Classifications and Clinical Assessment of Haemorrhoids:The Proctologist’s Corner

2020 ◽  
Vol 15 ◽  
Author(s):  
Arcangelo Picciariello ◽  
Petr Tsarkov ◽  
Vincenzo Papagni ◽  
Sergey Efetov ◽  
Daniel Markaryan ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Clinical Evaluation ◽  
Clinical Assessment ◽  
Adult Population ◽  
Preoperative Assessment ◽  
Classification Systems ◽  
Patient Treatment ◽  
Benign Condition ◽  
Haemorrhoidal Disease ◽  
Therapeutic Choice

BACKGROUND: Haemorrhoidal disease (HD) is a benign condition affecting a considerable part of adult population. HD can be considered a social and economic burden with high impact on patient lifestyle. Several new techniques and devices have been proposed for HD treatment; however, preoperative assessment is essential and the use of classification system is recommended. METHODS: In the last two decades many studies described the preoperative assessment and several attempts of classification for HD. This review focuses on the most relevant studies found in literature where classification systems and clinical evaluation with differential diagnosis have been evaluated. RESULTS: The knowledge of classification systems and differential diagnosis for HD has been shown to play a central role in the clinical assessment and in the best treatment choice. Although there are new challenging techniques and devices for HD treatment, a preoperative assessment is always mandatory. CONCLUSION: Preoperative clinical evaluation is essential for HD patient treatment and outcome. Classification systems are useful for the therapeutic choice and for researches on new medical or surgical treatments. In fact, the international guidelines advise several therapeutic options depending on the severity of the HD.

scholarly journals Young child with painful edema and purpura: a case report

2021 ◽  
Vol 47 (1) ◽  
Author(s):  
Sarah Contorno ◽  
Giorgio Cozzi ◽  
Irene Berti ◽  
Egidio Barbi ◽  
Andrea Taddio
Keyword(s):  
Differential Diagnosis ◽  
Child Abuse ◽  
Case Report ◽  
Young Child ◽  
Sickle Cell ◽  
Benign Condition ◽  
Sickle Cell Crisis

Abstract Background We reported the case of a two-old-year boy with a painful acute hemorrhagic edema. This is a self-limited benign condition: usually, affected children are well appearing and this strongly support the diagnosis. In the opposite, in our case, we observed a painful presentation of the edema. Therefore, we demonstrated that rarely, this condition could have also a painful presentation. Conclusions This case report helps clinician to know that also acute hemorrhagic edema could have a painful presentation, so we must considered it in the differential diagnosis with sepsis, sickle cell crisis and child abuse. We believe that these findings will be of interest to pediatricians.

THE CLASSIC TYPE OF EHLERS–DANLOS SYNDROME: DIFFERENTIAL DIAGNOSIS AND PECULIARITIES OF PATIENT MANAGEMENT

2021 ◽  
Vol 100 (5) ◽  
pp. 62-69
Author(s):  
А.N. Semyachkina ◽  
◽  
E.А. Nikolaeva ◽  
А.R. Zabrodina ◽  
L.P. Melikyan ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Adult Population ◽  
Gene Mutations ◽  
Hereditary Disease ◽  
Ehlers Danlos Syndrome ◽  
Severe Pathology ◽  
Type V ◽  
Danlos Syndrome

The Classic Ehlers–Danlos syndrome (cEDS) is an autosomal dominant hereditary disease caused by type V collagen defect. The incidence of pathology is estimated at 1:20,000 of the population. The results of a long-term (15 years) follow-up of a group of patients (n=18) with cEDS, including 5 boys and 13 girls aged from 3 to 18 years, are presented. The diagnosis was made based on the presence of 2 large and 5 small international diagnostic criteria in all patients. The progreduated character of the disease is shown, which is most obvious in the dynamics of the state of the musculoskeletal system. Genetic verification of the diagnosis was performed in 6 patients; 5 probands had mutations in the COL5A1 gene, and one in the COL5A2 gene. Mutations already registered in the database were detected only in 2 children. Previously unknown substitutions were found in 4 patients. The article presents the issues of differential diagnosis of this severe pathology and touches upon the issue of continuity between medical pediatric specialists and doctors of various specialties working with the adult population.

