scholarly journals Les Occlusions Intestinales Par Nœud Ileo-Sigmoïdien : Aspects Diagnostiques, Thérapeutiques Et Pronostiques

2017 ◽  
Vol 13 (33) ◽  
pp. 254
Author(s):  
James Didier. L. ◽  
Chaibou MS. ◽  
Adama. S. ◽  
Idé K. ◽  
Abdoulaye MB. ◽  
...  
Keyword(s):  
Delayed Diagnosis ◽  
Clinical Signs ◽  
Rare Condition ◽  
Morbidity Rate ◽  
National Hospital ◽  
Surgical Specialty ◽  
Average Hospital ◽  
Ileosigmoid Knot ◽  
Compound Volvulus ◽  
Intestinal Obstructions

Introduction: Ileosigmoid knot (ISK), also known as compound volvulus or double volvulus, is a rare disease and affects mostly male subjects in their fourth decade. Delayed diagnosis often leads to complications with a high incidence of digestive necrosis. Materials and methods: This was a 10-year retrospective, descriptive and analytical study from 1 January 2007 to 31 December 2016, which covered all patients operated emergently for ISK in the surgical and surgical specialty departments at the Niamey National Hospital (NNH). Results: The series involved 8 cases of ISK, representing 0.82% of intestinal obstructions. There were 7 men and 1 woman. The average age of patients was 44.33 years with extremes ranging from 25 to 60 years. The main clinical signs were: abdominal pain (100%), inability to pass gas and stool (100%), vomiting (87.5%) and abdominal meteorism (87.5%). Four patients (50%) had a clear obstructive syndrome and the other 4 patients (50%) had associated signs of peritoneal irritation. Paraclinical diagnosis was difficult because of atypical clinico-radiological signs, but in all cases an abdominal x-ray was performed and showed a double loop of dilated sigmoid shadow in 87.5% of the cases. Laparotomy was the first approach used in all patients and led to a 50% necrosis rate. Hartmann’s colectomy and ideal colectomy were used in identical proportions, with 50% each. Ideal colectomy was characterized by a morbidity rate of 50% and a mortality rate of 25% compared to 0% for Hartmann’s procedure. The overall morbidity was 25% and the overall mortality was 12.5%. The average hospital stay was 65.87 days (range 17 to 128 days). The average time before reestablishment of digestive continuity was 50.37 days (range 31-128 days). Conclusion: Ileosigmoid knot is a rare condition at Niamey national hospital where the diagnostic approach is similar to that of occlusions in general, but remains difficult due to its uncommonness and atypical clinico-radiological signs. Necrosis rates and postoperative complications remain high.

scholarly journals Acute otitis media in an infant complicated with osteoarthritis of temporomandibular joint and sub-periosteal abscess of the clavicle

2021 ◽  
Vol 37 (1) ◽  
Author(s):  
Kaoutar Cherrabi ◽  
Hind Cherrabi
Keyword(s):  
Septic Arthritis ◽  
Temporomandibular Joint ◽  
Nutritional Assessment ◽  
Acute Otitis Media ◽  
Clinical Signs ◽  
Rare Condition ◽  
Pediatric Emergency ◽  
Ear Infections ◽  
The Right

