Periampullary Carcinoma: Clinical Presentation and Diagnosis - a hospital based study

This descriptive study was carried out including 10 patients with periampullary carcinoma in Nishtar Hospital, Multan. The objectives were to study different clinical presentations of periampullary carcinoma and various means of investigations to diagnose it. All patients having suspicion of periampullary carcinoma were studied. Original study included ten patients having remaining four patients were female. All male patients were smoker. Eight patients were amongst lower class, one patient was from middle class and remaining one patient was from upper class. Common clinical features were progressive painless jaundice, anorexia, weight loss, pruritis, abdominal pain, vomiting and malena. All patients were evaluated on history, clinical examination and laboratory investigations. All patients found to be anemic. LFT`s were raised in all patients. ERCP was successful in 90% of cases in diagnosing the pathology and biopsy was possible in 40% of cases. Ultrasonography was quite good in differentiating the type of jaundice. It detected the tumour site in only 20% of cases. Ultrasonography was not able to detect the metastasis effectively. CT scan was quite helpful to detect metastasis. Ultrasonography and ERCP were quite good in diagnosing the biliary obstruction. CT% scan was helpful in staging purpose. We do not have the facilities of endoscopic ultrasonography, MRI, MRCP, PTHC, helical tomography and laparoscopy.

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Small Bowel Perforations by Metallic Grill Brush Bristles: Clinical Presentations and Opportunity for Prevention

The American Surgeon ◽

10.1177/000313481608200515 ◽

2016 ◽

Vol 82 (5) ◽

pp. 412-415 ◽

Cited By ~ 1

Author(s):

Salvador Sordo ◽

Travis L. Holloway ◽

Russell L. Woodard ◽

Bruce E. Conway ◽

Lillian F. Liao ◽

...

Keyword(s):

Risk Factors ◽

Abdominal Pain ◽

Small Bowel ◽

Ct Scan ◽

Chart Review ◽

Clinical Presentation ◽

Home Visits ◽

Alternative Methods ◽

Clinical Presentations ◽

Unusual Injury

Increasing reports on the incidental ingestion of metallic bristles from barbeque grill cleaning brushes have been reported. We sought to describe the clinical presentation and grilling habits of patients presenting after ingesting metallic bristles in an attempt to identify risk factors. We performed a chart review of six patients with documented enteric injury from metallic bristles. Subjects were contacted and administered a survey focused on the events surrounding the bristle ingestion. We arranged for in-home visits to inspect the grill and grill brush whenever possible. Of the six subjects identified, three (50%) were male, five (83%) were white, and they ranged in age from 18 to 65 years (mean 42.5). All complained of abdominal pain. All bristles were identified by CT scan. Three patients underwent laparoscopic enterorrhaphy, and two underwent laparotomy. The remaining patients did not require intervention. None had replaced their grill brush in at least two years. Surgeon's awareness of this unusual injury is important to identify and manage this problem. Alternative methods to clean the grill should be sought and grill brushes should be replaced at least every two years.

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1001 Intra-Articular Distal Radius Fracture Surgical Intervention Threshold Origins and Development

British Journal of Surgery ◽

10.1093/bjs/znab134.344 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

G Esworthy ◽

N Johnson ◽

J Dias ◽

P Divall

Keyword(s):