scholarly journals Verbal Fluency Performance in Normal Adult Population in Iran: Norms and Effects of Age, Education and Gender

2021 ◽  
Author(s):  
Saeedeh Shirdel ◽  
◽  
Setareh Esmaeeli ◽  
Kaveh Alavi ◽  
Pezhman Ghaemmaghami ◽  
...  
Keyword(s):  
Clinical Assessment ◽  
Verbal Fluency ◽  
Standardized Test ◽  
Mother Tongue ◽  
Adult Population ◽  
Semantic Fluency ◽  
Semantic Categories ◽  
Persian Language ◽  
Significant Difference ◽  
The Mean

Objective: Verbal fluency is a cognitive function that can be easily assessed in bedside and provide useful data for clinical assessment of a variety of cognitive functions. We decided to provide a standardized test for the assessment of verbal fluency in Persian language, including both phonemic and semantic fluency subtests. Method: First, three letters (P, D, and Sh) and three categories (animals, fruits, and objects of kitchen) were selected based on a pilot study and a panel of specialists. Then, we selected 500 Persian speaking participants (47.8% male) that were 18 to 65 years old via convenient sampling from general population. Participants were stratified according to age, gender, and education. They performed the verbal fluency test. Results: The mean number of generated words in letter fluency and semantic fluency (±SD) were 8.3±4.1 and 18.0±5.5, respectively. Age, educational level, and mother tongue were associated with letter fluency. Semantic fluency was associated with age, gender, education level, and mother tongue. Conclusion: For a more reliable clinical assessment, we suggest to use all of the three letters and three semantic categories for each subject, calculate the mean of the produced words and compare them with the suggested cut-points provided for each subcategory. Age was negatively correlated with the number of generated words in letter fluency (r=-0.33; p<0.001) and semantic fluency tasks (r=-0.26; p<0.001). In letter fluency task, there was not a statistically significant difference between males and females according to the number of generated words (P=0.057). However, in semantic fluency, female participants generated more words (p=0.005). Mother tongue (Farsi) showed a significant effect both on letter fluency (t=5.55, p<0.001) and semantic fluency (t=9.41, p<0.001). Level of education had a significant association with both letter fluency (F=117.23, p<0.001) and semantic fluency (F=64.48, p<0.001).

Color-flow Doppler sonography in the differential diagnosis and management of amiodarone-induced thyrotoxicosis

2007 ◽  
Vol 48 (6) ◽  
pp. 628-634 ◽  
Author(s):  
M. Loy ◽  
E. Perra ◽  
A. Melis ◽  
M. E. Cianchetti ◽  
M. Piga ◽  
...  
Keyword(s):  
Blood Flow ◽  
Differential Diagnosis ◽  
Clinical Outcome ◽  
Doppler Sonography ◽  
Color Flow ◽  
Therapeutic Choice ◽  
Color Flow Doppler Sonography ◽  
Increased Blood Flow

Background: Amiodarone-induced thyrotoxicosis (AIT) may be caused by excessive thyroidal hormone synthesis and release (type 1) or by a destructive process (type 2). This differentiation is considered essential for therapeutic choice. Purpose: To evaluate the utility of color-flow Doppler sonography (CFDS) in the differential diagnosis and management of AIT. Material and Methods: The clinical and laboratory data, thyroid sonography (grayscale sonography [GSS], CFDS), thyroid radioiodine uptake (RAIU) and thyroid scintigraphy, treatment, and clinical outcome were retrospectively reviewed in 21 AIT patients. The CFDS pattern of thyroid nodules was separately described from that of the perinodular parenchyma, and AIT was classified as type 1 (increased blood flow) or type 2 (low/no blood flow). Type 1 AIT patients were treated with methimazole (alone or associated with potassium perchlorate), while type 2 patients were treated with prednisone or amiodarone withdrawal alone. Results: Eleven patients with increased blood flow were considered as type 1, and 10 with low/no blood flow as type 2. Ten of the 11 patients in the first group showed a hypervascular nodular pattern, while one showed a hypervascular parenchymal pattern. Clinical diagnoses were toxic nodular goiter and Graves' disease, respectively. Of the 10 patients with low/no blood flow, six had normal thyroid volume, three small diffuse goiter, and one small multinodular goiter. The clinical outcome showed that 20 of the 21 patients were treatment responsive. Conclusion: CFDS is a useful tool in the differential diagnosis of AIT. This differentiation appeared to be of clinical relevance as regards therapeutic choice. Separate evaluation of parenchymal blood flow from that of nodules may prove beneficial in the diagnosis of underlying thyroid diseases in patients with type 1 AIT.

