scholarly journals An unusual case of chronic anal pain – a pin in the bum?

2010 ◽  
Vol 92 (6) ◽  
pp. e27-e28 ◽  
Author(s):  
Adam Charles Critchley ◽  
Stephen John Holtham
Keyword(s):  
Anterior Resection ◽  
Unusual Case ◽  
Rectal Mucosa ◽  
Definitive Diagnosis ◽  
High Index ◽  
Pelvic Surgery ◽  
Anal Pain ◽  
High Index Of Suspicion

We report the case of a 70-year-old woman who had previously undergone anterior resection in 2001 for a diverticular stricture. Bleeding from pelvic veins intra-operatively necessitated the use of two thumbtacks to aid haemostasis. Over the next 7 years, she presented repeatedly with anal pain, bleeding and mucus discharge per rectum. Multiple lower gastrointestinal endoscopies failed to make a definitive diagnosis until a single thumbtack was found eroding through the rectal mucosa. This was removed and she has been subsequently asymptomatic. This condition was clearly difficult to diagnose and requires a high index of suspicion in those patients who have previously undergone pelvic surgery.

Subglottic and Tracheal Malignancies

1992 ◽  
Vol 71 (5) ◽  
pp. 233-237 ◽  
Author(s):  
Kevin S. Kennedy ◽  
Gregg S. Parker
Keyword(s):  
Chest Pain ◽  
Unusual Case ◽  
Disease Process ◽  
Accurate Diagnosis ◽  
High Index ◽  
Morbidity And Mortality ◽  
Diagnosis And Treatment ◽  
Review Of The Literature ◽  
Survival Patterns ◽  
High Index Of Suspicion

Subglottic and tracheal malignancies are the least frequently encountered laryngeal cancers. When these tumors are encountered, they have often reached advanced size prior to producing symptoms. Once symptoms are brought to the attention of the otolaryngologist, rapid and accurate diagnosis is essential to effect the earliest possible treatment and to minimize morbidity and mortality associated with this problem. Illustrative cases are presented including a highly unusual case that presented with cardiac-like chest pain. A review of the literature including the pertinent anatomy, pathophysiology, and methods of diagnosis and treatment is presented. Increased familiarity with this disease process and a high index of suspicion on the part of the otolaryngologist may lead to improved survival patterns in patients with these malignancies.

scholarly journals Subperiosteal Osteoid Osteoma of the Neck of Talus

2009 ◽  
Vol 48 (173) ◽  
Author(s):  
Javed Ahmad Khan ◽  
S Vaidya ◽  
P Devkota ◽  
BM Acharya ◽  
NMS Pradhan ◽  
...  
Keyword(s):  
Osteoid Osteoma ◽  
Ankle Sprain ◽  
Definitive Diagnosis ◽  
High Index ◽  
Review Of Literature ◽  
Ankle Pain ◽  
Diagnostic Dilemma ◽  
High Index Of Suspicion

Juxta-articular, subperiosteal osteoid osteomas arising around the ankle are unusual. Tumors arising on the neck of the talus commonly produce symptoms mimicking monoarticular arthritis. Patients are usually treated for arthritis or ankle sprain, which often leads to a delay in definitive diagnosis. Here we present a case of osteoid osteoma of neck of talus which was presented as ankle pain. It puzzled us until MRI was done. Diagnostic dilemma and delay can be avoided by high index of suspicion. The patient was treated with open removal of the tumor. We also present brief review of literature about juxta-articular, subperiosteal osteoid osteoma which is uncommon from the typical osteoid osteoma occurring elsewhere in the body.Keywords: juxta-articular, subperiosteal, osteoid osteoma, talus neck

Stridor: an unusual presentation of lateral medullary syndrome

2007 ◽  
Vol 121 (7) ◽  
pp. 1-2 ◽  
Author(s):  
S Vaidyanathan ◽  
R Capper ◽  
D Chadha
Keyword(s):  
Airway Obstruction ◽  
Unusual Case ◽  
Upper Airway ◽  
High Index ◽  
Upper Airway Obstruction ◽  
Unusual Presentation ◽  
Angioneurotic Oedema ◽  
Lateral Medullary Syndrome ◽  
High Index Of Suspicion

We report an unusual case of lateral medullary syndrome which presented with symptoms of acute upper airway obstruction mimicking angioneurotic oedema. Although dysphonia and dysphagia are common symptoms of lateral medullary syndrome, we have found no other reports of this condition presenting as stridor. This case highlights the importance of maintaining a high index of suspicion for central causes of common otolaryngological symptoms in the absence of local signs.

scholarly journals Urinary Ascites: Cryptic Presentation of Unrecognized Urinary Bladder Injury

2012 ◽  
Vol 2 (1) ◽  
pp. 60-62
Author(s):  
Mehruba Alam Ananna ◽  
M Ashrafuddin Ahmed ◽  
WMM Haque ◽  
Ziauddin Ahmed
Keyword(s):  
Urinary Bladder ◽  
Medical Record ◽  
Postoperative Period ◽  
Serum Biochemistry ◽  
Biochemical Changes ◽  
High Index ◽  
Pelvic Surgery ◽  
Bladder Injury ◽  
Urinary Ascites ◽  
High Index Of Suspicion

A case of urinary ascites in a 37-year-old woman caused by an unrecognized bladder injury inflicted during hysterectomy done seven months earlier is presented here. The site of injury was located by conventional retrograde cystography and repaired by laparotomy. The medical record suggesting uneventful peri and postoperative period, absence of expected typical changes in serum biochemistry and the unusual aetilogy of the ascites led to the delay in the diagnosis.The case demonstrates the importance of high index of suspicion of bladder injury following pelvic surgery in patients with ill-defined symptoms and unexplained ascites even in the absence of typical biochemical changes. DOI: http://dx.doi.org/10.3329/birdem.v2i1.12364 Birdem Med J 2012; 2(1) 60-62

