Diagnostic difficulties and features of endovideosurgical treatment of a patient with mucocele of the appendix

The mucocele of the appendix is the expansion of the appendix with the accumulation of a large amount of mucus. The mechanism and causes of mucocele are not fully understood. According to some authors, such changes in the appendix can occur due to cicatricial narrowing of the lumen of the appendix, compression or blockage of its base. Other authors believe that the mucocele of the appendix is a benign tumor that develops from the remnants of primitive mesenchyme and is sometimes prone to malignancy. Clinical manifestations of mucocele of the appendix are nonspecific. In a number of patients, this disease causes pain in the right abdomen, more often pulling, intermittent. However, the disease is often asymptomatic. In this regard, diagnosis is established only during performing an operation, most often, regarding acute appendicitis. Nevertheless, instrumental diagnostic methods such as ultrasound and computed tomography of the abdominal and pelvic organs make it possible to suspect mucocele. Despite the frequent asymptomatic, non-aggressive course, a number of life-threatening complications can become the outcome of the mucocele of the vermiform appendix. The most formidable complication is the rupture of the appendix with mucus entering free abdominal cavity, followed by the development of peritoneal pseudomyxoma due to implantation of mucus-forming cells. The only option for radical treatment of the mucocele of the appendix is a surgical intervention. A presented clinical case demonstrates the difficulties of diagnosis, as well as the features of surgical treatment of a patient with a mucocele of the appendix.

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Dynamic neuropathy of the common peroneal nerve at the level of the fibular head (literature review and case report)

Russian journal of neurosurgery ◽

10.17650/1683-3295-2019-21-1-54-59 ◽

2019 ◽

Vol 21 (1) ◽

pp. 54-59

Author(s):

M. G. Bashlachev ◽

G. Yu. Evzikov ◽

V. A. Parfenov ◽

N. B. Vuitsyk ◽

F. V. Grebenev

Keyword(s):

Ankle Joint ◽

Peroneal Nerve ◽

Correct Diagnosis ◽

Clinical Manifestations ◽

Common Peroneal Nerve ◽

Diagnostic Methods ◽

Fibular Head ◽

Study Objective ◽

The Common ◽

The Right

The study objective is to report a case of dynamic neuropathy of the common peroneal nerve at the level of the fibular head and to discuss diagnostic methods and neurosurgical treatment. Materials and methods. We report a case of dynamic neuropathy of the common peroneal nerve at the level of the fibular head in a female patient. The patient was treated in the Neurology Clinic of I.M. Sechenov First Moscow State Medical University. We analyzed clinical manifestations and compared them with the data described in research literature. Results. Upon admission, the patient complained of pain in the anterolateral surface of the right shin and in the dorsum of the foot during walking. At rest, the patient experienced no pain. We observed no motor or sensory disorders typical of nerve root disorders at the level of L5. Lasegue’s test was negative. The patient had a positive Tinel’s sign in the area of the right fibular head. In order to clarify the diagnosis, we performed a repeated extension test in the right ankle joint and it was positive. The patient underwent surgery that included peroneal nerve decompression and neurolysis at the level of the fibular head. In the postoperative period, the patient had complete pain relief. Conclusion. Due to the difficulties in the diagnostics of dynamic neuropathy of the common peroneal nerve, this disease is often mistaken for radiculopathy at the level of L5. Thorough clinical examination, testing for Tinel’s sign in the area of the fibular head, and repeated extension test in the ankle joint ensure the correct diagnosis and reduce the frequency of ineffective surgeries on the lumbar spine. Surgical decompression of the common peroneal nerve at the level of the fibular head with obligatory opening of the entrance to the nerve canal is an effective method of treatment in such patients.

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PSEUDOMYXOMA ON APPENDICULAR MUCOCELE

International Journal of Advanced Research ◽

10.21474/ijar01/12222 ◽

2020 ◽

Vol 8 (12) ◽

pp. 842-846

Author(s):

Yehouenou Tessi T. Romeo ◽

◽

Asaad El Bakkari ◽

Adeyemi A. Boris ◽

Khadija Ben El Hosni ◽

...