Radiologic Reporting of Simple Hepatic Cyst Versus Biliary Cystadenoma May Lead to Unnecessary Surgery

2021 ◽  
pp. 000313482110540
Author(s):  
Aman Kumar ◽  
Alex Zendel ◽  
Michael Batres ◽  
David A. Gerber ◽  
Chirag S. Desai
Keyword(s):  
Differential Diagnosis ◽  
Cyst Wall ◽  
Cystic Lesion ◽  
Liver Cyst ◽  
Hepatic Cyst ◽  
Preoperative Imaging ◽  
Imaging Studies ◽  
Biliary Cystadenoma ◽  
Benign Condition ◽  
Simple Hepatic Cyst

Background and Aims Simple liver cyst (SHC) is a benign condition with no malignant potential. They are typically discovered incidentally due to the increased use of abdominal imaging, but some patients may present with abdominal pain. A radiologist’s differential diagnosis in cases of SHC will often include “rule out biliary cystadenoma.” Under these circumstances, patients and surgeons are more likely to pursue surgical options even in asymptomatic cases. The aim of this study is to conduct a retrospective analysis of presentation, radiologic reporting, management plan, and histopathology of patients referred to a tertiary hospital in order to determine the correlation between radiology and histology. Methods We retrospectively analyzed the clinical, radiological, and histopathological data of 20 patients operated for a diagnosis of a cystic lesion in the liver. Result The CT/MRI of 6 (30%) patients was reported as a biliary cystadenoma, 13 (65%) were reported as a simple hepatic cyst and 1 patient (5%) had hepatocellular carcinoma (HCC) with the additional diagnosis of multiple hepatic cysts. The lesion reported as HCC on the scan was separate from the cystic lesions. The modality of imaging for these cysts was evenly split, 50% of patients had a CT scan, and 50% had an MRI performed. All imaging studies were interpreted by an attending radiologist and most of them were discussed in multidisciplinary meetings. Nineteen patients (95%) had an intraoperative diagnosis of a simple liver cyst based on its visual appearance and clear fluid within the cyst. These patients underwent cyst wall fenestration and de-roofing with the cyst wall sent for histopathology. One patient (5%) with HCC underwent a non-anatomical liver resection. Histopathology was conclusive for a benign hepatic cystic lesion from the cyst wall biopsy. All 20 patients in this study underwent surgery, either due to symptoms or due to radiologic diagnosis of BCA. Four of the 20 cases (20%) were asymptomatic and out of these four cases, 3 (75%) were diagnosed as cystadenoma on the preoperative imaging studies. All 19 cases were diagnosed as a simple liver cyst on pathology. Conclusion In summary, there is a growing trend of “ruling-out the diagnosis of biliary cystadenoma” in patients who present with liver cysts. Patients are appropriately more anxious after this preoperative diagnosis and the treating surgeons have medico-legal concerns regarding conservative management in asymptomatic patients diagnosed as BCA. This single center experience draws attention to the radiology criteria utilized for diagnosing a biliary cystadenoma and suggests that it is time to revisit the imaging interpretation and differential diagnosis.

