scholarly journals Necrotizing sarcoid granulomatosis with clinical presentations of recurrent acute abdomen. Case report and literature review

2017 ◽  
Vol 89 (11) ◽  
pp. 60-68 ◽  
Author(s):  
V I Vasilyev ◽  
S G Palshina ◽  
B D Chaltsev ◽  
S G Radenska-Lopovok ◽  
T N Safonova
Keyword(s):  
Acute Abdomen ◽  
Clinical Laboratory ◽  
Morphological Changes ◽  
Abdominal Cavity ◽  
High Dose ◽  
Drug Induced ◽  
Serological Tests ◽  
Surgical Interventions ◽  
First Case ◽  
Clinical Presentations

The authors have described the world’s first case of necrotizing sarcoid granulomatosis (NSG) in a 22-year-old woman with the clinical presentations of acute abdomen, which are associated with abdominal lymph nodal infiltration and necrosis, obvious constitutional disturbances (fever, nocturnal sweats, and significant weight loss), high inflammatory activity (anemia, leukocytosis, high erythrocyte sedimentation rates and C-reactive protein levels), the gradual appearance of splenic and hepatic necrotic foci, and infiltration into the lung and lacrimal glands with the development of unilateral uveitis. The patient underwent five surgical interventions, several needle biopsies for recurrent abdominal syndrome, and long-term antibiotic treatment for presumed sepsis, which had caused drug-induced hepatitis. Bacteriological examination of blood, puncture samples, and removed abdominal cavity tissues, serological tests, and immunomorphogical study of biopsy samples and removed tissues yielded negative results for the presence of bacterial, fungal, and tuberculosis infections. NSG was diagnosed on the basis of the systemic nature of the lesion, the presence of granulomas with severe abdominal lymph nodal necrosis and necrotizing granulomatous/lymphocytic vasculitis in the mesentery and removed spleen, as well as the absence of granulomas in the spleen, appendix, and biopsy materials of the liver, colonic mucosa, and parotid gland. Fludarabine therapy was first used in world practice due to the inefficient treatment with high-dose glucocorticoids and cyclophosphamide and to a disease relapse when reducing their doses. The paper gives a detailed review of the literature on the clinical, laboratory, radiological, and morphological manifestations of the disease, which allow the differential diagnosis of NSG with different variants of granulomatous lesions. Based on the 5-year follow-up of the patient and on the analysis of clinical, laboratory, radiological, and morphological changes, the authors uphold the concept that the disease is an independent nosological entity: necrotizing angiitis with sarcoid reactions, rather than the entity of nodular or classic sarcoidosis.

scholarly journals Abdominal angiostrongyliasis: report of two cases with different clinical presentations

2008 ◽  
Vol 50 (6) ◽  
pp. 339-341 ◽  
Author(s):  
Rubens Rodriguez ◽  
Roberta Martins Dequi ◽  
Lucas Peruzzo ◽  
Paulo Moacir Mesquita ◽  
Errol Garcia ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Acute Abdomen ◽  
Mesenteric Ischemia ◽  
Liver Involvement ◽  
Surgical Specimen ◽  
Ileal Perforation ◽  
Clinical Forms ◽  
Serum Igg ◽  
First Case ◽  
Clinical Presentations

Abdominal angiostrongyliasis is a sporadic infectious disease caused by the nematode Angiostrongylus costaricensis. It usually presents as acute abdomen, secondary to mesenteric ischemia, and pronounced eosinophilia. In some cases its course is insidious and transient, and the diagnosis is suspicious. The disease is confirmed by the detection of A. costaricensis elements in surgical specimen. The treatment is supportive, with avoidance of antihelminthic administration due to a possible erratic migration followed by worsening of the disease. We report two cases, both with intense eosinophilia and serum IgG-ELISA positive to A. costaricensis. The first case presented ileal perforation and was surgically treated. The second one showed hepatic nodules at ultrasound and was only symptomatically treated, evolving to an apparent protracted resolution. These two cases exemplify different clinical forms of the disease, one of them with liver involvement.