Abstract Background Otomastoiditis is a very frequent affection and a current complication of mal-treated benign ear infections in children. However, this a very rare case of the association of two rare complications of otomastoiditis in a newborn. On the one hand, septic arthritis of the temporomandibular joint which is a very rare condition that is difficult to diagnose, and when unrecognized or not treated accordingly, it can resolve in serious infectious complication and or definitive injury to the temporomandibular joint. On the other hand, osteomyelitis of the clavicle is also very rare, and only a few cases have been cited in the literature concerning infants. Case presentation This 46-day-old infant was brought to pediatric emergency consultation for 2 swelling inflammatory bulges, one in the right mastoid and pre-auricular regions, and another in the right basi-cervical area. The infant was hypertrophic febrile, hypotonic, and pale. He had preserved archaic reflexes. Besides, blood test showed an inflammatory syndrome, inflammatory anemia, and no other abnormalities. Upon supplementary computed tomodensitometry exam, the diagnosis of a combination of septic arthritis of the right temporomandibular joint and sub-periosteal abscess of the ipsilateral clavicle in a context of hypotrophy and malnutrition was suspected. A pus sample was obtained for bacteriological evaluation, after which the infant had a course of intravenous associated antibiotics, along with nutritional assessment and management. Surgical drainage of both collections was performed. The 6-month follow-up was satisfactory, without clinical signs of functional impact on temporomandibular joint, or acromioclavicular joint. Conclusion This work stresses the necessity of thorough clinical examination of infants even in cases of benign ear infections, as well as the importance of adapted treatment and follow-up, which could allow early diagnosis, appropriate treatment, or even prevention of severe complications that can be associated with such benign conditions.

scholarly journals CLINICAL MANIFESTATIONS OF SARCOIDOSIS ON THE PROLABIUM AND ORAL MUCOSA: MANAGEMENT

2018 ◽  
pp. 34-36
Author(s):  
P.M. Skrypnikov ◽  
T.P. Skrypnikova ◽  
Yu.M. Vitko
Keyword(s):  
Oral Cavity ◽  
Oral Mucosa ◽  
Correct Diagnosis ◽  
Clinical Signs ◽  
Clinical Manifestations ◽  
Morbidity Rate ◽  
Unknown Etiology ◽  
Toxic Substances ◽  
Male Population ◽  
Female Population

The statistics indicates on the tendency of morbidity rate of sarcoidosis to increase. The pathology affects young and older people notably. Sarcoidosis becomes a common chronic disease, which is often difficult to diagnose. Insufficient experience in recognition of this disease leads to misdiagnosis and ineffective treatment. All mentioned above highlights the extreme relevance of this issue. Sarcoidosis is a multisystem inflammatory nature disease of unknown etiology. The hereditary predisposition is taken to be but the whole family cases are also known. An abnormal immune response is also considered among the theories of the development of the disease. The infectious factor is also regarded as the cause of the disease. The increasing activity of lymphocytes, which start to produce substances promoting the formation of the granulomas, which are considered to be the basis for the pathological process, can initiate the onset of the disease. The maximum morbidity rate of sarcoidosis is observed between the ages of 35 to 55 years. Two age periods of the peak in male population are 35-40 years and about 55 years. The rate of sarcoidosis morbidity among female population is 65%. Up to 700 new cases of sarcoidosis are registered in Ukraine annually. The clinical signs of sarcoidosis vary. This pathology is more often manifested by the bilateral lymphadenopathy of lung roots, eyes and skin lesions. The liver, spleen, lymph nodes, heart, nervous system, muscles, bones and other organs can also be affected. In dental practice sarcoidosis can be manifested on the prolabium, oral mucosa and salivary glands. Blood laboratory indices (the increased level of calcium) are changed in sarcoidosis. Chest X-ray, MRI and CT also demonstrate changes in the lungs. The test for detection of granulomas shows positive Kveim reaction (the formation of purple-red nodules due to administration of antigen). Biopsy and bronchoscopy facilitate detection of both direct and indirect signs of sarcoidosis of the lungs. A general treatment of sarcoidosis is provided by a pulmonologist, who can assess the severity of the lesion and provide appropriate treatment. The core of treatment is based on corticosteroids. In severe cases immunosuppressors, anti-inflammatory drugs, antioxidants are prescribed. A dentist performs oral cavity sanation, professional hygiene. Mouth rinses with Dekasan solution, sublingual Lisobakt pills are prescribed to prevent inflammatory lesions. Patients with sarcoidosis are recommended to avoid solar radiation and contact with chemical and toxic substances harmful to the liver, reduction of the consumption of foods rich in calcium. Healthy life-style is crucial in prevention of exacerbations of sarcoidosis. In the remission period regular medical check-ups and oral cavity sanation are recommended. The correct diagnosis in rare diseases requires highly qualified dental professionals, the interdisciplinary approach in the diagnosing and management of patients with this pathology.

