scholarly journals A Patient With a Chronic Cough: An Unexpected Case of Calcium Pill Aspiration

2019 ◽  
Vol 7 ◽  
pp. 232470961982877 ◽  
Author(s):  
Pooja Poudel ◽  
Andrew Chu ◽  
Kanish Mirchia ◽  
Manju Paul
Keyword(s):  
Chronic Cough ◽  
Medical Condition ◽  
Delayed Diagnosis ◽  
Shortness Of Breath ◽  
Long Period ◽  
Diagnostic Bronchoscopy ◽  
Life Threatening ◽  
History Of ◽  
Prompt Action

Foreign body aspiration is a life-threatening medical condition that requires prompt action. Delayed diagnosis is associated with long-term serious complication often leading to death. In adults, it can remain undetected for a long period of time. The patient gives a long history of a cough, which clinicians often ignore. A chest radiograph is unreliable to exclude the disease as it may not show radiolucent objects. Diagnostic bronchoscopy is necessary to exclude the disease. We report a case of 70-year-old woman who had a 1-month history of a cough and was admitted for shortness of breath, and on further evaluation, we incidentally detected calcium tablets in her bronchus. The present case demonstrates the need for early bronchoscopy especially when the cause of a chronic cough is not known.

Delayed diagnosis of bilateral subdural effusions complicating intracranial hypotension in a patient presenting with post lumbar puncture headache

2021 ◽  
Vol 14 (2) ◽  
pp. e239559
Author(s):  
Saleheen Huq ◽  
Menaka G Iyer ◽  
Samson O Oyibo
Keyword(s):  
Lumbar Puncture ◽  
Delayed Diagnosis ◽  
Bed Rest ◽  
Viral Meningitis ◽  
Magnetic Imaging ◽  
Intracranial Complications ◽  
Life Threatening ◽  
History Of ◽  
Discharge From Hospital ◽  
Subdural Effusions

A 34-year-old woman presented with an unrelenting headache which had been ongoing since discharge from hospital 4 days before. She initially presented 2 weeks earlier with a 7 days history of severe headache, for which she had a CT scan, lumbar puncture and treatment for possible viral meningitis. The headache got worse 4 days after the lumbar puncture. Despite analgesics and bed rest, the headache persisted. A subsequent magnetic imaging scan demonstrated bilateral subdural effusions. She was given supportive treatment, which included advice concerning strict bed rest and analgesia. The headache took several months to abate. A third of patients suffer from post lumbar puncture headaches and this should be explained during informed consenting and post procedure. Not all post lumbar puncture headaches are simple headaches. A post lumbar puncture headache continuing for more than 7–14 days after the procedure requires further investigation to exclude life-threatening intracranial complications.

scholarly journals Systematic review of clinical outcomes after prophylactic surgery

2016 ◽  
Vol 98 (6) ◽  
pp. 353-357 ◽  
Author(s):  
CR Davis ◽  
AEJ Trevatt ◽  
A Dixit ◽  
V Datta
Keyword(s):  
Systematic Review ◽  
Acute Appendicitis ◽  
Prophylactic Surgery ◽  
Cochrane Central Register ◽  
Short Term ◽  
Asymptomatic Patients ◽  
Central Register ◽  
Life Threatening ◽  
History Of