Eosinophilia

2020 ◽  
pp. 5254-5258
Author(s):  
Peter F. Weller
Keyword(s):  
Myeloid Leukaemia ◽  
Kinase Inhibitors ◽  
Hypereosinophilic Syndrome ◽  
Allergic Diseases ◽  
High Dose ◽  
Eosinophilic Granulomatosis With Polyangiitis ◽  
Drug Induced ◽  
Serological Tests ◽  
Dietary History ◽  
Hypersensitivity Vasculitis

Eosinophilia (eosinophil count >0.45 × 109/litre) is associated with some infections, some allergic diseases, and a variety of other conditions, sometimes neoplastic. Parasitic diseases—eosinophilia is a characteristic feature of infection by multicellular helminth parasites (e.g. Strongyloides stercoralis) with diagnosis typically based on geographical/dietary history, serological tests, and examination of stool or tissues for parasite forms. Other diseases—eosinophilia can be caused by the fungal disease coccidioidomycosis, and modest eosinophilia may accompany retroviral infections such as HIV and HTLV-1. Common allergic diseases—asthma, rhinitis, and atopic dermatitis are associated with modest eosinophilia. Drug reactions—these are a frequent cause of eosinophilia, at times in reactions characterized by rashes and pyrexia. More severe reactions may also manifest with (1) pulmonary eosinophilia and lung infiltrates; (2) interstitial nephritis; (3) hepatitis; (4) myocarditis; (5) drug-induced hypersensitivity vasculitis; (6) gastroenterocolitis; and (7) DRESS syndrome. Other conditions—these include (1) eosinophilic granulomatosis with polyangiitis; (2) hyper-IgE syndromes; (3) chronic myeloid leukaemia, acute myeloid leukaemia, and lymphoma; (4) a variety of pulmonary, skin, gastrointestinal, and endocrine diseases. Hypereosinophilic syndromes are defined by (1) eosinophilia (>1.5 × 109/litre) sustained over a month, (2) lack of an identifiable cause precipitating a secondary eosinophilia, and (3) symptoms and signs of organ involvement. About 30% of patients will have either a myeloproliferative condition (chronic eosinophilic leukaemia) or hypereosinophilia mediated by clonal expansion of specific T cells producing interleukin-5 (IL-5). Treatment—patients without organ damage do not require treatment. Aside from supportive care, chronic eosinophilic leukaemia may respond to tyrosine kinase inhibitors (e.g. imatinib), and nonmyeloproliferative hypereosinophilic syndrome may respond to high-dose corticosteroids, with hydroxyurea, interferon-α‎ or anti-IL-5 monoclonal antibody used in refractory cases.

scholarly journals Capnocytophaga canimorsus-associated sepsis presenting as acute abdomen: do we need to think outside the box?

2019 ◽  
Vol 12 (3) ◽  
pp. e228167 ◽  
Author(s):  
Soban Ahmad ◽  
Amman Yousaf ◽  
Faisal Inayat ◽  
Shahzad Anjum
Keyword(s):  
Acute Abdomen ◽  
Present Report ◽  
Capnocytophaga Canimorsus ◽  
First Case ◽  
Clinical Presentations ◽  
History Of ◽  
Successful Clinical Outcome ◽  
Aggressive Care ◽  
Infectious Aetiology

Capnocytophaga canimorsus is a commensal bacterium commonly found in the oral cavity of dogs and cats. Although this organism rarely causes infection, prompt diagnosis is crucial for survival of these patients. Several unusual clinical presentations of this infection have been reported in the published medical literature. The present report represents the first case of C. canimorsus-related sepsis presenting with symptoms of acute abdomen in a patient with no known history of immunodeficiency. Prompt aggressive care and appropriate antibiotic therapy resulted in a successful clinical outcome with no long-term morbidity. This paper illustrates that clinicians should include this infectious aetiology among the differentials of patients presenting with acute abdomen, regardless of their immune status. Additionally, this paper outlines our current understanding of the epidemiology of and risk factors for C. canimorsus-associated sepsis, the pathophysiology of this disorder, and currently available approaches to diagnosis and management.