scholarly journals Ultrasonographic Diagnosis of Ileal Intussusception in Calf

2021 ◽  
Vol 49 ◽  
Author(s):  
Ana Clara Sarzedas Ribeiro ◽  
Rodolfo José Cavalcanti Souto ◽  
Tayrlla Polessa Rodrigues Silva ◽  
José Augusto Bastos Afonso ◽  
Carla Lopes Mendonça ◽  
...  
Keyword(s):  
Intestinal Obstruction ◽  
Low Cost ◽  
Clinical Signs ◽  
Chloride Content ◽  
Diagnostic Tools ◽  
Adjacent Segment ◽  
Ultrasound Images ◽  
Target Pattern ◽  
Non Invasive ◽  
Intestinal Obstructions

Background: Intussusception, characterized by invagination of an intestinal segment into the lumen of the adjacent segment, is one of the main causes of intestinal obstruction in cattle, and occurs more frequently in calves. The diagnosis of the disease is based on the history, clinical examination, and complementary exams, which are a challenge in this species, especially in calves, in which transrectal palpation is limited. As it is a non-invasive, effective, and low-cost test, ultrasonography could be an important tool in the diagnosis of intestinal obstructions, in which time is essential for the prognosis. Therefore, the objective was to report a case of intussusception in a calf diagnosed by ultrasound.Case: A 4-month-old calf, weaned at 3 months and raised intensively, was treated at the Clínica de Bovinos de Garanhuns, campus of the Universidade Federal Rural de Pernambuco (CBG/UFRPE), with a history of apathy, anorexia, and dyschezia for 3 days. On physical examination, fever, moderate dehydration, tachycardia, tachypnea with polypnea, bilaterally bulging abdomen, sound of fluid on ballottement, ruminal and intestinal hypomotility, and melena were observed. The hematological findings revealed leukocytosis due to neutrophilia (degenerate neutrophils), hypoproteinemia, and hyperfibrinogenemia. The analysis of the ruminal fluid showed compromised microbiota and increased chloride content. The transabdominal ultrasonography demonstrated, in the right ventral region, hypermotile and full small bowel loops and an increase in the volume of the peritoneal fluid. In addition, there was a segment of the small intestine which, in cross-section, showed multiple concentric rings (“onion rings”, “target pattern”, or “bull’s eye”) and adherence to adjacent loops, compatible with intestinal obstruction due to intussusception. Due to the seriousness of the clinical condition and the ultrasound findings, the animal was euthanized and the necropsy revealed focal fibrinous peritonitis and intestinal obstruction due to intussusception in ileum intestinal segments.Discussion: Intussusception has previously been reported in calves, however this is the first report of ultrasound diagnosis of the disease in Brazil. Although the etiology is rarely confirmed, the age group and recent changes in diet (weaning) were predisposing factors. The history, clinical signs, and laboratory tests were similar to those described in cattle with intussusception, however they may be present in other gastrointestinal illnesses. Other authors have also reported that the nonspecificity of the signs and the impossibility of performing transrectal palpation made it difficult to diagnose intestinal obstruction in calves without the use of other diagnostic tools. As it is a non-invasive and accurate technique, ultrasound has been used in ruminants for diagnostic purposes, including intestinal obstructions. In the present case, the main findings are described as the presence of a lesion with the appearance of multiple concentric rings, hypermotile, dilated, and full intestinal loops. The pathological findings were compatible with the ultrasound images and similar to those described by other authors, confirming the diagnosis. The use of ultrasonography as a diagnostic tool in cattle should be expanded, aiming at the early determination of diagnosis and prognosis, to reduce producer costs and animal discomfort. In cases of intussusception, late diagnosis makes treatment unfeasible.

