scholarly journals Colonic Diverticulitis Complicated by Liver Abscess: Case Series and Review of Literature

2018 ◽  
Vol 1 (1) ◽  
pp. 12-19
Author(s):  
Meka Adi Uffenheimer ◽  
Paul A Kohanteb ◽  
Cynthia Liu ◽  
Alagappan Annamalai ◽  
Ashley Wachsman ◽  
...  
Keyword(s):  
Liver Abscess ◽  
Medical Center ◽  
Clinical Manifestations ◽  
Case Series ◽  
Administrative Database ◽  
Colonic Diverticulitis ◽  
Ct Guided ◽  
Female Ratio ◽  
Recurrent Diverticulitis ◽  
Purulent Peritonitis

Aim: Evaluate patients with colonic diverticulitis complicated by liver abscesses at a single center and provide review of literature.Methods: Patients with colonic diverticulitis and liver abscess were identified via an administrative database and imaging search engine at Cedars Sinai Medical Center (CSMC). Clinical manifestations, laboratory and imaging findings and treatment strategies were assessed.Results: We identified 10 patients with a median age of 59 and a 7:3 male: female ratio. The top presenting signs and symptoms were: fever (90%), malaise (70%), anorexia (60%), nausea (40%), and right upper quadrant abdominal pain (30%). Mean white blood cell count was 22.4 1000/UL, total bilirubin 2.59 mg/DL, and alkaline phosphatase 206.6 IU/L. Of the reported liver abscess cultures, 5 patients grew a single organism and 2 had multiple organisms. Most common bacteria genus was Streptococcus (n=4). Five patients had right hepatic abscesses, 3 had bilobar, and 2 had left hepatic abscesses. Four patients had locally complicated diverticulitis: 2 with paracolonic abscess and 2 with purulent peritonitis. Nine patients had CT-guided drainage of liver abscess, while 2 needed surgical drainage of liver abscess (one required both). Five patients had colectomy: 1 emergently and 4 electively. Two patients who did not have colectomy had recurrent diverticulitis, and underwent colectomy following recurrence.Conclusion: Majority of patients with diverticulitis with liver abscess were males presenting with fever, and leukocytosis. Most had right liver lobe abscesses and most underwent colectomies. Diverticulitis with liver abscess is likely best treated as locally complicated disease and should undergo colectomy.

Clinical Manifestations of Cholelithiasis in Quito, Ecuador. A Cohort Study

2021 ◽  
pp. 12
Author(s):  
◽  
◽  
Keyword(s):  
Epigastric Pain ◽  
Medical Center ◽  
Clinical Manifestations ◽  
Abdominal Ultrasound ◽  
Common Symptom ◽  
Low Back ◽  
Female Ratio ◽  
Male Female Ratio ◽  
The Right ◽  
A Prospective Study

Introduction: A prospective study was carried out, with the aim of establishing the clinical manifestations of cholelithiasis in the population of Quito, Ecuador. Methods: During the period from January 2012 to October 2017, 534 patients were referred from different outpatient clinics of the Ecuadorian Institute of Social Security to the Batan Medical Center with the diagnosis of cholelithiasis after a clinical assessment and abdominal ultrasound, to be treated surgically. Results: Sixty-nine percent of patients were female with a male-female ratio of 1:2.21. Mean age was 44.9 years. Pain was the most common symptom in our study: 95.7%. Among these patients, pain was located in the epigastrium in 49.8%, in the right hypochondrium in 45.1% and only 0.8% had low back pain. Pain ranged from moderate and even severe. The remaining 4.3% of patients had dyspepsia or were asymptomatic. Conclusions: This finding highlights the fact that epigastric pain must be always considered as a clinical manifestation on cholelithiasis.

Entamoeba histolytica liver abscess case: could stool PCR avoid it?