Distal Radius ◽

Clinical Presentation ◽

Surgical Intervention ◽

Threshold Value ◽

British Society ◽

Relevant Today ◽

Clinical Presentations ◽

Post Traumatic ◽

Current Guidance ◽

Traumatic Arthritis

Abstract Background Treatment of intra-articular distal radius fractures is guided by the displacement of the articular fragments. Symptomatic post-traumatic arthritis is expected to occur if step displacement is > 2mm; this value is often used as an indication for surgery if closed reduction is not possible. Method A systematic review was performed to establish the origin and adaptations of the threshold, with papers screened and relevant citations reviewed. Orthopaedic textbooks were reviewed to ensure no earlier mention of the threshold was present. Results Knirk and Jupiter, 1986, are the first to quantify a threshold, with all their patients developing arthritis with >2mm displacement. Some papers have discussed using 1mm, although 2mm is most widely reported. Current guidance from the British Society for Surgery of the Hand supports 2mm. Although this paper is still widely cited, the authors published a re-examination of the data showing methodological flaws which is not as widely reported. They claim their conclusions are still relevant today; however, the radiological arthritis does not correlate with the clinical presentation. Conclusions Knirk and Jupiter originated the threshold value of 2mm. The lack of correlation between the radiological and clinical presentations warrants further investigation. The principle of treatment remains restoration of normal anatomical position.

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Case series on variable presentations of tuberculosis of the breast

BMJ Case Reports ◽

10.1136/bcr-2020-236019 ◽

2020 ◽

Vol 13 (12) ◽

pp. e236019

Author(s):

Tharun Ganapathy Chitrambalam ◽

Jeyakumar Sundaraj ◽

Pradeep Joshua Christopher ◽

Ramyasree Paladugu

Keyword(s):

Clinical Presentation ◽

Case Series ◽

Common Type ◽

Breast Abscess ◽

Breast Lump ◽

Clinical Presentations ◽

Malignant Lesions

Tuberculosis (TB) of the breast is extremely rare and is often mistaken for benign or malignant lesions of the breast. They are rare even in countries which are endemic for TB, like India. The most common type of clinical presentation is a vague lump in the breast, but there are even other types of presentations which are documented. In olden days, there was a lot of dilemma and challenge in diagnosing TB of the breast, but thanks to improved pathological knowledge and the advent of investigations such as QuantiFERON-TB gold and GeneXpert, TB can be diagnosed early nowadays and treated accordingly. In this study series, we report 10 cases of TB of the breast with variable clinical presentations as fibroadenosis, breast abscess, duct ectasia and breast lump on evaluation, and the challenges encountered in establishing the diagnosis.

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Spontaneous Pneumomediastinum, Pneumothorax, Pneumopericardium and Subcutaneous Emphysema—Not So Uncommon Complications in Patients with COVID-19 Pulmonary Infection—A Series of Cases

Journal of Clinical Medicine ◽

10.3390/jcm10071346 ◽

2021 ◽

Vol 10 (7) ◽

pp. 1346

Author(s):

Talida Georgiana Cut ◽

Cristina Tudoran ◽

Voichita Elena Lazureanu ◽

Adelina Raluca Marinescu ◽

Raluca Dumache ◽

...

Keyword(s):

Mechanical Ventilation ◽

Subcutaneous Emphysema ◽

Diffuse Alveolar Damage ◽

Demographic Data ◽

Pathophysiological Mechanism ◽

Spontaneous Pneumomediastinum ◽

Intensive Care Stay ◽

Laboratory Investigations ◽

Male Patients ◽

Pulmonary Pathology

(1) Background: Spontaneous pneumomediastinum (PM), pneumothorax (PT), and pneumopericardium (PP) were recently reported as rare complications in patients with severe COVID-19 pneumonia, and our study aims to follow the evolution of these involvements in 11 cases. The presumed pathophysiological mechanism is air leak due to extensive diffuse alveolar damage followed by alveolar rupture. (2) Methods: We followed the occurrence of PM, PN, PP, and subcutaneous emphysema (SE) in 1648 patients hospitalized during the second outbreak of COVID-19 (October 2020–January 2021) in the main hospital of infectious diseases of our county and recorded their demographic data, laboratory investigations and clinical evolution. (3) Results: Eleven patients (0.66%) developed PM, with eight of them having associated PT, one PP, and seven SE, in the absence of mechanical ventilation. Eight patients (72.72%) died and only three (27.27%) survived. All subjects were nonsmokers, without known pulmonary pathology or risk factors for such complications. (4) Conclusions: pneumomediastinum, pneumothorax, and pneumopericardium are not so uncommon complications of SARS-CoV2 pneumonia, being observed mostly in male patients with severe forms and associated with prolonged hospitalization and poor prognosis. In some cases, with mild forms and reduced pulmonary injury, the outcome is favorable, not requiring surgical procedures, mechanical ventilation, or intensive care stay.

