Results Ten patients were male and 11 were female. The time elapsed onset of fever and cough to diagnosis was 3 to 7 days. The body temperatures of patients fluctuated between 36.7 and 38.9°C. One elderly female patient had no fever. On chest CT, 14 patients with family clustered COVID-19 had bilateral lung lesions. By contrast, 7 patients with no history of familial gatherings showed single lung exudative lesions or consolidation. Seven patients with family clustered COVID-19 had bilateral multiple exudative lesions. Four patients with no history of familial gathering had unilateral lesions. Conclusion Not all patients with COVID-19 have direct epidemiological links to an infected case. They may become infected because of poor protection. In patients with family clustered COVID-19, chest CT often showed multiple exudative lesions in both lungs. In some patients, symptoms may be complicated by influenza virus infection.

Evaluation of Direct-Acting Oral Anticoagulant Use in Patients With Cancer

2017 ◽  
Vol 31 (5) ◽  
pp. 441-444 ◽  
Author(s):  
Daphne O. Davis ◽  
Kyle A. Davis
Keyword(s):  
Medical Center ◽  
Data Extraction ◽  
Oral Anticoagulants ◽  
Vein Thrombosis ◽  
Patients With Cancer ◽  
Superficial Vein Thrombosis ◽  
History Of ◽  
Clinically Significant ◽  
Direct Acting ◽  
Or History

Purpose: To evaluate the use of direct-acting oral anticoagulants in patients with cancer and venous thromboembolism (VTE) treated at Ochsner Medical Center with the intent of determining the efficacy and safety of these agents. Methods: Patients were identified by a retrospective data extraction of patients treated at Ochsner Medical Center from January 1, 2013, through December 31, 2015. Patients were included for review if they were ≥18 years of age, with a confirmed diagnosis of VTE and active or history of cancer, and if they received dabigatran, apixaban, rivaroxaban, or edoxaban for at least 6 months. The primary objectives were the rate of recurrence of VTE and the incidence of bleeding at 6 months. Results: Thirty-seven patients were identified. Twelve patients were diagnosed with PE, 21 with DVT, 3 with DVT and PE, and 1 with DVT and superficial vein thrombosis (SVT). Apixaban was used most often (n = 27). No patients experienced a recurrent DVT or PE at 6 months. Two patients experienced adverse effects during treatment. Conclusions: In this single-center, retrospective, observational study in patients with cancer receiving DOAC therapy, there were no episodes of recurrent VTE and only 2 episodes of clinically significant bleeding.

scholarly journals Metastatic Tumors of the Oral Cavity

2014 ◽  
Vol 15 (2) ◽  
pp. 263-271 ◽  
Author(s):  
DS Sanketh ◽  
N Amrutha ◽  
Shankargouda Patil
Keyword(s):  
Oral Cavity ◽  
Soft Tissues ◽  
Clinical Manifestations ◽  
Metastatic Tumor ◽  
Metastatic Tumors ◽  
Jaw Bones ◽  
History Of ◽  
Metastatic Process ◽  
Conducive Environment ◽  
Oral Metastasis

ABSTRACT The pivotal reason for morbidity and mortality of any type of cancer is due to metastasis that occurs as a result of adaptation of genetically unstable cancer cells, in an ectopic conducive environment. Oral metastasis in spite of being unusual or rare represents around 25% of the first signs of metastatic spread. Literature says there are more number of cases of jaw bone metastasis reported than in the oral soft tissues. The most common primary organs metastasizing to the jaw bones and the oral soft tissues are the breast and the lungs respectively. The issue in diagnosing a metastatic tumor arises either when the patient does not reveal the history of the primary illness he or she may be suffering from or when he or she is unaware of it. Diagnosis in such situations is a challenge to the clinician or pathologist. Diagnosing any lymph node or distant metastasis from oral cancer is very important for the prognosis of the patient. In this review we have made an attempt, to explain some recent concepts of pathophysiology of the metastatic process, the clinical manifestations of metastatic tumors to the oral region and to discuss their diagnostic workup. How to cite this article Rao RS, Patil S, Sanketh DS, Amrutha N. Metastatic Tumors of the Oral Cavity. J Contemp Dent Pract 2014;15(2):263-271.

REPORT OF SUBCOMMITTEE ON ACCIDENTAL POISONING

PEDIATRICS ◽  
1961 ◽  
Vol 27 (4) ◽  
pp. 676-680
Author(s):  
Keyword(s):  
Public Health ◽  
Urban Areas ◽  
Health Surveys ◽  
Clinical Manifestations ◽  
The Body ◽  
Lead Intoxication ◽  
Accidental Poisoning ◽  
History Of ◽  
Ready Access ◽  
Age Range

LEAD INTOXICATION occurs most frequently in children between 1 and 3 years of age. (In the various series of cases reported in the literature approximately 85% of the cases were first diagnosed in the children in this age range.) For reasons not completely understood approximately 80% of symptomatic cases occur during the summer months. With rare exceptions children exhibiting clinical lead intoxication reside in the older sections of urban areas where they may have ready access to crumbling, peeling or easily chipped paint. Lead pigment paints were widely used for indoor painting until approximately 25 years ago. Lead pigments are still found in exterior paints, particularly those specified as mildew suppressants. Since the absorption of lead from the intestine proceeds slowly a child must nibble upon these flakes for several months before a quantity of lead sufficient to produce toxic manifestations is absorbed into the body. The child need ingest only a few chips each week; but if he continues this practice for longer than 3 to 6 months the clinical manifestations of lead intoxication to be described may occur thereafter, especially during the summer months. Although a history of pica may be a valuable question to ask in public health surveys, one must not overlook the possibility of pica even when it is denied. It is important for the clinician to realize that mothers may or may not observe their children eating a paint chip now and then. Even when they do see it they may not attribute much importance to the ingestion of the paint. If the clinician strongly suspects the possibility of lead poisoning he should proceed with the necessary laboratory diagnostic steps.

Actinomycosis of the Larynx and Pharynx

1978 ◽  
Vol 86 (5) ◽  
pp. ORL-739-ORL-742 ◽  
Author(s):  
James H. Brandenburg ◽  
William W. Finch ◽  
Wayne R. Kirkham
Keyword(s):  
Medical Center ◽  
Cricoid Cartilage ◽  
The Body ◽  
Clinical Aspects ◽  
Review Of The Literature ◽  
University Of Wisconsin ◽  
Penicillin Therapy ◽  
History Of ◽  
Laryngeal Stridor

This paper presents a case report of a 67-year-old man who was seen in the Otolaryngology Clinic, University of Wisconsin Medical Center with a seven-month history of dyspnea and laryngeal stridor. On examination there were several slightly tender firm submucosal nodules in the soft palate and left tonsilar area and a 1.5-cm polypoid subglottic mass arising from the body of the cricoid cartilage. Because of the marked airway obstruction, a tracheotomy was necessary. The laryngeal polypoid mass was removed and biopsies were obtained from the submucosal nodular masses of the palate. Microscopic examination of the tissue revealed the lesions to be caseating granulomas, and actinomycosis was identified on the cultures. The patient received long-term penicillin therapy and has remained asymptomatic. A discussion of the biologic and clinical aspects of actinomycosis is included. A review of the literature revealed only one other description of endolaryngeal actinomycosis.

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