Diagnosis ◽  
2020 ◽  
Vol 7 (1) ◽  
pp. 69-73 ◽  
Author(s):  
Albert Bernet Sánchez ◽  
Alba Bellés Bellés ◽  
Jesus Aramburu Arnuelos ◽  
Alfredo Jover Sanz ◽  
Eva Sesé Abizanda ◽  
...  
Keyword(s):  
Entamoeba Histolytica ◽  
Liver Abscess ◽  
Clinical Manifestations ◽  
Clinical History ◽  
Immunosuppressive Drugs ◽  
Molecular Techniques ◽  
Extraintestinal Manifestation ◽  
Ct Guided ◽  
Parasite Detection ◽  
Stool Samples

AbstractBackgroundLiver abscess is the most common extraintestinal manifestation of Entamoeba histolytica. Clinical manifestations could appear after returning from an endemic area or several years after the exposure. The diagnosis usually requires microbiological confirmation.Case presentationWe present a case of a 55-year-old woman diagnosed with Crohn’s disease treated with immunosuppressive drugs, who was admitted to the Emergency Service with liver parenchyma abscesses. Computed tomography (CT)-guided puncture showed pus, and both Gram staining and fresh parasite visualization were negative. Hepatic pus bacteriological culture was reported as negative and parasite multiplex polymerase chain reaction (PCR) was performed, being positive for E. histolytica. The same PCR was performed on blood, pleural fluid and stool samples, all of them being positive for E. histolytica.ConclusionsReviewing the clinical history of this patient, it was observed that parasite detection in three stool samples was negative 2 months before the current admission. Due to the lack of sensitivity of the microscopy techniques, we propose to routinely perform parasite detection in stools using molecular techniques, especially in immunocompromised patients.

scholarly journals AB0725 MACROPHAGE ACTIVATION SYNDROME IN CHILDREN WITH RHEUMATIC DISEASES: ANALYSIS OF CASE SERIES

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1393.3-1394
Author(s):  
M. Kaleda ◽  
I. Nikishina ◽  
V. Matkava ◽  
A. Shapovalenko ◽  
E. Fedorov ◽  
...  
Keyword(s):  
Macrophage Activation Syndrome ◽  
Macrophage Activation ◽  
Early Stage ◽  
Clinical Manifestations ◽  
Case Series ◽  
Overlap Syndrome ◽  
High Dose ◽  
Female Ratio ◽  
Course Of Disease ◽  
Activation Syndrome

