scholarly journals Oropharyngeal dysphagia as dominant and life-threatening symptom in dermatomyositis

2009 ◽  
Vol 66 (8) ◽  
pp. 671-674 ◽  
Author(s):  
Zorana Djakovic ◽  
Sonja Vesic ◽  
Maja Tomovic ◽  
Jelena Vukovic
Keyword(s):  
Aspiration Pneumonia ◽  
Oropharyngeal Dysphagia ◽  
Magnetic Resonance Images ◽  
Inflammatory Myopathies ◽  
Laboratory Findings ◽  
Endoscopic Gastrostomy ◽  
Nutritional Deficit ◽  
Swallowing Pain ◽  
Life Threatening ◽  
Proximal Myopathy

Background. Dysphagia can be a serious problem in patients with inflammatory myopathies. It may be associated with nutritional deficit, aspiration pneumonia, and poor prognosis. Case report. We presented a 60-year-old male, suffering from difficulty in swallowing, pain and weaknes in the proximal parts of his extremities, and skin manifestation. Laboratory findings showed increased creatine kinase and aldolase. Antinuclear antibodies to HEP-2 subtrate revealed titer of 1:40. Electromyoneurography demonstrated evidence of a proximal myopathy. A muscle biopsy revealed myositis. The baruim swallow test was remarkable for regurgitation, and nasal emerging of barium. Nuclear magnetic resonance images of cranium was normal. Tumor markers CEA, and Ca 19-9 were increased. A dose of 1 mg daily prednisolone was administered and percutaneous enteral feeding was performed. Two months later, the patient developed febrile state, aspiration pneumonia, and died due to respiratory failure. Conclusion. In cases of dermatomyositis with the serious dysphagia, percutaneous endoscopic gastrostomy should be performed as soon as possible. Owerall survival rate is low, even with an adequate therapy administration. Inflammatory myopathies should be considered in any patient with oropharyngeal dysphagia.

scholarly journals Prevention and management of major complications in percutaneous endoscopic gastrostomy

2021 ◽  
Vol 8 (1) ◽  
pp. e000628
Author(s):  
Kurt Boeykens ◽  
Ivo Duysburgh
Keyword(s):  
Clinical Practice ◽  
Abdominal Wall ◽  
Percutaneous Endoscopic Gastrostomy ◽  
Early Recognition ◽  
Endoscopic Technique ◽  
Abdominal Wound ◽  
Review Of The Literature ◽  
Endoscopic Gastrostomy ◽  
Major Complications ◽  
Life Threatening

BackgroundPercutaneousendoscopic gastrostomy is a commonly used endoscopic technique where a tube isplaced through the abdominal wall mainly to administer fluids, drugs and/orenteral nutrition. Several placement techniques are described in the literaturewith the ‘pull’ technique (Ponsky-Gardener) as the most popular one.Independent of the method used, placement includes a ‘blind’ perforation of thestomach through a small acute surgical abdominal wound. It is a generally safetechnique with only few major complications. Nevertheless these complicationscan be sometimes life-threatening or generate serious morbidity.MethodAnarrative review of the literature of major complications in percutaneousendoscopic gastrostomy.ResultsThis review was written from a clinical viewpoint focussing on prevention andmanagement of major complications and documentedscientific evidence with real cases from more than 20 years of clinical practice.ConclusionsMajorcomplications are rare but prevention, early recognition and popper management areimportant.

scholarly journals Membranoproliferative Glomerulonephritis Type 1 Secondary to an Infected Ventriculoperitoneal Shunt: a Case Report

2014 ◽  
Vol 12 (2) ◽  
pp. 119-121
Author(s):  
Christos Paliouras ◽  
Foteini Lamprianou ◽  
Georgios Ntetskas ◽  
Georgios Mattas ◽  
Nikolaos Karvouniaris ◽  
...  
Keyword(s):  
Ventriculoperitoneal Shunt ◽  
Membranoproliferative Glomerulonephritis ◽  
Classical Pathway ◽  
Glomerular Injury ◽  
Laboratory Findings ◽  
Immune Mediated ◽  
Histologic Pattern ◽  
Life Threatening ◽  
Subsequent Activation

AbstractVentricular shunting is the usual method for treatment of congenital or acquired hydrocephalus. Immune-mediated glomerulonephritis (shunt nephritis) is a rare but life-threatening complication of this neurosurgical technique. Intraglomerular deposition of circulating immune complexes and the subsequent activation of the classical pathway of serum complement’s cascade result in glomerular inflammation. Membranoproliferative gomerulonephritis is the most common histologic pattern observed in renal biopsy. The diagnosis needs high suspicion and is based on clinical and laboratory findings. Deterioration of renal function in association with signs of infection and low levels of serum complement’s proteins C3 and C4 make the diagnosis possible. The prognosis is variable and depends on the time of diagnosis after the onset of glomerular injury. The optimal treatment includes timely removal of the infected shunt in combination with aggressive antibiotic therapy. In this paper we present the case of a membranoproliferative glomerulonephritis type 1 in a patient with a ventriculoperitoneal shunt. Although this type of shunting is considered safer than the ventriculoatrial one, the risk of complications such as an immune-mediated glomerulonephritis still exists.