scholarly journals Pancreatitis: common but forgotten causes

2021 ◽  
Vol 12 (2) ◽  
pp. 96-99
Author(s):  
E. R. Donсova ◽  
O. V. Remizov ◽  
N. V. Novoselya
Keyword(s):  
Ulcerative Colitis ◽  
Clinical Laboratory ◽  
Abdominal Cavity ◽  
Clinical Manifestations ◽  
Blood Analysis ◽  
Aminosalicylic Acid ◽  
Drug Induced ◽  
Ulcer Disease ◽  
Coprological Examination ◽  
High Degree

Objective: to study the causes of pancreatitis. Materials and methods: a clinical case of acute pancreatitis during the treatment of ulcerative colitis with 5-aminosalicylic acid-containing drugs. Methods: clinical, laboratory and instrumental (biochemical blood analysis, standard coprological examination, Ultrasound examination of the abdominal cavity, Esophagogastroduodenoscopy). Results: based on the data of the clinic, laboratory and instrumental studies, a diagnosis was made: drug-induced pancreatitis associated with mesalazine intake. Ulcerative colitis, total form, high degree of activity. Duodenal ulcer disease associated with Helicobacter pylori, unstable remission. Erosive bulbitis. The indicated therapy with polyenzyme drugs, proton pump inhibitors, antispasmodics, and glucocorticosteroids resulted in the resolution of clinical manifestations and the normalization of altered laboratory parameters. Conclusions: the use of 5-aminosalicylic acid preparations for the treatment of ulcerative colitis may be associated with the development of pancreatitis, which must be taken into account in clinical practice.

scholarly journals Clinical cases: acute appendicitis in newbons

2021 ◽  
Vol 10 (2) ◽  
pp. 203-208
Author(s):  
Roman V. Bocharov ◽  
Vladimir G. Pogorelko ◽  
Anna B. Yushmanova ◽  
Andrey V. Karavaev ◽  
Ekaterina A. Semchenko
Keyword(s):  
Acute Appendicitis ◽  
Clinical Laboratory ◽  
Pregnancy Termination ◽  
Abdominal Cavity ◽  
Newborn Infants ◽  
Perforated Appendicitis ◽  
Intestinal Wall ◽  
Study Data ◽  
Surgical Interventions ◽  
Cell Counts

Aim. The goal of this study is to describe the clinical observations of acute appendicitis in two newborn infants. This study was a retrospective analysis performed using data obtained from medical records. Two preterm infants had a gestational age of 33 weeks, a threat of pregnancy termination, rapid childbirth in one case, and a cesarean section in another. At birth, their body weights were low, 2340 and 2420 g, respectively. The condition of the babies was evaluated on the Apgar scale, and both scored 7/8 points. We studied the data of clinical, laboratory, and instrumental study data and surgical intervention protocols. In the presented newborns, neonatal jaundice, respiratory failure of the III degree, and hypoxic perinatal damage to the central nervous system occurred from birth. On the first childs twelfth day and the second childs ninth day, they experienced a clinically acute inflammatory process in the abdominal cavity, confirmed by inflammation markers (high white blood cell counts and levels of C-reactive protein). According to the sonography of the abdominal organs, the absence of intestinal motility in the right abdominal cavity, the presence of intestinal wall pneumatosis, signs of conglomerate formation from the intestinal loops were revealed. The surgical interventions performed were a laparoscopy and a conversion to laparotomy. In both cases, inflammatory bowel changes corresponded to the course of necrotic enterocolitis, diagnosed with gangrenous-perforated appendicitis and purulent-fibrinous peritonitis. In the section, the mucous appendix was not changed. Conclusion. The aggravated premorbid background in premature infants predisposes them to necrotic enterocolitis, which can occur in children of this age with isolated perforation of the appendix. The course of necrotic enterocolitis is complicated by the formation of purulent-fibrinous peritonitis due to the destruction of the appendix with minimal changes in its walls.

scholarly journals Rationale for analgesia to prevent postoperative hyperalgesia in children, according to the morphological study of skin in the wound