Background:Macrophage activation syndrome (MAS) is a rare, but severe life-threatening complication of chronic rheumatic disease (RD) in children, which associated with high risks of the multiple organ failure and mortality.Objectives:Tо analyze demographic, clinical and laboratory parameters, timing of MAS and disease outcome in patients (pts) with MAS and RD.Methods:The study included all pts of single center with RD, who developed the MAS. The diagnosis was recognized according to Classification criteria for MAS in sJIA [1].Results:We observed 52 pts with RD and MAS: 31 (59.6%) with sJIA, 19 (36.5%) – SLE, 1(1.9%) – juvenile dermatomyositis (JDM), 1 (1.9%) – overlap syndrome (JIA+JDM). Pts with MAS accounted of 26% of all pts with sJIA, 7.6% of all pts with SLE. The mean age of pts at onset of sJIA was 2.6 y [1.5; 5.75], at onset of SLE – 11.8 y [8.6; 13.95]. The patient with JDM was 6.5 years old, pts with overlap syndrome – 3.5 years old. Male to female ratio was 1:1,7. A total of 63 episodes of MAS was recorded (41 – in sJIA, 20 – SLE, 1 – JDM, 1 - overlap syndrome). 23 pts (44.2%) had MAS at onset, 26 pts (50%) – “classic” MAS (during the course of disease), 3 pts (5.8%) – recurrent MAS. The clinical manifestations of MAS included fever (90.4%), hepatomegaly (50%), pericarditis (46.2%), hemorrhagic rash (32.7%), neurologic involvement (42.3%), lung involvement (34.6%). We found hyperferritinemia in 98%, thrombocytopenia in 78.8%, increased transaminases in 88.5%, hypofibrinogenemia in 40.4%, hypertriglyceridemia in 42.3 % of pts. Most severe course of MAS was established in pts with ferritin levels >1500 ng/ml and with hypertriglyceridemia more than 6.0 mmol/l at an early stage. Bone marrow investigation was performed in 21 pts, and the evidence of haemophagocytosis was confirmed in 8 pts (38%). First features of MAS were fever, sleepiness, lower platelet counts, high TA. Lesions of the skin and mucous were mainly represented by point hemorrhages at an early stage in pts with SLE and MAS, the development of a bright rash with itching was typical for pts with sJIA and MAS. There are no principal differences between course of MAS in sJIA and other RD in children, but mild “subclinical” cases of MAS were observed only in pts with sJIA on biologics. For treatment of MAS all pts were administered high dose of glucocorticoids (per os+iv). Pts with SLE received: cyclophosphamide iv - 5 (26.3%), cyclosporine per os 1 (5.2%), IVIGs - 6 (31.6%), rituximab - 2 pts (10.5%). Pts with sJIA received: cyclosporine per os - 20 (64.5%), IVIGs - 25 (80.6%), 1 etoposide - (3.2%). Patient with overlap syndrome received cyclosporine per os. 8 pts (15.4%) died from MAS (3 with sJIA, 5 – with SLE).Conclusion:MAS can develop in various children’s RD, but more often in pts with sJIA. In our observation more pts had MAS during the course of disease, not at onset. Rapid recognition of MAS can improve treatment outcomes and prognosis.References:[1]Ravelli A, Minoia F, Davì S, et al. 2016.Disclosure of Interests:None declared

scholarly journals Pulmonary hamartoma, a rare benign tumour of the lung - Case series

2014 ◽  
Vol 5 (3) ◽  
pp. 112-115 ◽  
Author(s):  
Ruchita Tyagi ◽  
Amamjit Bal ◽  
Divyesh Mahajan ◽  
Raje Nijhawan ◽  
Ashim Das
Keyword(s):  
Histopathological Examination ◽  
Tertiary Care ◽  
Medical Science ◽  
Lung Nodule ◽  
Case Series ◽  
Pulmonary Nodules ◽  
Solitary Pulmonary Nodules ◽  
Ct Guided ◽  
Female Ratio ◽  
Pulmonary Hamartoma

Introduction - Pulmonary hamartoma, with incidence of 0.25-0.32%, accounts for 6% of solitary pulmonary nodules. The role of radiology is limited as only 10-30% of cases show characteristic ‘popcorn’ calcification and Computed Tomography can detect approximately  50% of hamartomas. Hence cytological and/or histopathological examination is required to make a definitive diagnosis and exclude malignancy. Objective – As pulmonary hamartoma is a rare entity detected serendipitously on radiography and requires cytological and histopathological examination for confirmation of diagnosis, we present nine cases of solitary pulmonary nodules which were diagnosed as pulmonary hamartoma.  Methods - We retrospectively screened departmental records and slides and found nine cases of pulmonary hamartoma in our tertiary care institute. Three cases were diagnosed on CT guided Fine Needle Aspiration Cytology and four cases were diagnosed on histopathological examination of surgical specimens, over a period of 16 years (1997-2012). Two cases were incidentally discovered to have pulmonary hamartoma at autopsy.  Observations – The age of the patients ranged from 17-63 years (mean-46.3), with male to female ratio being 3.5:1. The size of the hamartoma varied from 0.4 – 1.3 cm, with mean diameter of 1 cm. Cytology showed mixture of bronchial epithelial cells, adipocytes and stromal fragments in fibromyxoid and chondroid background. Histopathology demonstrated lobules of cartilage and adipose tissue with intervening clefts lined by respiratory epithelium and mesenchymal stroma. Conclusion – Every solitary pulmonary nodule is not malignant. It is important to correctly diagnose pulmonary hamartoma, a rare, yet benign neoplasm presenting as a solitary lung nodule and distinguish it from malignancy.Asian Journal of Medical Science, Volume-5(3) 2014: 112-115 http://dx.doi.org/10.3126/ajms.v5i3.9243 

scholarly journals Successful Diagnoses and Remarkable Metabolic Disorders in Patients With Solitary Hypothalamic Mass: A Case Series Report