Keyword(s):

Clinical Symptoms ◽

Iliac Fossa ◽

Disease Onset ◽

Vermiform Appendix ◽

Complete Resection ◽

Mucocele Of The Appendix ◽

Thin Walled ◽

Ct Density ◽

The Right ◽

Underlying Pathology

Mucocele of the appendix is a descriptive term for mucinous distension of the appendiceal lumen (vermiform appendix) regardless of the underlying pathology. It refers to the progressive retrograde dilatation of the vermiform appendix with concomitant intraluminal accumulation of the mucoid substance. It is an uncommon pathology that occurs in both sexes. it especially poses the problem of differential diagnosis in particular in women because of the location of clinical symptoms in the right iliac fossa. The incidence is estimated between 0.2 % and 0.4 % of the appendectomied specimens.The estimated incidence is approximately 1/1 000 000/year. The disease onset is usually after the age of 40 years and more frequently affects females.The means of medical imaging are mainly ultrasound and scanner. On CT typical mucocele appears as a cecal-based, rounded and well-defined mass, thin-walled, with fine parietal calcifications CT density is variable, from fluid to tissue. A stercolith is sometimes visible at the base of the appendix. The wall of the mucocele may be thickened, irregular, taking the contrast there may be peri-appendicular inflammation, which may be inflammatory or tumor, without specificity.The treatment of unbroken appendicular mucocele is surgical, preferably by laparotomy than laparoscopy. The appendectomy is performed, without breaking the appendix, with complete resection of the meso-appendix, and sampling for cytology of the peritoneal fluid.

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Role of connective tissue dysplasia in obstetrics and gynecology

Kazan medical journal ◽

10.17816/kmj2001 ◽

2014 ◽

Vol 95 (6) ◽

pp. 897-904

Author(s):

A S Gasparov ◽

E D Dubinskaya ◽

I A Babicheva ◽

N V Lapteva ◽

M F Dorfman

Keyword(s):

Connective Tissue ◽

Musculoskeletal Diseases ◽

Molecular Genetic ◽

Connective Tissue Diseases ◽

Clinical Manifestations ◽

Diagnostic Methods ◽

Obstetrics And Gynecology ◽

Special Importance ◽

Life Threatening ◽

Connective Tissue Dysplasia

A review of literature on the problem of connective tissue dysplasia in obstetric and gynecological practice is presented. The questions of terminology, classification, clinical manifestations and diagnosis are surveyed. Currently, many experts note the change of the classical clinical course of a significant number of internal diseases, increased prevalence of allergic and autoimmune diseases. Since the 90s of the last century, connective tissue dysplasia is considered one of the main reasons of the above mentioned conditions. Connective tissue dysplasia is the malformation, which is the basis of a significant number of internal diseases, with diverse symptoms and no clear diagnostic criteria. Researches on connective tissue dysplasia are mainly focused on cardiologic and pulmonary diseases, musculoskeletal diseases, and autoimmune processes. Researches addressing connective tissue diseases in a number of gynecological diseases and conditions in obstetrics appeared only recently. The presence of connective tissue dysplasia in women is a major problem in obstetrics and gynecology. Most reliable biochemical and molecular genetic studies are currently unavailable to a practicing doctor due to technical difficulties and considerable cost. So clinical-genealogical method of examination of patients and their families, as well as the widespread use of instrumental diagnostic methods are of special importance. Obstetricians and gynecologists while managing such patients should pay close attention to the phenotypic features of connective tissue dysplasia and carefully evaluate the cardiovascular and pulmonary systems, blood coagulation to avoid possible serious, often life-threatening, complications.

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Diagnosis Akut Abdomen akibat Peritonitis

e-CliniC ◽

10.35790/ecl.v9i1.31853 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Amalita Mannana ◽

Stephanus J. Ch. Tangel ◽

Eko Prasetyo

Keyword(s):