scholarly journals Abdominal pregnancy misdiagnosed as an intrauterine pregnancy: a cause of failed induction of labour for fetal death

2019 ◽  
Vol 8 (8) ◽  
pp. 3382
Author(s):  
Nkencho Osegi ◽  
Olakunle I. Makinde ◽  
Peter O. Eghaghe ◽  
Zakaa Zawua ◽  
Bright N. Ohaka
Keyword(s):  
Maternal Mortality ◽  
Preoperative Diagnosis ◽  
Fetal Death ◽  
Delayed Diagnosis ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Induction Of Labour ◽  
Intrauterine Fetal Death ◽  
Abdominal Pregnancy ◽  
Intrauterine Pregnancy

Abdominal pregnancy is a rare form of ectopic pregnancy usually associated with fetal death among other complications, although very rare cases of live births have been reported. There is also a high risk of maternal mortality. A high index of suspicion is required to make a preoperative diagnosis as diagnosis from history, examination and ultrasound is often missed. Misdiagnoses as an intrauterine pregnancy usually occur. This misdiagnosis makes management of patients with an abdominal pregnancy a challenge and may affect treatment outcome. We managed a 35 year old pregnant multipara who was referred to us on account of repeated failed attempts at induction of labour for intrauterine fetal death. Three obstetric ultrasound scans done during the course of patient’s management reported an intrauterine dead fetus. We also failed to achieve uterine evacuation. We resorted to carry out a hysterotomy and following laparotomy, we found an abdominal pregnancy. This finding was unexpected by us, however, we delivered the dead fetus and was able to successfully manage the placenta. Discovering an abdominal pregnancy at surgery carried out for a supposed intrauterine pregnancy is usual for many cases of abdominal pregnancy. Clinicians should be aware of the clinical signs and symptoms that raise a suspicion of abdominal pregnancy as prompt preoperative diagnosis of abdominal pregnancy helps to plan and offer early and appropriate intervention. This reduces the incidence of maternal mortality usually due to massive intra-abdominal haemorrhage arising from delayed diagnosis and poor placenta management.  

Thyrotoxic hepatitis

2017 ◽  
Vol 63 (1) ◽  
pp. 46-50
Author(s):  
Dmitrij V. Pikulev ◽  
Aleksej V. Klemenov
Keyword(s):  
Liver Injury ◽  
Clinical Symptoms ◽  
Correct Diagnosis ◽  
Clinical Signs ◽  
Rare Condition ◽  
Liver Function Tests ◽  
Biliary Cirrhosis ◽  
Liver Pathology ◽  
Drug Induced ◽  
Clinical Variants

In most cases, liver pathology in hyperthyroidism is confined to asymptomatic changes in laboratory indices, while clinical signs are much rarer. Three clinical variants of liver pathology in patients with hyperthyroidism can be differentiated: drug-induced hepatitis that develop in response to administration of thyrostatic agents (mainly propylthiouracil); concomitant autoimmune liver diseases (autoimmune hepatitis, primary biliary cirrhosis), and hepatopathies as a direct manifestation of thyrotoxicosis (thyrotoxic hepatitis). Thyrotoxic hepatitis is a rare condition difficult to diagnose. The variety of etiological factor of liver pathology in hyperthyroidism, universal clinical symptoms, and the lack of specific histological markers make it difficult to make a correct diagnosis. A clinical case of Graves’ disease complicated with severe thyrotoxic hepatitis, the edema-ascites syndrome and hyperbilirubinemia is reported. The patient was diagnosed with thyrotoxic hepatitis after all other reasons for liver pathology have been ruled out. The concomitant thyrogenic myocardiodystrophy, cardiomegaly and atrial fibrillation required ruling out the diagnosis of cardiogenic liver injury and made diagnosing more difficult. Normalization of the thyroid status in patients receiving mercazolyl therapy was accompanied by alleviation of clinical symptoms of hepatitis and the positive dynamics of the indices of liver function tests. A brief review of the data on clinical variants and mechanisms of liver injury in patients with thyrotoxicosis is presented.