Introduction Prophylactic appendicectomy is performed prior to military, polar and space expeditions to prevent acute appendicitis in the field. However, the risk–benefit ratio of prophylactic surgery is controversial. This study aimed to systematically review the evidence for prophylactic appendicectomy. It is supplemented by a clinical example of prophylactic surgery resulting in life-threatening complications. Methods A systematic review was performed using MEDLINE® and the Cochrane Central Register of Controlled Trials. Keyword variants of ‘prophylaxis’ and ‘appendicectomy’ were combined to identify potential papers for inclusion. Papers related to prophylactic appendicectomy risks and benefits were reviewed. Results Overall, 511 papers were identified, with 37 papers satisfying the inclusion criteria. Nine reported outcomes after incidental appendicectomy during concurrent surgical procedures. No papers focused explicitly on prophylactic appendicectomy in asymptomatic patients. The clinical example outlined acute obstruction secondary to adhesions from a prophylactic appendicectomy. Complications after elective appendicectomy versus the natural history of acute appendicitis in scenarios such as polar expeditions or covert operations suggest prophylactic appendicectomy may be appropriate prior to extreme situations. Nevertheless, the long-term risk of adhesion related complications render prophylactic appendicectomy feasible only when the short-term risk of acute appendicitis outweighs the long-term risks of surgery. Conclusions Prophylactic appendicectomy is rarely performed and not without risk. This is the first documented evidence of long-term complications following prophylactic appendicectomy. Surgery should be considered on an individual basis by balancing the risks of acute appendicitis in the field with the potential consequences of an otherwise unnecessary surgical procedure in a healthy patient.

scholarly journals COVID-19 Pneumonia in Patients with Chronic Myocarditis (HBV-Associated with InfarctLike Debute): Specifics of the Diseases Course, the Role of the Basic Therapy (Part II)

2020 ◽  
Vol 16 (5) ◽  
pp. 730-736
Author(s):  
O. V. Blagova ◽  
N. V. Varionchik ◽  
M. M. Beraia ◽  
V. A. Zaidenov ◽  
E. A. Kogan ◽  
...  
Keyword(s):  
Immunosuppressive Therapy ◽  
Troponin T ◽  
Oral Anticoagulants ◽  
Adverse Outcomes ◽  
Interleukin 17 ◽  
Chronic Myocarditis ◽  
Life Threatening ◽  
History Of ◽  
Therapy Withdrawal

Chronic infectious-immune myocarditis of severe course can potentially be considered as a factor that aggravates the course of new coronavirus disease (COVID-19) and increases the risk of adverse outcomes. The interaction of chronic myocarditis and COVID-19 during long-term immunosuppressive therapy has not been studied. We present a description of a 35-year-old female patient with chronic infectious-immune myocarditis (morphologically confirmed, with a history of infarction-like onset and thromboembolic complications), who had continuous immunosuppressive therapy with methylprednisolone and mycophenolate mofetil. The patient also received new oral anticoagulants and tenofovir (for chronic HBV infection). COVID-19 (SARS-Cov-2 RNA+) was diagnosed in May 2020. Risk factors for the adverse course of coronavirus infection included severe obesity, heart failure, and life-threatening ventricular arrhythmias. Correction of immunosuppressive therapy (withdrawal of the cytostatic agent, administration of hydroxychloroquine) and therapy with levofloxacin, an interleukin-17 inhibitor (netakimab) were performed. The severity of pneumonia and respiratory failure was moderate despite high fever and high levels of inflammatory markers in the blood (including interleukin-6). Signs of exacerbation of myocarditis, increased levels of troponin T and anticardial antibodies (compared with the initial ones) were not found. It can be assumed that supportive immunosuppressive therapy for myocarditis has a positive effect on the course of coronavirus pneumonia and avoids exacerbation of myocarditis. Careful continuation of immunosuppressive therapy with temporary withdrawal of aggressive cytostatics can be recommended in chronic myocarditis. Further study of the features of the course of previous myocarditis and COVID-19 pneumonia is necessary.

scholarly journals A rare case of acquired benign tracheoesophageal fistula

2020 ◽  
Vol 2020 (2) ◽  
Author(s):  
Sarah Bouayyad ◽  
Meera Beena ◽  
Ajay Nigam
Keyword(s):  
Case Report ◽  
Patient Selection ◽  
Tracheoesophageal Fistula ◽  
Rare Case ◽  
Foreign Bodies ◽  
Medical Condition ◽  
Surgical Methods ◽  
Life Threatening ◽  
History Of ◽  
Tracheoesophageal Puncture