Literature Review ◽

Ct Scan ◽

Abdominal Cavity ◽

Clinical Manifestations ◽

Secondary Peritonitis ◽

Diagnostic Methods ◽

Google Scholar ◽

Clinical Impression ◽

Abdominal Ultrasonography ◽

Rebound Tenderness

Abstract: Peritonitis is defined as inflammation of serosal membrane that lines the abdominal cavity (peritoneum) and the organs contained therein. Secondary peritonitis accounts for 1% of urgent emergent hospital admidssions and is the second leading cause of sepsis in patients in intensive care units globally. Despite the growth in the availability of imaging and laboratory test, the rapid diagnosis of peritonitis remains a challenge for physicians in emergency medicine, surgery, and critical care. This study was aimed to obtain the rapid and appropriate diagnostic methods of secondary peritonitis. This was a literature review study using databases of PubMed, ClinicalKey, and Google Scholar on topics related to the diagnosis of secondary peritonitis. The results showed that there were 12 literatures in this study consisting of 5 review articles, 1 literature review, and 6 prospective studies. The literatures reviewed the diagnosis of secondary peritonitis based on clinical manifestations, physical examination, and the other examinations including laboratory examination, abdominal ultrasound, and abdominal CT scan. In conclusion, the diagnosis of secondary peritonitis is based on clinical manifestation including abdominal pain, rigidity, and rebound tenderness. These sign and symptoms may be supported by laboratory and radiology findings as additional tests if needed. Abdominal ultrasonography is the most practical and non-invasive radiology test for rapid diagnostic in a subgroup of patients with secondary peritonitis whose clinical impression is unclear. Keywords: Secondary Peritonitis, Diagnosis of Secondary Peritonitis, Acute Abdomen Abstrak: Peritonitis adalah inflamasi pada selaput serosa yang membungkus rongga abdomen (peritoneum) dan organ yang terkandung di dalamnya. Peritonitis sekunder menyumbang 1% insiden pada pasien yang masuk di UGD dan merupakan penyebab utama kedua terjadinya sepsis pada pasien di ICU secara global. Di tengah perkembangan ketersediaan pemeriksaan radiologi dan laboratorium yang pesat, diagnosis yang cepat pada peritonitis masih menjadi tantangan bagi para dokter dalam penanganan darurat, pembedahan, dan perawatan pasien kritis. Penelitian ini bertujuan untuk mengetahui metode diagnosis yang cepat dan tepat pada peritonitis sekunder. Jenis penelitian ialah literature review menggunakan database PubMed, ClinicalKey, dan Google Scholar. Hasil penelitian mendapatkan 12 literatur terdiri dari 5 review article, 1 literature review, dan 6 prospective study yang mengulas tentang diagnosis peritonitis sekunder ditegakkan berdasarkan manifestasi klinis, pemeriksaan fisik, dan berbagai pemeriksaan penunjang lainnya yang mencakup pemeriksaan laboratorium, USG abdomen, dan CT scan abdomen. Simpulan penelitian ini ialah diagnosis peritonitis sekunder ditegakkan berdasarkan manifestasi klinis seperti nyeri abdomen, rigiditas, dan rebound tenderness. Tanda dan gejala ini dapat didukung oleh temuan radiologi dan laboratorium sebagai pemeriksaan tambahan bila diperlukan. USG abdomen merupakan pemeriksaan radiologi yang paling praktis dan non-invasif untuk diagnosis cepat pada kelompok pasien peritonitis sekunder dengan kesan klinis yang tidak jelas.Kata kunci: peritonitis sekunder, diagnosis peritonitis sekunder, akut abdomen

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Implantable cardioverter defibrillators at the end of life: future perspectives on clinical practice

Netherlands Heart Journal ◽

10.1007/s12471-020-01438-6 ◽

2020 ◽

Vol 28 (11) ◽

pp. 565-570

Author(s):

R. Stoevelaar ◽

A. Brinkman-Stoppelenburg ◽

R. L. van Bruchem-Visser ◽

A. G. van Driel ◽

R. E. Bhagwandien ◽

...

Keyword(s):

End Of Life ◽

Healthcare Professionals ◽

Point Of View ◽

Implantable Cardioverter Defibrillators ◽

Number Of Patients ◽

Life Threatening ◽

The Right ◽

Patients Experience ◽

Cardioverter Defibrillators ◽

Fragmentation Of Care

Abstract The implantable cardioverter defibrillator (ICD) is effective in terminating life-threatening arrhythmias. However, in the last phase of life, ICD shocks may no longer be appropriate. Guidelines recommend timely discussion with the patient regarding deactivation of the shock function of the ICD. However, research shows that such conversations are scarce, and some patients experience avoidable and distressful shocks in the final days of life. Barriers such as physicians’ lack of time, difficulties in finding the right time to discuss ICD deactivation, patients’ reluctance to discuss the topic, and the fragmentation of care, which obscures responsibilities, prevent healthcare professionals from discussing this topic with the patient. In this point-of-view article, we argue that healthcare professionals who are involved in the care for ICD patients should be better educated on how to communicate with patients about ICD deactivation and the end of life. Optimal communication is needed to reduce the number of patients experiencing inappropriate and painful shocks in the terminal stage of their lives.