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Compression neuropathies of the forearm: anatomy, clinical features and management

British Journal of Hospital Medicine ◽

10.12968/hmed.2021.0187 ◽

2021 ◽

pp. 1-10

Author(s):

Alexander Scarborough ◽

Robert J MacFarlane ◽

Michail Klontzas ◽

Rui Zhou ◽

Mohammad Waseem

Keyword(s):

Peripheral Nerve ◽

Brachial Plexus ◽

Upper Limb ◽

Peripheral Nerves ◽

Clinical Presentation ◽

Permanent Damage ◽

Peripheral Nerve Lesions ◽

Clinical Presentations ◽

Wide Range ◽

Prompt Diagnosis

The upper limb consists of four major parts: a girdle formed by the clavicle and scapula, the arm, the forearm and the hand. Peripheral nerve lesions of the upper limb are divided into lesions of the brachial plexus or the nerves arising from it. Lesions of the nerves arising from the brachial plexus are further divided into upper (proximal) or lower (distal) lesions based on their location. Peripheral nerves in the forearm can be compressed in various locations and by a wide range of pathologies. A thorough understanding of the anatomy and clinical presentations of these compression neuropathies can lead to prompt diagnosis and management, preventing possible permanent damage. This article discusses the aetiology, anatomy, clinical presentation and surgical management of compressive neuropathies of the upper limb.

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DEMOGRAPHIC PROFILE OF ACUTE FEBRILE ENCEPHALOPATHY CASES IN PEDIATRIC AGE GROUP PATIENTS: A STUDY FROM WESTERN RAJASTHAN

10.36106/ijsr/1302690 ◽

2021 ◽

pp. 72-73

Author(s):

Laxmi Rathore ◽

P. K. Khatri ◽

Saroj K. Meena ◽

Archana Bora ◽

Suneel Bhooshan

Keyword(s):

Lower Class ◽

Mental States ◽

Clinical Feature ◽

Female Ratio ◽

Pediatric Age Group ◽

History Of ◽

Laboratory Investigations ◽

Demographic Distribution ◽

Viral Etiologies ◽

Male To Female

Acute Febrile Encephalopathy is a clinical term used to describe patients presenting with short febrile illnesses with altered mental states. Demographic distribution plays an essential role in the diagnosis of viral etiologies. One hundred ve suspected AFE cases were enrolled in the study. A detailed history by predesigned performa and laboratory investigations was obtained for data collection. Viral etiology was diagnosed in 32 (30.48%) cases. The male to female ratio was 1.39:1. Total 56.25% of positive cases were from the lower class, 28.13% from the middle class, and 15.63% from the upper class. 24 (75%) cases from rural, while only 8 (25%) of the urban population showed viral etiologies. In 19 (59.4%) cases were either history of incomplete vaccination or not vaccinated, 13 (40.6%) cases had a history of complete immunization among positive cases. The predominant clinical feature was fever (100%) followed by seizures 66(62.86%), vomiting 37(35.24%), headache 14(13.33%), paresis in 16(15.24%) and altered sensorium in 29(27.62%), respectively. To conclude, the etiologic panorama of AFE varies with several factors such as time and demographical location, age, and immunization status. There is an urgent need to conduct more studies to prole the viral etiologies according to their prevalence in geographical areas so the treatment can be tailored accordingly and prophylaxis treatment or immunization can be boosted in the population at risk of getting the disease.