Abstract Acquired benign tracheoesophageal fistula (TOF) is a rare medical condition that usually results from trauma, foreign bodies or granulomatous infections. This is an unusual presentation of a male patient with a history of laryngectomy who has had over a period of several years inappropriately and vigorously used valve cleaning brushes to clean tracheal secretions, which has led to the formation of a TOF. Due to the patient’s obsessive habit, we could not manage him using conventional surgical methods. Instead, we opted for the placement of a salivary bypass tube, which yielded good results and recovery. To the best of our knowledge, no other case of similar aetiology has been published. We would like to highlight the importance of appropriate patient selection and education prior to performing a tracheoesophageal puncture to avoid developing life-threatening complications as demonstrated in our case report.

scholarly journals Angioedema - Our Experience Focused On Socio-Demographic, Etiological and Clinical Characteristics of the Condition and Its Management

2019 ◽  
Vol 7 (3) ◽  
pp. 341-346
Author(s):  
Svetlan Dermendjiev ◽  
Vesela Slavcheva Blagoeva
Keyword(s):  
Family History ◽  
Medical Condition ◽  
Working Women ◽  
Clinical Importance ◽  
Demographic Characteristics ◽  
Upper Respiratory Tract ◽  
Life Threatening ◽  
History Of ◽  
Inflammatory Drugs ◽  
Voluntary Basis

BACKGROUND: Angioedema (AE) is acute oedema of the skin and mucous surfaces, involving the respiratory and gastrointestinal tracts. AE could be a life-threatening medical condition. Regardless of its growing clinical importance, many aspects of its aetiology and pathogenesis remain poorly understood. Its incidence, demographic characteristics, diagnosis and therapy, need further investigation. AIM: This study reports our experience with angioedema concerning its social and demographic characteristics, aetiology, clinical features, diagnosis and treatment outcomes. Study design: Eighty-eight patients with AE were enrolled. The study is a retrospective analysis of patients treated in our Clinics. METHODS: All participants were asked on a voluntary basis to fill out a specially designed questionnaire on the day of their discharge. Other important data sources included: patients’ history and notes during the hospital stay, information from previous admissions, etc. Parametric and non-parametric statistical methods were used for data processing. Data analysis was performed using SPSS (SPSS Inc., IBM SPSS Statistica) version 20.0 RESULTS: Based on our results, AE affects more frequently patients over 50 years of age, regardless of their sex. Urban residents prevail, among them - more commonly working women. Non-steroidal anti-inflammatory drugs (NSAIDs), hormones and antibiotics were among the most common triggers – in 8%, 4.5% and 11.4% of the cases respectively. In 9.09% of the patients, food-induced AE was seen, the most common foods reported, were – nuts, eggs and egg products. The common sites of involvement were periorbital area and lips. In only 9.1% of the patients, oedema progressed to spread to the upper respiratory tract. Cardiac conditions were the most frequent underlying disorders – 33%, of the patients, auto-immune thyroiditis was the second most common-14.8%, followed by musculo- skeletal disorders (10.2%) and diabetes (4.5%) Family history of allergy was seen in 8.4% of the patients, the most frequent allergic disorder, reported, was asthma. In patients with HAE, family history was present in 2.9% of the patients. CONCLUSIONS: All patients received therapy with steroids and antihistamines, resulting in resolution of symptoms and no invasive procedures were necessary. Based on our results, the diagnosis of AE is often difficult and delayed and requires specialist evaluation. If recognised on time and adequately treated, the outcomes are favourable.