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Clinical Presentation, Diagnosis, and Management of Idiopathic Enlargement of the Right Atrium: An Analysis Based on Systematic Review of 153 Reported Cases

Cardiology ◽

10.1159/000511434 ◽

2020 ◽

pp. 1-10

Author(s):

Jing Zhang ◽

Li Zhang ◽

Lin He ◽

He Li ◽

Yuman Li ◽

...

Keyword(s):

Sudden Cardiac Death ◽

Surgical Resection ◽

Right Atrium ◽

Cardiac Death ◽

Clinical Presentation ◽

Clinical Manifestations ◽

Diagnosis And Management ◽

Presenting Symptoms ◽

Life Threatening ◽

The Right

Idiopathic enlargement of the right atrium (IERA) is a rare cardiac anomaly, and only sporadic cases have been reported. Little is known about its clinical relevance, and inconsistencies in medical and surgical management remain among different settings. In this paper, we systematically reviewed the published cases of the IERA in terms of clinical presentation, diagnosis, and management. A total of 153 cases of IERA were covered. Arrhythmia, dyspnea, and palpitation were found to be the most common clinical manifestations. It tends to be associated with life-threatening complications and sudden cardiac death. Diagnosis was mostly established by using echocardiography. Presenting symptoms, abnormal ECG findings, and therapeutic modalities were significantly related to the prognosis of IERA. Symptomatic patients were significantly more likely to have poor outcomes than asymptomatic patients (<i>p</i> = 0.044), and conservative treatment was more associated with adverse outcomes compared to surgical resection (<i>p</i> = 0.016). In conclusion, IERA, although rare, tends to be associated with potential life-threatening complications and sudden cardiac death. Echocardiography is the most common diagnostic modality. Surgical resection is indicated for symptomatic patients.

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Dyspnea and Wheezing: Still a Challenge for Pulmonologists

Case Reports in Pulmonology ◽

10.1155/2012/610949 ◽

2012 ◽

Vol 2012 ◽

pp. 1-3

Author(s):

Ana Sofia Castro ◽

Ana Barroso ◽

Sara Conde ◽

Bárbara Parente

Keyword(s):

Respiratory Symptoms ◽

Benign Tumor ◽

Clinical Manifestations ◽

Fiberoptic Bronchoscopy ◽

Lobe Bronchus ◽

Endoscopic Intervention ◽

Endoscopic Techniques ◽

Benign Schwannoma ◽

Nerve Sheath ◽

The Right

Schwannoma is a neurogenic tumor originating from the nerve sheath Schwann cells. Intrathoracic location is rare, and the endobronchial location is exceptional. Schwannoma is a rare tumor; the majority of lesions are benign and usually asymptomatic. The authors present a case report of a 83-year-old woman, nonsmoker, observed in the emergency department for wheezing and cough lasting for 2 months. Chest tomography showed a right hilar pulmonary mass, ill defined, with thick and irregular walls, centered on the upper lobe bronchus, which was obliterated. Fiberoptic bronchoscopy showed a necrotic mass obstructing the right upper lobe bronchus whose biopsy allowed the diagnosis of benign schwannoma. Subsequently, the patient carried tumor ablation by laser bronchoscopy, with the resolution of the respiratory symptoms. This case stands out for its rarity but also because it is an excellent example of the importance of endoscopic techniques for therapeutic purposes. Schwannoma is a benign tumor in which surgical or endoscopic intervention generally prevents local recurrence and associated clinical manifestations.

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Massive right-sided colon diverticular bleeding complicated by the transfusion related acute lung injury (TRALI)

Open Medicine ◽

10.2478/s11536-012-0079-8 ◽

2012 ◽

Vol 7 (6) ◽

pp. 716-719

Author(s):

Ivana Urošević ◽

Ivanka Perčić ◽

Aleksandar Knežević ◽

Aleksandar Savić ◽

Ivanka Savić

Keyword(s):

Acute Lung Injury ◽

Lung Injury ◽

Complete Recovery ◽

Transfusion Reaction ◽

Diverticular Bleeding ◽

Lower Gastrointestinal Hemorrhage ◽

Diagnostic Difficulties ◽

Life Threatening ◽

The Right ◽

Review Current

AbstractColonic diverticulosis is a condition which causes extensive bleeding of the lower gastrointestine in 40–50% of cases. In particular, right-sided diverticulosis, although uncommon requires lifesaving colectomy. Transfusion related acute lung injury (TRALI) is a transfusion reaction, which can occur after administration of various blood products. Although life threatening, it can be completely reversed usually within 72 to 96 hours. Here, we report a case of a young Caucasian male hospitalized due to severe anemia, hematochezia and extensive blood loss, all due to lower gastrointestinal hemorrhage from right-sided diverticulosis. These conditions were overlooked endoscopically and diagnosed then treated surgically with the right-sided hemicolectomy. During postoperative course, four hours after the last transfusion, patient developed fever, hypoxia and noncardiogenic pulmonary oedema, but made complete recovery through aggressive oxygen support within 96 hours. The aim of this case was to review current literature, to draw attention to a serious and under-diagnosed transfusion reaction, as well as discuss possible explanations for the diagnostic difficulties that occurred in this case.