scholarly journals Acne fulminans in a Vietnamese boy successfully treated with prednisolone and ibuprofen: A case report

2018 ◽  
Vol 5 (9) ◽  
pp. 2708-2711
Author(s):  
Quang Van Vu
Keyword(s):  
Delayed Diagnosis ◽  
Severe Infection ◽  
Rare Condition ◽  
Severe Form ◽  
Rapid Improvement ◽  
Case Presentation ◽  
Reactive Protein ◽  
Acne Fulminans ◽  
Systemic Manifestations ◽  
First Time

Background: Acne fulminans (AF) is a rare disorder, the most severe form of the entire clinical spectrum of acne. It is characterized by the emergence of painful inflammatory nodules that turn into ulcers, concomitant with systemic manifestations. Here, we report for the first time a Vietnamese boy with Acne fulminans successfully treated with prednisolone and ibuprofen. Case presentation: The patient is a 14-year-old male teenager with moderate acne since the age of 13. After a day of swimming, his acne suddenly became inflamed and painful lesions were present on his face and back. He had high fever and polyarthritis, and tests showed leukocytosis, neutrophilia, and elevated C-reactive protein (CRP). Severe infection was diagnosed and treated by addition of antibacterial therapy for a long period, however, the condition did not improve. When called upon to evaluate the patient, we established the diagnosis of acne fulminans and initiated treatment with prednisone (1mg/kg/day) and ibuprofen (500 mg for two times daily). Following this treatment regimen, there was a rapid improvement. Conclusion: Herein, we have reported a Vietnamese boy with typical AF, but delayed diagnosis and treatment because of a rare condition. Our results support the role and benefit of prednisolone for AF treatment.

scholarly journals Difficult to Diagnose the Cause of Intestinal Obstruction due to Abdominal Cocoon Syndrome

2021 ◽  
Author(s):  
Cemal Ulusoy ◽  
Andrej Nikolovski ◽  
Nazım Öztürk
Keyword(s):  
Small Bowel ◽  
Intestinal Obstruction ◽  
Small Bowel Obstruction ◽  
Abdominal Mass ◽  
Clinical Signs ◽  
Rare Condition ◽  
Abdominal Cocoon ◽  
Sclerosing Encapsulating Peritonitis ◽  
Encapsulating Peritonitis ◽  
Palpable Abdominal Mass

Abdominal cocoon syndrome (sclerosing encapsulating peritonitis) is a rare condition associated with clinical signs of intestinal dysfunction, episodes of small bowel obstruction and sometimes a palpable abdominal mass. We present the case of a 46-year-old male patient with clinical signs of intestinal obstruction caused by primary sclerosing encapsulating peritonitis.

Management of chronic atherosclerotic mesenteric ischemia

VASA ◽  
2011 ◽  
Vol 40 (2) ◽  
pp. 99-107 ◽  
Author(s):  
Zeller ◽  
Macharzina
Keyword(s):  
Mesenteric Ischemia ◽  
Delayed Diagnosis ◽  
Clinical Signs ◽  
Duplex Ultrasound ◽  
Celiac Trunk ◽  
Mesenteric Arteries ◽  
Clinical Aspects ◽  
High Morbidity ◽  
Chronic Mesenteric Ischemia ◽  
External Compression

Chronic mesenteric ischemia (CMI) is most likely caused by atherosclerosis and less frequently by external compression, fibromuscular dysplasia and vasculitis. Symptomatic CMI is an uncommon, potentially under-diagnosed condition caused by fixed stenoses or occlusion of in most conditions at least two visceral arteries. If only one of the three major bowel providing arteries - the celiac trunk, the superior and inferior mesenteric arteries - is affected, the patient is usually asymptomatic due to a tight collateral network. Symptoms and clinical signs of CMI may vary from the classical triad of postprandial pain, weight loss and upper abdominal bruit to nonspecific symptoms thus frequently resulting in delayed diagnosis. Established non-invasive diagnostic means are duplex ultrasound or CT- and MR-angiography offering excellent three dimensional reconstruction of the vessel pathology facilitating the decision for the appropriate revascularisation strategy. During the last decade, despite higher restenosis rates endovascular revascularization has replaced surgical revascularization as therapy of choice in most centers. If untreated CMI of atherosclerotic origin is associated with a high morbidity and mortality. This manuscript reviews the most relevant clinical aspects of the disease and the current practice of diagnosis and treatment of CMI.