Tracheobronchopathia osteochondroplastica: a cause of chronic cough and haemoptysis

2021 ◽  
Vol 14 (4) ◽  
pp. e240125
Author(s):  
Talha Shahzad ◽  
Nadeem Rizvi ◽  
Sabeeh Siddiqui ◽  
Rashida Ahmed
Keyword(s):  
Chronic Cough ◽  
Good Health ◽  
Final Diagnosis ◽  
Fibreoptic Bronchoscopy ◽  
Histopathological Analysis ◽  
Shortness Of Breath ◽  
Recurrent Pneumonia ◽  
History Of ◽  
Membranous Wall ◽  
Tracheobronchopathia Osteochondroplastica

Tracheobronchopathia osteochondroplastica (TPO) is a rare disorder of the tracheopulmonary tree characterised by osseous and cartilaginous submucosal nodules projecting into the tracheal lumen, sparing the posterior tracheal membranous wall. Symptoms are non-specific and may include dry cough, hoarseness, dyspnoea, recurrent pneumonia and occasionally haemoptysis. A fibreoptic bronchoscopy showing multiple tracheal nodules followed by pathological biopsy is required to reach the final diagnosis. Here, we report two cases of TPO, both with history of biomass fuel exposure and almost similar clinical presentions with chronic cough, shortness of breath and intermittent haemoptysis. They both underwent fibreoptic bronchoscopy showing multiple tracheal nodules whose histopathological analysis showed the diagnosis of TPO. Both patients were treated conservatively and remained in good health afterwards. Physicians should be aware about the need of advanced surgical procedures including endotracheal stent placement in more severe cases.

Neural plasticity and emotional memory

1998 ◽  
Vol 10 (4) ◽  
pp. 829-855 ◽  
Author(s):  
R. M. POST ◽  
S. R. B. WEISS ◽  
H. LI ◽  
M. A. SMITH ◽  
L. X. ZHANG ◽  
...  
Keyword(s):  
Neural Plasticity ◽  
Molecular Mechanisms ◽  
Emotional Memory ◽  
Neonatal Rat ◽  
Prior History ◽  
Rat Pups ◽  
Life Threatening ◽  
History Of ◽  
And Behavior

Posttraumatic stress disorder is the pathological replay of emotional memory formed in response to painful, life-threatening, or horrifying events. In contrast, depression is often precipitated by more social context-related stressors. New data suggest that different types of life experiences can differentially impact biochemistry, physiology, anatomy, and behavior at the level of changes in gene expression. Repeated separation of neonatal rat pups from their mother results in many long-lasting alterations in biology and behavior paralleling that in depression, including hypercortisolism. The role of the amygdala in modulating emotional memory is highlighted, as well as some of its unique properties such as metaplasticity (i.e., the differential direction of long-term adaptation, either potentiation or depression) in response to the same input as a function of the prior history of stimulation. The implications of these emerging data on the physiological and molecular mechanisms underlying emotional memory emphasize the particular importance of prevention and early intervention.

scholarly journals Cancer and Anorexia Nervosa in the Adolescence: A Family-Based Systemic Intervention

2011 ◽  
Vol 2011 ◽  
pp. 1-8 ◽  
Author(s):  
Gabriella De Benedetta ◽  
Ida Bolognini ◽  
Silvia D'Ovidio ◽  
Antonello Pinto
Keyword(s):  
Anorexia Nervosa ◽  
Cancer Patients ◽  
Medical Condition ◽  
Clinical History ◽  
Adolescent Cancer ◽  
Systemic Intervention ◽  
Life Threatening ◽  
History Of ◽  
Disordered Eating Behavior ◽  
Family Based

Objective. Anorexia nervosa is difficult to diagnose in cancer patients since weight loss, aversion for food, and eating disturbances are frequent in patients undergoing chemotherapy and radiotherapy. Nevertheless, efforts are mandatory to recognize and manage this condition which may occur also in cancer patients with a special regard to adolescents. Methods. Through the clinical history of Anna, a 15-year-old adolescent with advanced cancer, we describe the effectiveness of a family-based systemic intervention to manage anorexia nervosa occurring in concomitance to osteosarcoma. Results. Through a two-year psychotherapy period involving different techniques applied to the whole family such as family genogram, family collage, and sculpture of family time, Anna was relieved from her condition. Conclusions. Upon early diagnosis and appropriate treatment, anorexia nervosa can be effectively approached in adolescent cancer patients. The presence of a life-threatening medical condition such as cancer may provide motivation for a patient to control disordered eating behavior in the context of an appropriate family-based systemic intervention. The general frame of anorexia occurring in cancer-bearing adolescents is reviewed and discussed.