2021 ◽  
Vol 12 ◽  
Author(s):  
Boni Xiang ◽  
Quanya Sun ◽  
Min He ◽  
Wei Wu ◽  
Bin Lu ◽  
...  
Keyword(s):  
Metabolic Disorders ◽  
Stereotactic Biopsy ◽  
Age Of Onset ◽  
Clinical Manifestations ◽  
Case Series ◽  
Initial Symptom ◽  
Safe Procedure ◽  
Metabolic Disturbances ◽  
Surgical Biopsy ◽  
Female Ratio

BackgroundSolitary intracranial hypothalamic mass occurs rarely. The etiological diagnosis of solitary hypothalamus lesion is challenging and often unachievable. Although previous studies indicated that lesions affecting the hypothalamus often cause significant metabolic disorders, few reports about the metabolic disturbances of patients with solitary hypothalamic mass have been reported.MethodTwenty-five patients with solitary hypothalamus lesions who had been evaluated and treated in Huashan Hospital from January 2010 to December 2020 were retrospectively enrolled. The clinical manifestations, radiological features, endocrine and metabolic disorders, and pathology were analyzed.ResultsThe male to female ratio was 5/20. The median age of onset was 22 (19, 35) years old. The most common initial symptom was polydipsia/polyuria (19/25, 76.0%) and amenorrhea (9/20, 45.0%). A high prevalence of hypopituitarism of different axes was found, with almost all no less than 80%. Central hypogonadism (21/22, 95.5%) and central diabetes insipidus (19/21, 90.5%) were the top two pituitary dysfunctions. Conclusive diagnoses were achieved by intracranial surgical biopsy/resection or stereotactic biopsy in 16 cases and by examining extracranial lesions in 3 cases. The pathological results were various, and the most common diagnoses were Langerhans cell histiocytosis (7/19) and hypothalamitis (5/19). The mean timespan from onset to diagnosis in the 19 cases was 34 ± 26 months. Metabolic evaluations revealed remarkable metabolic disorders, including hyperlipidemia (13/16, 81.3%), hyperglycemia (10/16, 62.5%), hyperuricemia (12/20, 60%), overweight/obesity (13/20, 65.0%), and hepatic adipose infiltration (10/13, 76.6%).ConclusionEither surgical or stereotactic biopsy will be a reliable and relatively safe procedure to help to confirm the pathological diagnosis of solitary hypothalamic mass. Metabolic disorders were severe in patients with solitary hypothalamic mass. The management of such cases should cover both the treatment of the primary disease, as well as the endocrine and metabolic disorders

scholarly journals Non-Surgical Treatment of Colonic Diverticulitis (a Review)

2020 ◽  
Vol 10 (2) ◽  
pp. 122-129
Author(s):  
Sh. V. Timerbulatov ◽  
E. N. Gainullina ◽  
M. V. Timerbulatov
Keyword(s):  
Financial Burden ◽  
Clinical Manifestations ◽  
Colonic Diverticulitis ◽  
Duration Of Treatment ◽  
Adequate Treatment ◽  
Noticeable Increase ◽  
Treatment And Prevention ◽  
Recurrent Diverticulitis ◽  
Antibiotic Drug ◽  
Critical Overview