Case report of a massive pseudoaneurysm of the anterior tibial artery

2021 ◽  
Vol 29 (2) ◽  
pp. 293-298
Author(s):  
Anna Dorn ◽  
Peter Galkin ◽  
Egan Kalmykov ◽  
Payman Majd
Keyword(s):  
Therapeutic Strategy ◽  
Delayed Diagnosis ◽  
Clinical Signs ◽  
Arterial Injury ◽  
The Body ◽  
Anterior Tibial Artery ◽  
Medical Procedures ◽  
Diagnosis And Therapy ◽  
Anterior Tibial ◽  
History Of

The majority of arterial pseudoaneurysms treated in our department of vascular surgery are consequences of catheter-associated medical procedures and located in the groin region. Clinical signs, combined with the recent history of a percutaneous intervention, ensure quick diagnosis and therapy. However, pseudoaneurysms can develop after any artery of the body is injured. No consensus on the therapeutic strategy is achieved because of the rare nature of this injury. This study provided an overview of the methods described in previous studies and contributions to their clinical experience. A case of a young man whose injury was not recognized immediately and who presented months after the accident with a pseudoaneurysm of unusual location and size was reported. Sonographic diagnosis was confirmed through computed tomography angiography, and open surgical repair was performed with satisfactory results. Conclusion. This case is a reminder that seemingly minor accidents can cause arterial injury, and patients should be carefully examined to avoid delayed diagnosis and therapy.

scholarly journals Giant Epignathus Teratoma Discovered at Birth: A Case Report and 7-Year Follow-Up

2017 ◽  
Vol 28 (2) ◽  
pp. 256-261 ◽  
Author(s):  
Cyntia Helena Pereira de Carvalho ◽  
Cassiano Francisco Weege Nonaka ◽  
Cassandra Teixeira Valle Elias ◽  
Rita de Cassia Simões Matheus ◽  
Roberto Menezes Bezerra Dias ◽  
...  
Keyword(s):  
Surgical Repair ◽  
Mature Teratoma ◽  
Clinical Signs ◽  
Microscopic Analysis ◽  
Rare Condition ◽  
Residual Tumor ◽  
Complete Regression ◽  
Surface Areas ◽  
Cell Layers

Abstract Teratomas are tumors composed by tissues derived from the three germ cell layers, and they are relatively uncommon in head and neck. The term epignathus has been applied to teratomas from the oropharynx. This paper reports the case of a giant epignathus teratoma discovered at birth, which was successfully managed and followed up for 7 years. A newborn boy presented a polypoid tumor mass exteriorizing through the mouth over a length of 9 cm, with some surface areas resembling skin and others exhibiting hair. Computed tomography showed that the mass arose deep from the left hemiface. Alpha-fetoprotein (AFP) levels were high (316,000 ng/mL). Surgery was performed and microscopic analysis confirmed the diagnosis of mature teratoma. Because of residual tumor and high AFP levels, the patient was submitted to chemotherapy, resulting in complete regression of the lesion and normalization of AFP levels. Surgical repair of a cleft palate was performed at 5 years of age. At 7 years of age, the patient was in good general health and showed no clinical signs of recurrence. Although epignathus is a rare condition, it should be diagnosed in the fetus as early as possible. Prenatal care provides unquestionable benefits, providing the early diagnosis of anomalies that can jeopardize the life of the fetus and contributing to the indication of cases that require treatment before birth.

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