scholarly journals Long-Term Isoflurane Therapy for Refractory Bronchospasm Associated with Herpes Simplex Pneumonia in a Heart Transplant Patient

2010 ◽  
Vol 2010 ◽  
pp. 1-4 ◽  
Author(s):  
C. Hornuss ◽  
M. Firsching ◽  
M. Dolch ◽  
A. Martignoni ◽  
A. Peraud ◽  
...  
Keyword(s):  
Herpes Simplex ◽  
Heart Transplant ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Anaesthetic Conserving Device ◽  
Life Threatening ◽  
History Of ◽  
Adequate Sedation ◽  
Isoflurane Treatment

A 47-year-old man with a history of heart transplant was admitted after severe traumatic brain injury and seizures. During mechanical ventilation, the patient developed bronchospasm that severely compromised respiratory function that led to cardiac arrest. After resuscitation, application of isoflurane through the Anaesthetic Conserving Device (AnaConDa) in the ICU successfully treated bronchospasm, provided adequate sedation, and enabled appropriate ventilation and diagnostic bronchoscopy. A subsequent bronchoalveolar lavage revealed a high amount of Herpes simplex DNA. Herpes simplex pneumonia was diagnosed and treated with acyclovir. Isoflurane treatment was applied for twelve days total without side effects on renal and cerebral function. The patient recovered quickly after the termination of sedation. At discharge, he was fully awake without focal neurological deficiency and his long-term outcome was excellent. This case demonstrates that isoflurane is a treatment option in life-threatening cases of bronchospasm and a safe option for long-term sedation.

Rhabdomyolysis Causing AV Blockade Due to Possible Atorvastatin, Esomeprazole, and Clarithromycin Interaction

2003 ◽  
Vol 37 (6) ◽  
pp. 808-811 ◽  
Author(s):  
Brooke E Sipe ◽  
Ronald J Jones ◽  
Gordon H Bokhart
Keyword(s):  
Chest Pain ◽  
Shortness Of Breath ◽  
Medication History ◽  
Reductase Inhibitors ◽  
Hepatic Diseases ◽  
Pacemaker Placement ◽  
History Of ◽  
Severe Weakness ◽  
Third Degree Atrioventricular Block

OBJECTIVE: To report rhabdomyolysis (RML) causing third-degree atrioventricular block secondary to a possible interaction between atorvastatin, esomeprazole, and clarithromycin. CASE SUMMARY: A 51-year-old white woman presented to the emergency department with severe weakness, near syncope, shortness of breath, and chest pain. On admission, her electrocardiogram demonstrated bradycardia (40 beats/min) and third-degree heart block. A creatine kinase (CK) level was >7000 U/L. Her medication history was significant for long-term use of atorvastatin (>1 y), a 6-week history of esomeprazole use, and three 500-mg doses of clarithromycin just prior to admission. Her symptoms of weakness, shortness of breath, and chest pain coincided with starting the esomeprazole. During her hospitalization, the woman required pacemaker placement and her CK continued to rise to >40 000 U/L. Screening for other causes of RML, such as thyrotoxicosis, infection, and immune or hepatic diseases, was negative. She gradually improved over a 26-day hospitalization. DISCUSSION: This is a case of RML resulting in third-degree atrioventricular blockade. An objective causality assessment of the adverse reaction via the Naranjo probability scale revealed a probable association with atorvastatin and a possible association with esomeprazole and clarithromycin. The pharmacokinetic profiles of these agents suggest that a possible contribution to this reaction was P-glycoprotein (PGP) inhibition by esomeprazole altering atorvastatin's normally significant first-pass clearance. CONCLUSIONS: PGP drug interactions with atorvastatin and other hydroxymethylglutaryl coenzyme A reductase inhibitors (statins) may be associated with unreported risks for RML. Further investigation into PGP impact on HMG-CoA appears warranted.

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