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Heart transplantation in a patient with primary malignant tumor

Russian Journal of Transplantology and Artificial Organs ◽

10.15825/1995-1191-2019-1-77-81 ◽

2019 ◽

Vol 21 (1) ◽

pp. 77-81

Author(s):

E. E. Kliver ◽

I. S. Murashov ◽

A. M. Volkov ◽

E. N. Kliver ◽

D. V. Doronin

Keyword(s):

Ventricular Tachycardia ◽

Right Ventricle ◽

Clinical Case ◽

Malignant Tumors ◽

Clinical Manifestations ◽

Apical Region ◽

Rf Ablation ◽

Life Threatening ◽

Electrophysiological Examination ◽

The Right

The article looks at a clinical case of a 31-year-old female with signs of paroxysmal ventricular tachycardia and Morgagni–Adams–Stokes syndrome. In April 2014, electrophysiological examination revealed a source of ventricular tachycardia localized in the apices of the right and left ventricles of the patient. The sources were then subjected to RF ablation followed by cardioverter-defibrillator implantation. Subsequent antiarrhythmic therapy failed to improve her state. In September 2016 the patient was re-examined and underwent RF ablation of the apical region of the right ventricle. Later on, taking into account continuously recurrent life-threatening cardiac rhythm disorders, as well as unpromising strategies for further conservative treatment, she was put on the waiting list and then underwent orthotopic cardiac transplantation. Histological examination and immunohistochemistry assay showed leiomyosarcoma in the source of ventricular tachycardia previously found in the apex of the right ventricle. This clinical case demonstrates a diversity of clinical manifestations of primary malignant tumors of the heart that pose a challenge for intravital diagnostics and interpretation of a clinical picture.

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A Clinical Case of Stomach Perforation Concealed by a Foreign Body

Creative Surgery and Oncology ◽

10.24060/2076-3093-2020-10-3-228-232 ◽

2020 ◽

Vol 10 (3) ◽

pp. 228-232

Author(s):

M. R. Garaev ◽

M. Yu. Vorotnikov ◽

Z. R. Garayeva ◽

M. A. Nartaylakov

Keyword(s):

Foreign Body ◽

Clinical Picture ◽

Clinical Case ◽

Foreign Bodies ◽

Abdominal Cavity ◽

Clinical Manifestations ◽

Diagnostic Methods ◽

Satisfactory Condition ◽

Therapy Choice ◽

Ct Data

Introduction. Stomach perforations caused by ingested foreign bodies are extremely rare injuries in adults, accounting for less than 1% of all gastrointestinal perforations. The clinical picture is diverse and often presents a diagnostic problem. There are few publications reporting such cases in literature.Materials and methods. Using the example of a clinical case, this paper describes the clinical picture, diagnostic role of X-ray instruments and surgical tactics of diagnosing and treating a stomach perforation concealed by a foreign object, which occurred one week prior to admission. The patient V., 52 yo, was admitted to hospital on an emergency basis in the condition of moderate severity, complaining of abdominal pain for two days. The onset of the disease had no apparent reason. Similar pains had bothered the patient a week earlier the incident but were relieved without treatment.Results and discussion. On the basis of clinical and laboratory-instrumental data, acute pancreatitis was pre-diagnosed. Conservative drug therapy with positive dynamics was started. Two days later, computed tomography of the abdominal organs with intravenous bolus contrast was performed. According to the CT data, a foreign body in the abdominal cavity was identified, which rested on the liver at the level of the gallbladder, perforating the wall of the pyloric department of the stomach. Localized inflammatory effusion in the abdominal fat was observed. The patient was operated and discharged in satisfactory condition.Conclusion. Stomach perforations caused by small-sized foreign bodies are characterized by non-specific clinical manifestations. The use of radiation diagnostic methods facilitates the timely diagnosis and therapy choice in patients with stomach perforations caused by small-sized foreign bodies.

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