Neurobrucellosis associated with feral swine hunting in the southern United States

2020 ◽  
Vol 13 (12) ◽  
pp. e238216
Author(s):  
Harry Ross Powers ◽  
Jared R Nelson ◽  
Salvador Alvarez ◽  
Julio C Mendez
Keyword(s):  
United States ◽  
At Risk ◽  
High Index ◽  
Southern United States ◽  
Endemic Country ◽  
Feral Swine ◽  
Neurological Sequelae ◽  
Initial Symptoms ◽  
The Usa ◽  
High Index Of Suspicion

Although uncommon, Brucella infection can occur outside the areas of high endemicity, such as the USA. In the southern USA, hunters of wild swine are at risk for brucellosis. We present a case of a patient with fever, headache and constitutional symptoms that were ongoing for 11 months. He was diagnosed with neurobrucellosis. The patient was treated successfully with intravenous ceftriaxone, oral doxycycline and oral rifampin therapy. He had persistent neurological sequelae after completing treatment. This case illustrates the high index of suspicion needed to diagnose neurobrucellosis in a non-endemic country because initial symptoms can be subtle. The disease can be treated successfully, but long-lasting neurological sequelae are common.

Mycobacterium Fortuitum Infections of the Hand

1992 ◽  
Vol 17 (6) ◽  
pp. 675-677 ◽  
Author(s):  
F. K. IP ◽  
S. P. CHOW
Keyword(s):  
Correct Diagnosis ◽  
High Index ◽  
Mycobacterium Fortuitum ◽  
High Index Of Suspicion

Five cases are reported of infection due to Mycobactenum fortuitum involving the hand following contaminated injection or traumatic wounds. Synovectomy, debridement, or amputation together with prolonged chemotherapy using kanamycin or amikacin were required. Doxycycline and sulphamethoxasole also seemed to be the effective antibiotics for this organism. A high index of suspicion is important in order to obtain the correct diagnosis.

scholarly journals Acute permethrin neurotoxicity: Variable presentations, high index of suspicion

2014 ◽  
Vol 1 ◽  
pp. 1026-1028 ◽  
Author(s):  
Bonny Drago ◽  
Namrata S. Shah ◽  
Samir H. Shah
Keyword(s):  
High Index ◽  
High Index Of Suspicion

Cricotracheal separation: a review and a case with bilateral recovery of recurrent laryngeal nerve function

2006 ◽  
Vol 120 (6) ◽  
pp. 497-501 ◽  
Author(s):  
D J McCrystal ◽  
C Bond
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Unusual Case ◽  
Open Repair ◽  
Laryngeal Nerve ◽  
Clinical Suspicion ◽  
Nerve Function ◽  
Short Term ◽  
High Index Of Suspicion ◽  
Type Of Injury

Cricotracheal separation (CTS) is an uncommon injury, with a high index of suspicion required to establish the diagnosis. Computerized tomography (CT) plays a role in diagnosis but cannot necessarily be relied upon. Bilateral recurrent laryngeal nerve (RLN) palsies are usually associated with this type of injury. We recently treated a patient with CTS in whom one RLN was intact from the time of the injury and the other nerve recovered within three months. Computed tomography was inconclusive.Early open repair of the injury and frequent follow-up examinations led to successful decannulation after six weeks and excellent short-term voice and airway outcomes.A detailed discussion of this unusual case is followed by a review of the current literature on CTS, with particular emphasis on significant management dilemmas and controversies.Clinical suspicion remains more sensitive than investigations in diagnosing CTS. Permanent bilateral RLN palsies are not inevitable following these injuries.

Benign ano-rectal disorders

2017 ◽  
Vol 10 (5) ◽  
pp. 253-261
Author(s):  
James Kynaston
Keyword(s):  
Primary Care ◽  
High Index ◽  
Diagnosis And Management ◽  
High Index Of Suspicion ◽  
Adult Presentation ◽  
Surgical Referral

Benign ano-rectal disorders are a common adult presentation to primary care; they also generate a significant number of secondary referrals. The exact prevalence of these conditions is difficult to determine, due to under-reporting of symptoms, which patients can find embarrassing and difficult to disclose. It can be challenging to distinguish between different ano-rectal disorders which present with similar symptoms. A high index of suspicion is required to detect serious malignant pathology. The aim of this article is to outline the epidemiology, pathophysiology, diagnosis and management of common benign ano-rectal disorders in primary care. The indications for surgical referral and important cancer referral guidelines are included.

Neonatal chikungunya encephalitis

2021 ◽  
pp. 004947552110632
Author(s):  
R. Sreekanth ◽  
Lakshmi Venugopal ◽  
B. Arunkrishnan ◽  
Somya chaturvedi ◽  
Shanmugha sundaram
Keyword(s):  
Skin Rash ◽  
Perinatal Transmission ◽  
Viral Disease ◽  
High Index ◽  
New Born ◽  
Laboratory Confirmation ◽  
High Index Of Suspicion

Chikungunya is a tropical viral disease and can present in the new born with perinatal transmission. Presentation usually mimics sepsis and high index of suspicion is needed for diagnosis specially at times of outbreak. Characteristic skin rash and perioral blotchy hyperpigmentation can point to diagnosis along with laboratory confirmation with RTPCR.

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