Pain medicine ◽  
2021 ◽  
Vol 6 (1) ◽  
pp. 31-36
Author(s):  
Dmytro Dmytriiev ◽  
Oleksandr Marchuk ◽  
Olena Kovalchuk
Keyword(s):  
Morphological Study ◽  
Morphological Changes ◽  
Abdominal Cavity ◽  
Nerve Fibers ◽  
Early Postoperative Period ◽  
High Dose ◽  
Tap Block ◽  
Postoperative Wound ◽  
Spinal Epidural ◽  
Small Nerve

In the article, morphological changes of skin in the area of postoperative wound are displayed. It was discovered that continuous infusion of high-dose fentanyl (10–20 mcg/kg/h) for analgesia in the early postoperative period in children operated on for tumors of abdominal cavity can result into opiod-induced hyperalgesia, which is followed by skin morphological changes around the postoperative wound with the development of necrosis in it center with expressed perifocal reactive changes in the form of severe inflammation, and significant violations of microcirculation with the formation of small nerve fibers on day 14. In its turn, using TAP-block and combined spinal-epidural analgesia showed small perineural edema. The fragmentation of nerve fibers was not determined, which indicates the absence of development of postoperative hyperalgesia. Ketamine infusion results into negligible perineural edema and reduction of postoperative hyperalgesia.

scholarly journals LYMPHANGIOMA AS A CAUSE OF ILEUS

2019 ◽  
Vol 23 (2) ◽  
pp. 91-94
Author(s):  
Olga V. Karaseva ◽  
V. A. Kapustin ◽  
A. O. Agayants ◽  
A. L. Gorelik ◽  
A. N. Kislyakov
Keyword(s):  
Acute Abdomen ◽  
Clinical Picture ◽  
Clinical Laboratory ◽  
Rare Complication ◽  
Abdominal Cavity ◽  
Lymphatic Vessels ◽  
Benign Tumors ◽  
Mesenteric Lymphangioma ◽  
Specialized Hospital ◽  
Surgical Tactics

Introduction. Lymphangiomas are mature benign tumors emanating from the lymphatic vessels making up 9-10% of all benign neoplasms in pediatric oncology. In our practice, we have encountered a rare complication of the lymphangioma of the abdominal cavity - an ileus Objective: To present a clinical picture, diagnostic and surgical tactics in a rare clinical observation of mesenteric lymphangioma, complicated by ileus. Material and methods. Boy aged of 6 years 4 months. He was taken to the emergency department of the Research Institute of NDHiT by an ambulance team (SMP) with suspected acute appendicitis 6 hours after the onset of the disease. Results. According to the results of clinical, laboratory and echographic examination, a child with a clinical picture of “acute abdomen” was suspected of an abdominal lymphangioma. For the purpose of the differential diagnosis of a complicated course of the lymphangioma of the abdominal cavity with complicated destructive appendicitis, 2 hours after hospitalization, laparoscopy was performed and there was confirmed lymphangioma of the ileum mesentery, complicated by the twisting of the latter. After elimination of the torsion, a section of the ileum with a tumor was resected with an end-to-end anastomosis. Histologically, the diagnosis of lymphangioma was confirmed. Conclusion. The cause of “acute abdomen” may be the development of complications of the mesenteric lymphangioma. Timely hospitalization of the child in a specialized hospital allows making a diagnosis in a timely manner, select the optimal surgical tactics and prevent life-giving complications

DIAGNOSIS AND TREATMENT OF MECKEL DIVERTICULUM COMPLICATIONS IN CHILDREN

2020 ◽  
pp. 162-168
Author(s):  
Barskaya M.A. ◽  
Varlamov A.V. ◽  
Zavyalkin V.A. ◽  
Kuzmin A.I. ◽  
Terekhina M.I.
Keyword(s):  
Intestinal Obstruction ◽  
Clinical Laboratory ◽  
Abdominal Cavity ◽  
Clinical Signs ◽  
Intestinal Bleeding ◽  
Meckel Diverticulum ◽  
Average Hospital ◽  
Surgical Interventions ◽  
Surgical Department ◽  
Results Of Treatment