Colonic diverticulitis poses an adverse medical and social problem for its prevalence, variety of clinical manifestations and complications and is becoming menacing as the people’s life expectancy reaches beyond 80 years. Many of the traditional principles no longer apply. This situation warrants an earlier diagnosis of colonic diverticulitis, its adequate treatment and prevention. The article presents a review of current literature on the conservative treatment of inflammatory colonic diverticulitis. The past 20 years have witnessed a noticeable increase to 20 % of hospitalisation rate with complicated diverticulitis and a higher associated financial burden. We discuss issues in the diagnosis and criteria for diverticulitis severity assessment with laboratory, biochemical data and radiation imaging (computer tomography, magnetic resonance imaging, ultrasound, colonoscopy). A critical overview is provided on anti-inflammatory and antibiotic drug usage in recurrence prevention and treatment of acute and recurrent diverticulitis, aside to recommendations in outpatient care. Despite a manifold of clinical studies and guidelines available, the adequate choice of drugs, dosages and duration of treatment remains an open challenge.

The Onodi Cell

2011 ◽  
Vol 145 (6) ◽  
pp. 1040-1042 ◽  
Author(s):  
Ji-Hyeon Shin ◽  
Sung Won Kim ◽  
Yong Kil Hong ◽  
Sin-Soo Jeun ◽  
Seok-Gu Kang ◽  
...  
Keyword(s):  
Medical Center ◽  
Tertiary Care ◽  
Clinical Manifestations ◽  
Case Series ◽  
Sinus Surgery ◽  
Endoscopic Endonasal ◽  
Anatomical Variant ◽  
Tertiary Care Medical Center ◽  
Onodi Cell ◽  
Sellar Floor

Objective. The Onodi cell is the posterior-most ethmoid air cell and an important anatomical variant because of the intimate spatial relationship with the optic nerve, internal carotid artery, and sellar floor during sphenoid sinus surgery. The authors evaluated the incidence of Onodi cells, their clinical importance, and the association between preoperative radiological findings and surgical findings. Study Design. Case series with chart review. Setting. Tertiary care medical center. Methods. The authors retrospectively reviewed the medical records of 162 cases, including preoperative paranasal sinus computed tomography (PNS CT) findings and the findings with the endoscopic endonasal transsphenoidal approach (EETSA). They evaluated the prevalence of Onodi cells and the clinical manifestations in the patients with these cells. They also examined the clinical significance of these cells during EETSA. Results. Onodi cells were identified in the preoperative PNS CT of 53 patients, whereas Onodi cells were observed in 54 (33.3%) of the 162 patients at EETSA. The Onodi cells were bilateral in 23 patients and unilateral in 31. In all cases, the Onodi cells limited the exposure of the sellar floor. Only after removing these cells was the entire sellar floor exposed so that the tumors could be removed completely. Conclusion. Onodi cells were observed more frequently than in previous studies, and 98.1% of them were identified on preoperative PNS CT. When reviewing PNS CT images preoperatively, one needs to identify the presence of Onodi cells. The Onodi cells must be removed to completely resect tumors located in the sellar region during EETSA.

scholarly journals Characteristics and Outcomes Among Hospitalized COVID-19-Positive Patients in a Nonurban Environment

2021 ◽  
Author(s):  
Robert P Lennon ◽  
Theodore J Demetriou ◽  
M Fahad Khalid ◽  
Lauren Jodi Van Scoy ◽  
Erin L Miller ◽  
...  
Keyword(s):  
New York ◽  
Medical Center ◽  
Academic Medical Center ◽  
Military Medicine ◽  
Case Series ◽  
Outcome Data ◽  
Urban Environments ◽  
Urban Setting ◽  
Published Data ◽  
Retrospective Case