Risk Factors for Aspiration Pneumonia after Percutaneous Endoscopic Gastrostomy

Gerontology ◽  
2007 ◽  
Vol 53 (4) ◽  
pp. 224-227 ◽  
Author(s):  
Toshiro Kitamura ◽  
Hajime Nakase ◽  
Hidehiko Iizuka
Keyword(s):  
Risk Factors ◽  
Aspiration Pneumonia ◽  
Percutaneous Endoscopic Gastrostomy ◽  
Endoscopic Gastrostomy

Incidence of Invasive Bacterial Disease in Children with Fever and Petechiae

PEDIATRICS ◽  
1984 ◽  
Vol 74 (1) ◽  
pp. 77-80 ◽  
Author(s):  
Quoc Van Nguyen ◽  
Elizabeth A. Nguyen ◽  
Leonard B. Weiner
Keyword(s):  
Bacterial Infections ◽  
Haemophilus Influenzae Type ◽  
Bacterial Disease ◽  
Type B ◽  
Laboratory Findings ◽  
Life Threatening ◽  
Symptom Complex ◽  
Significant Disease ◽  
Single Laboratory ◽  
Normal Laboratory

The records of 129 patients admitted to the hospital with the findings of fever and petechiae were reviewed to determine the incidence of invasive bacterial disease in patients with this symptom complex. Twenty-six patients (20.2%) had culture-proven bacterial infections; 13 (11.1%) of the group had Neisseria meningitidis, eight had Haemophilus influenzae type B. No single laboratory test was sufficiently sensitive to detect all patients with life-threatening bacterial infections, but a combination of normal laboratory findings was highly specific for those without significant disease.

Predictive Value of Glycemia and Free Fatty Acid Levels upon Admission of Children with Scorpionism in Egypt

2022 ◽  
Author(s):  
Khaled Abdalla Abd-Elbaseer ◽  
Eman Ahmed Abd-Elmawgood ◽  
H. M. Qubaisy ◽  
Yaser F. Abd-Elraheem ◽  
Abdel-Rahman Abdel-Hamed El-Saied ◽  
...  
Keyword(s):  
Heart Failure ◽  
Organ Dysfunction ◽  
Serum Levels ◽  
Serum Glucose ◽  
Blood Levels ◽  
Scorpion Sting ◽  
Laboratory Findings ◽  
Scorpion Envenomation ◽  
Risk Patients ◽  
Life Threatening

Scorpion envenomation is a life-threatening emergency and causes serious health problems in tropical and subtropical regions. The aim of this study was to correlate the serum levels of biochemical parameters at admission in children with scorpion envenomation with subsequent morbidity and mortality. It was a prospective, observational, and descriptive study conducted for scorpion-envenomed children who presented to emergency and intensive care units between April 2019 and September 2019. Demographic, clinical, and laboratory findings of patients were recorded and tabulated. Routine investigations were done for all patients in addition to blood levels of lactate, free fatty acids (FFA), and insulin. All patients were compared according to outcome as survivors and nonsurvivors and according to glucose level as normoglycemic and hyperglycemic groups. There were 62 scorpion sting cases; their mean age was 8.6 ± 3.2 years. Patients aged more than 6 years (74.2%), and males (66.1%) were more affected than others. As regards severity, 25.8% were suffering organ dysfunction, 40.3% suffered systemic manifestations without organ dysfunction, and (33.9%) with only local manifestations. Serum glucose and FFA were significantly higher in nonsurvivors compared with survivors. Shock, convulsion, coma, heart failure, and pulmonary edema were significantly more common in hyperglycemic than normoglycemic group. Hyperglycemia, and raised FFA were associated with severe scorpion envenomation. Raised FFA was well correlated with presence of heart failure, leucocytosis, and hyperglycemia. Adding serum glucose and FFA to monitoring parameters of scorpionism severity can help the prediction of high-risk patients.

scholarly journals Aortic penetration due to a fish bone: a case report

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Daming Jiang ◽  
Yi Lu ◽  
Yigong Zhang ◽  
Zhanglong Hu ◽  
Haifeng Cheng
Keyword(s):  
Foreign Body ◽  
Fish Bone ◽  
Term Treatment ◽  
Aortoesophageal Fistula ◽  
First Case ◽  
Long Term Treatment ◽  
Swallowing Pain ◽  
Life Threatening ◽  
Sharp Foreign Body