Meckel diverticulum is a congenital abnormality of the intestinum appearing due to the failure of the vitelline duct closure. Meckel diverticulum may have no clinical signs however in 20-25% its complications may cause different acute surgical conditions demanding surgical interventions. These complications may appear with the symptoms of abdominal pain, intestinal hemorrhage and intestinal obstruction. The aim of the study was to analyze the results of treatment of Meckel diverticulum complications in children. We have analyzed the results of diagnostics and treatment of 69 children aged between 10 months and 13 years. All the children were admitted to the surgical department of Samara Regional Clinical Hospital named after V.D. Seredavin between 2013 and October 2020. The presented complications of Meckel diverticulum were: diverticulitis (37), intestinal bleeding (17), intestinal volvulus (9), intestinal obstruction (3), intussusception (3). Most frequently the complications were present in infants and preschool children. All the patients underwent clinical, laboratory, ultrasound, X-Ray (when necessary) and intraluminal endoscopic (when necessary) examinations. However, in most cases complications were diagnosed during laparoscopy. All the children underwent surgical treatment. Most of the surgeries were laparoscopic (54, 35 of them were video assisted mini laparotomies). Two patients presented postoperative complications: anastomotic leaks; both of the children required repeated surgeries. The reasons of complications were underestimation of the paients’ conditions at the moment of surgical interventions and significance of the inflammatory process in the abdominal cavity. We employed ileostomies to those children which we closed 3 weeks after that when the general conditions were appropriate. We had no lethal cases. The average hospital stay was 11,6 days.

Electron-diffraction studies in synthetic polymer materials

1983 ◽  
Vol 41 ◽  
pp. 362-365
Author(s):  
D.T. Grubb
Keyword(s):  
Electron Diffraction ◽  
Synthetic Polymer ◽  
Polymer Materials ◽  
Crystallographic Structure ◽  
High Dose ◽  
Electron Dose ◽  
Dose Rates ◽  
First Case ◽  
Diffraction Patterns ◽  
The Many

Diffraction studies in polymeric and other beam sensitive materials may bring to mind the many experiments where diffracted intensity has been used as a measure of the electron dose required to destroy fine structure in the TEM. But this paper is concerned with a range of cases where the diffraction pattern itself contains the important information.In the first case, electron diffraction from paraffins, degraded polyethylene and polyethylene single crystals, all the samples are highly ordered, and their crystallographic structure is well known. The diffraction patterns fade on irradiation and may also change considerably in a-spacing, increasing the unit cell volume on irradiation. The effect is large and continuous far C94H190 paraffin and for PE, while for shorter chains to C 28H58 the change is less, levelling off at high dose, Fig.l. It is also found that the change in a-spacing increases at higher dose rates and at higher irradiation temperatures.

Impairment Tutorial: Functionally Limiting Upper Extremity Pain: Controversies in Impairment Rating

2003 ◽  
Vol 8 (5) ◽  
pp. 4-12
Author(s):  
Lorne Direnfeld ◽  
James Talmage ◽  
Christopher Brigham
Keyword(s):  
Upper Extremity ◽  
Radicular Pain ◽  
Illness Behavior ◽  
Orthopedic Surgeon ◽  
First Case ◽  
Clinical Presentations ◽  
Whole Person ◽  
Physical Examinations ◽  
Upper Extremity Impairment ◽  
The Individual

Abstract This article was prompted by the submission of two challenging cases that exemplify the decision processes involved in using the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). In both cases, the physical examinations were normal with no evidence of illness behavior, but, based on their histories and clinical presentations, the patients reported credible symptoms attributable to specific significant injuries. The dilemma for evaluators was whether to adhere to the AMA Guides, as written, or to attempt to rate impairment in these rare cases. In the first case, the evaluating neurologist used alternative approaches to define impairment based on the presence of thoracic outlet syndrome and upper extremity pain, as if there were a nerve injury. An orthopedic surgeon who evaluated the case did not base impairment on pain and used the upper extremity chapters in the AMA Guides. The impairment ratings determined using either the nervous system or upper extremity chapters of the AMA Guides resulted in almost the same rating (9% vs 8% upper extremity impairment), and either value converted to 5% whole person permanent impairment. In the second case, the neurologist evaluated the individual for neuropathic pain (9% WPI), and the orthopedic surgeon rated the patient as Diagnosis-related estimates Cervical Category II for nonverifiable radicular pain (5% to 8% WPI).

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