ABSTRACT Introduction Virtually all hospitalized coronavirus disease-2019 (COVID-19) outcome data come from urban environments. The extent to which these findings are generalizable to other settings is unknown. Coronavirus disease-2019 data from large, urban settings may be particularly difficult to apply in military medicine, where practice environments are often semi-urban, rural, or austere. The purpose of this study is compare presenting characteristics and outcomes of U.S. patients with COVID-19 in a nonurban setting to similar patients in an urban setting. Materials and Methods This is a retrospective case series of adults with laboratory-confirmed COVID-19 infection who were admitted to Hershey Medical Center (HMC), a 548-bed tertiary academic medical center in central Pennsylvania serving semi-urban and rural populations, from March 23, 2020, to April 20, 2020 (the first month of COVID-19 admissions at HMC). Patients and outcomes of this cohort were compared to published data on a cohort of similar patients from the New York City (NYC) area. Results The cohorts had similar age, gender, comorbidities, need for intensive care or mechanical ventilation, and most vital sign and laboratory studies. The NYC’s cohort had shorter hospital stays (4.1 versus 7.2 days, P < .001) but more African American patients (23% versus 12%, P = .02) and higher prevalence of abnormal alanine (>60U/L; 39.0% versus 5.9%, P < .001) and aspartate (>40U/L; 58.4% versus 42.4%, P = .012) aminotransferase, oxygen saturation <90% (20.4% versus 7.2%, P = .004), and mortality (21% versus 1.4%, P < .001). Conclusions Hospitalists in nonurban environments would be prudent to use caution when considering the generalizability of results from dissimilar regions. Further investigation is needed to explore the possibility of reproducible causative systemic elements that may help improve COVID-19-related outcomes. Broader reports of these relationships across many settings will offer military medical planners greater ability to consider outcomes most relevant to their unique settings when considering COVID-19 planning.

scholarly journals 766. Everything Old is New Again-A Case Series of New World Leishmaniasis in African Children in Portland, Maine

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S428-S428
Author(s):  
Jennifer Jubulis ◽  
Amanda Goddard ◽  
Elizabeth Seiverling ◽  
Marc Kimball ◽  
Carol A McCarthy
Keyword(s):  
Latin America ◽  
Cutaneous Leishmaniasis ◽  
New World ◽  
Pediatric Patients ◽  
Data Extraction ◽  
Clinical Manifestations ◽  
Case Series ◽  
Surgical Excision ◽  
Skin Lesions ◽  
Travel History

Abstract Background Leishmaniasis has many clinical manifestations and treatment regimens, dependent on species and host. Old world leishmaniasis is found primarily in Africa and Asia, and is associated with visceral disease, while new world disease, seen primarily in Latin America, is more commonly mucocutaneous. We present a case series of pediatric African patients with New World cutaneous leishmaniasis (NWCL). Methods Data extraction was performed via chart review, analyzing travel history, clinical presentation, diagnosis, and management in children with cutaneous leishmaniasis presenting to the pediatric infectious diseases clinic in Portland, ME. Biopsy specimens were sent to the federal CDC for identification by PCR and culture. Results Five cases of NWCL were diagnosed in pediatric patients in Maine from November 2018 through February 2020. Median age of patients was 10 years (range 1.5-15 years). Four cases (80%) occurred in children from Angola or Democratic Republic of Congo, arriving in Maine via Central/South America, with one case in a child from Rwanda who arrived in Maine via Texas. Three patients had multiple skin lesions and two had isolated facial lesions. Leishmaniasis was not initially suspected resulting in median time to diagnosis of 5 months (range 1-7 months). Four patients were initially treated with antibacterials for cellulitis and one was treated with griseofulvin. After no improvement, patients underwent biopsy with 2 patients diagnosed with L panamensis, 1 with L braziliensis, 1 with mixed infection (L panamensis and L mexicana), and 1 with Leishmania species only. One patient was managed with surgical excision, 3 with ketoconazole, and 1 was observed off therapy. Four patients were referred to otolaryngology. All continue to be followed in infectious disease clinic. Conclusion We present five cases of new world cutaneous leishmaniasis in African pediatric patients arriving to Maine through Latin America or Texas. Patients were diagnosed with cellulitis, tinea corporis or atopic dermatitis initially, underscoring importance of high index of suspicion in migrant patients. Detailed travel history and epidemiologic knowledge is essential to diagnosis, as patients may present with illness not congruent with country of origin. Optimal therapy remains unclear. Disclosures All Authors: No reported disclosures

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