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‘Tales of Wonder and Horror’: Coverage of insanity in the Leeds press, 1808-1840

10.26686/wgtn.17057984 ◽

2021 ◽

Author(s):

◽

Evgeniya Kryssova

Keyword(s):

Eighteenth Century ◽

Lower Class ◽

The Body ◽

Upper Class ◽

Press Coverage ◽

Social Analysis ◽

Periodical Literature ◽

Legal Cases ◽

The North ◽

The Press

<p>The press was at the centre of the reform of the meaning of insanity, during its evolution from an equivocal eighteenth-century concept of melancholia to a medicalised Victorian notion of ‘lunacy’. During the late Georgian era newspapers provided a public forum for the opinion of newly emerging psychiatric practitioners and fostered the fears and concerns about mental illness and its supposed increase. The press was also the main source of news on crime, providing readers with reports on criminal insanity and suicide. In the first half of the nineteenth century, newspaper contents included official legal reports, as well as editorial commentary and excerpts from other publications, and newspaper articles can rarely be traced to one single author. Historians of British insanity avoid consulting periodical literature, choosing to use asylum records and coroners’ reports, as these sources are more straightforward than newspapers. However, Rab Houston’s recent study of the coverage of suicide in the north of Britain shows that the provincial press has been unjustly overlooked and can offer the material for a unique social analysis. Asylum records and coroners’ records do not contain the same detail provided in the press. Newspaper commentary can arguably reveal contemporary attitudes towards insanity and, moreover, sources such as asylum records only deal with the lower-class patients, as the middle- and upper-class insane were usually privately detained. This thesis examines the press coverage of insanity in Leeds newspapers, and expands on previous research by looking at the way insanity was portrayed in the two most popular publications in the industrial region of Yorkshire: the Leeds Intelligencer and the Leeds Mercury. Chapter one focuses on legal cases that featured a verdict of insanity and explores the language used by the press in the reports of, mainly, violent domestic crime. Chapter two looks at reports of suicide and considers how contemporary views on financial and moral despondency influenced the portrayal of self-murder. Chapter three considers editorial articles that cannot be described as either crime or suicide reports. This chapter uncovers the presence of surprisingly humorous and entertaining articles on insanity found in editorials and the ‘Miscellany’ sections of the newspapers. Ultimately, this thesis argues that the reportage of insanity in the Leeds press was sensational, moralistic and selectively sympathetic; furthermore, such portrayal of insanity was reinforced throughout the body of the paper. Leeds newspapers segregated the insane by adopting a moralising tone and by choosing to use class-specific language towards the insane of different social ranks.</p>

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Initial clinical presentation of children with acute and chronic versus acute subdural hemorrhage resulting from abusive head trauma

Journal of Neurosurgery Pediatrics ◽

10.3171/2014.12.peds14607 ◽

2015 ◽

Vol 16 (2) ◽

pp. 177-185 ◽

Cited By ~ 7

Author(s):

Kenneth W. Feldman ◽

Naomi F. Sugar ◽

Samuel R. Browd

Keyword(s):