Abstract Background Aortoesophageal fistula (AEF) caused by an esophageal foreign body is a life-threatening crisis, with rapid progress and high mortality. The first case of AEF was reported in 1818, but the first successfully managed case was not until 1980. Although there have been some reports on this condition, in most cases, the aorta was invaded and corroded due to its adjacent relationship with the esophagus and subsequent mediastinitis. To date, few reports have described an aortic wall directly penetrated by a sharp foreign body, likely because this type of injury is extremely rare and most patients cannot receive timely treatment. Here, we present a rare case of a fish bone that directly pierced the aorta via the esophagus. Case presentation A 31-year-old female experienced poststernum swallowing pain after eating a meal of fish. Gastroscope showed a fishbone-like foreign body had penetrated the esophagus wall. Computed tomography revealed that the foreign body had directly pierced the aorta to form an AEF. Surgery was successfully performed to repair the aorta and esophagus. The postoperation and follow-up was uneventful. Conclusions For the treatment of foreign bodies in the esophagus, we should be alert of the possibility of AEFs. The effective management of AEFs requires early diagnosis and intervention, as well as long-term treatment and follow-up, which still has a long way to go.

scholarly journals Ascending Paralysis in a 36-Year-Old Woman With Bipolar Disorder and Recent Aspiration Pneumonia

2020 ◽  
Vol 8 ◽  
pp. 232470962093164
Author(s):  
Aditi Vian Varma-Doyle ◽  
Kristen Garvie ◽  
Seema Walvekar ◽  
Mae Igi ◽  
Radha Mayuri Garikepati
Keyword(s):  
Bipolar Disorder ◽  
Respiratory Failure ◽  
Aspiration Pneumonia ◽  
Ivig Therapy ◽  
Conversion Disorder ◽  
Clinical Findings ◽  
Symptom Improvement ◽  
Csf Analysis ◽  
Life Threatening ◽  
High Index Of Suspicion

Guillain-Barré syndrome (GBS) is an acute inflammatory demyelinating polyneuropathy affecting both motor and sensory peripheral nerves. Typically presenting after a gastrointestinal or a respiratory tract infection, it manifests as ascending paralysis with concomitant areflexia in patients. Cytoalbuminologic dissociation is a supportive finding on cerebrospinal fluid (CSF) analysis. Due to variability in presentation, misdiagnosis and delay in treatment can occur, and consequently, GBS can become life threatening due to respiratory failure. We report ascending paralysis in a 36-year-old woman with known history of bipolar disorder who recently recovered from aspiration pneumonia following a drug overdose event. Given her psychiatric history, she was initially misdiagnosed as conversion disorder. Intravenous immunoglobulin (IVIG) therapy was initiated at our hospital due to strong suspicion of GBS, based on history and physical examination findings consistent with flaccid quadriparesis and impending respiratory failure. CSF analysis and radiological findings subsequently supported our clinical suspicion and clinical findings. Concurrent IVIG therapy, pain management, aggressive physical and respiratory therapy, and monitoring resulted in symptom improvement. One must have a high index of suspicion for GBS when presented with acute inflammatory demyelinating neuropathies in patients who present with ascending paralysis. Early initiation of therapy is key and can prevent life-threatening complications.

Crushing deutetrabenazine for treatment of tardive dyskinesia in a patient with severe orofacial symptoms: A case report

2020 ◽  
Vol 77 (18) ◽  
pp. 1477-1481
Author(s):  
Jon P Wietholter ◽  
Jenna Sizemore ◽  
Kara Piechowski
Keyword(s):  
Tardive Dyskinesia ◽  
Oropharyngeal Dysphagia ◽  
Orofacial Dyskinesia ◽  
Oral Nutrition ◽  
Endoscopic Gastrostomy ◽  
Dopamine Receptor Antagonists ◽  
Lack Of Information ◽  
Medication Delivery ◽  
History Of ◽  
First And Second Generation

Abstract Purpose Tardive dyskinesia (TD) is a hyperkinetic movement disorder that results from exposure to dopamine receptor antagonists and/or first- and second-generation antipsychotics. While cessation of the offending agent(s) through early detection is recommended, TD symptoms may be irreversible and require further treatment. Deutetrabenazine is approved by the Food and Drug Administration for treatment of persistent TD. Irreversible orofacial dyskinesia, a common affliction in TD, can progress to severe oropharyngeal dysphagia requiring alternate means of nutrition and medication delivery. Enteral administration of crushed deutetrabenazine has not been studied, and its use to treat TD in patients who cannot take medications by mouth has not been reported previously. Summary A 38-year-old female patient with a history of bipolar I disorder and TD secondary to atypical antipsychotic exposure developed worsening athetosis, hyperkinesia, and severe orofacial dyskinesia after initiation of ziprasidone. The patient had no improvement after discontinuation of atypical antipsychotics and required percutaneous endoscopic gastrostomy (PEG) placement for nutrition due to persistent aspiration and inability to tolerate oral nutrition. Despite a lack of information regarding administration of crushed deutetrabenazine tablets via PEG, that form of therapy was initiated and resulted in improvement of TD symptoms without noticeable adverse effects. Conclusion TD can result in significant orofacial dyskinesia with impaired delivery of needed medications and nutrition. We describe a case in which a patient with severe TD and orofacial dyskinesia experienced improvement of symptoms with use of crushed deutetrabenazine. Larger studies to further evaluate use of crushed deutetrabenazine for treatment of TD are needed.

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