Pain Emergencies and Complications of Pain Treatments

2019 ◽  
pp. 221-240
Author(s):  
Isaac Tong ◽  
R. Jason Yong ◽  
Beth B. Hogans
Keyword(s):  
Decision Making ◽  
Differential Diagnosis ◽  
Chest Pain ◽  
Clinical Assessment ◽  
Associated Factors ◽  
Clinical Decision Making ◽  
Acute Chest Pain ◽  
Clinical Decision ◽  
Common Occurrence ◽  
Pain Characteristics

Chapter 13 reviews some common pain-associated emergencies and also discusses some complications of pain treatments that require immediate attention. Pain is a common occurrence in emergent illness, and some complications of pain treatments require emergent management. Chest pain is an excellent example of clinical decision-making following a process of organized, rapid pain assessment and then diagnostic and treatment reasoning based on the findings and observations of the clinical assessment. Providers assessing patients for acute chest pain elicit basic pain characteristics of region, quality, severity, and timing as well as usually associated factors and then pursue testing and treatment for elements in the differential diagnosis accordingly. The chapter illustrates this same process applied to conditions of acute abdominal, limb, headache, and spine emergencies. In the second part of the chapter, emergencies arising in the context of pain treatments are discussed, including overdose and withdrawal from opioids, benzodiazepines, and other pain-active medications as well as pump and device complications.

scholarly journals 085 Syndrome of transient headache and neurologic deficits with cerebral fluid lymphocytosis (HANDL) as a mimic for transient ischaemic attack (TIA)

2019 ◽  
Vol 90 (e7) ◽  
pp. A27.2-A27
Author(s):  
Jasmine F Ashhurst ◽  
Rami Haddad
Keyword(s):  
Differential Diagnosis ◽  
Neurological Deficit ◽  
Unknown Aetiology ◽  
Focal Neurological Deficit ◽  
Benign Condition ◽  
Mri Brain ◽  
Ischaemic Attack ◽  
Ct Brain ◽  
Patient Presentation ◽  
New Onset

IntroductionHaNDL is a rare neurological disorder of unknown aetiology that is characterised by headache, neurological deficit and pleocytosis in the cerebrospinal fluid (CSF). It is a benign condition that has spontaneous resolution of symptoms within months.A 50 year old female presented to Emergency with an acute focal neurological deficit of right sided weakness, dysphasia and dysarthria lasting less than one hour. Over the preceding months she had a new onset of headache. She was worked up for a likely diagnosis of TIA.MethodsCase report.ResultsInitial CT Brain(angiography) showed no stroke or other identifiable cause of symptoms.MRI brain showed excessive nonspecific T2 hyperintensities, requiring further investigation for possible vasculitis. MR angiography was normal and there was no evidence of stroke.Viral PCR’s were negative.Lumbar puncture (LP) showed pleocytosis (leucocytes 309×10E6/L), raised intracranial pressure and high protein, raising suspicion for HaNDL. This normalised on subsequent outpatient LP, along with symptoms.ConclusionsA diagnosis of HaNDL is made as a diagnosis of exclusion, though should be considered as a differential diagnosis for various presentations in which transient acute focal neurology is a presenting complaint.Due to relatively few reported cases of HaNDL, it is possible that HaNDL is being underdiagnosed due to variability in patient presentation and lack of understanding of the syndrome.As in this case, when a patient presents with transient acute focal neurology in the absence of headache as a prominent presenting symptom, it is reasonable to consider HaNDL as a differential diagnosis.

scholarly journals Calcific myonecrosis: diagnostic dilemma

2018 ◽  
Vol 100 (6) ◽  
pp. e158-e160
Author(s):  
HE Matar ◽  
P Stritch ◽  
S Connolly ◽  
N Emms
Keyword(s):  
Magnetic Resonance Imaging ◽  
Differential Diagnosis ◽  
Magnetic Resonance ◽  
Malignant Tumour ◽  
Resonance Imaging ◽  
Diagnostic Dilemma ◽  
Benign Condition ◽  
Calcific Myonecrosis ◽  
History Of ◽  
Growing Mass

Calcific myonecrosis is a rare benign condition affecting mainly the muscles of a single leg compartment. It is thought to follow a history of trauma with a latent period of years. Patients present with a slowly growing mass. Differential diagnosis from a malignant tumour can be made from the history and the distinctive radiographical features of a fusiform lesion with predominantly peripheral calcifications. Magnetic resonance imaging may be necessary to confirm the diagnosis; treatment is largely symptomatic.

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