Head Trauma ◽

Clinical Presentation ◽

Abusive Head Trauma ◽

Group Differences ◽

Similar Proportion ◽

Subdural Hemorrhage ◽

Retinal Hemorrhages ◽

Clinical Presentations ◽

Scale Scores ◽

Multicenter Retrospective Review

OBJECT At presentation, children who have experienced abusive head trauma (AHT) often have subdural hemorrhage (SDH) that is acute, chronic, or both. Controversy exists whether the acute SDH associated with chronic SDH results from trauma or from spontaneous rebleeding. The authors compared the clinical presentations of children with AHT and acute SDH with those having acute and chronic SDH (acute/chronic SDH). METHODS The study was a multicenter retrospective review of children who had experienced AHT during 2004–2009. The authors compared the clinical and radiological characteristics of children with acute SDH to those of children with acute/chronic SDH. RESULTS The study included 383 children with AHT and either acute SDH (n = 291) or acute/chronic SDH (n = 92). The children with acute/chronic SDH were younger, had higher initial Glasgow Coma Scale scores, fewer deaths, fewer skull fractures, less parenchymal brain injury, and fewer acute noncranial fractures than did children with acute SDH. No between-group differences were found for the proportion with retinal hemorrhages, healing noncranial fractures, or acute abusive bruises. A similar proportion (approximately 80%) of children with acute/chronic SDH and with acute SDH had retinal hemorrhages or acute or healing extracranial injures. Of children with acute/chronic SDH, 20% were neurologically asymptomatic at presentation; almost half of these children were seen for macrocephaly, and for all of them, the acute SDH was completely within the area of the chronic SDH. CONCLUSIONS Overall, the presenting clinical and radiological characteristics of children with acute SDH and acute/chronic SDH caused by AHT did not differ, suggesting that repeated abuse, rather than spontaneous rebleeding, is the etiology of most acute SDH in children with chronic SDH. However, more severe neurological symptoms were more common among children with acute SDH. Children with acute/chronic SDH and asymptomatic macrocephaly have unique risks and distinct radiological and clinical characteristics.

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Language and Politics: Prose as a Medium of Societal Apartheid in Shakespeare’s Julius Caesar

Jordan Journal of Modern Languages and Literature ◽

10.47012/jjmll.13.1.4 ◽

2021 ◽

Vol 13 (1) ◽

pp. 57-74

Keyword(s):

Lower Class ◽

Upper Class ◽

Julius Caesar ◽

Contextual Approach ◽

Class Discrimination ◽

The Poor ◽

Language And Politics ◽

Aristotelian Rhetoric ◽

At Home

This paper studies the use of prose in Julius Caesar as a tool of political and social apartheid and class discrimination. Usually, Shakespeare assigns blank verse to upper-class characters and prose to lower class ones. The study analyzes three occasions in which prose is used by two patricians and an eloquent cobbler. The paper means to explain the diversion of patricians to prose and add another voice to the already heaping interpretations given in criticism. It argues that the diversion of the two patricians to prose has two functions. Firstly, it shows that prose is indigenous to the poor and the patricians use it when they address the poor or talk about them. Secondly, Shakespeare shows that the diversion of the patricians to prose is a wrong choice and leads to moral depravity or failure of mission. In contrast, the cobbler uses prose effectively because it is indigenous to him and he feels at home using it. The study uses the contextual approach to analyze the three speeches. Keywords: Prose, blank verse, patricians, plebeians, Aristotelian rhetoric, republican politics.

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Left Supraclavicular Lymphadenopathy as the Only Clinical Presentation of Prostate Cancer: A Case Report

Acta Medica Martiniana ◽

10.1515/acm-2017-0011 ◽

2017 ◽

Vol 17 (2) ◽

pp. 41-44 ◽

Cited By ~ 1

Author(s):

Mohanad Abusultan ◽

Pavel Hanzel ◽

D. Durcansky ◽

A. Hajtman

Keyword(s):

Prostate Cancer ◽

Lymph Nodes ◽

Clinical Presentation ◽

Cervical Lymphadenopathy ◽

Cervical Lymph Node Metastasis ◽

Unknown Primary ◽

Unknown Primary Site ◽

Regional Lymph Nodes ◽

Node Metastasis ◽

Male Patients

AbstractProstate cancer usually metastasis to the regional lymph nodes and can rarely metastases to nonregional supradiaphragmatic lymph nodes. Cervical lymph node metastasis of prostate cancer is extremely rare. However, it should be considered in the differential diagnosis of cervical lymphadenopathy in male patients with adenocarcinoma of unknown primary site. In this report we present a rare case of metastatic prostate adenocarcinoma with left supraclavicular lymphadenopathy as the only clinical presentation with no other evidence of metastasis to the regional lymph nodes or bone metastasis.

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