scholarly journals Serum Sickness Secondary to Fluoxetine

2018 ◽  
Vol 2 (5) ◽  
Author(s):  
Fatema S Esaa ◽  
Pooja R Shah ◽  
Lisa A Beck
Keyword(s):  
Treatment Plan ◽  
Hospitalized Patients ◽  
Serum Sickness ◽  
Unique Case ◽  
Pathophysiologic Mechanism ◽  
Appropriate Treatment ◽  
Culprit Drug ◽  
Life Threatening

Drug-related cutaneous eruptions are common, affecting approximately 2-3% of hospitalized patients, and can vary in severity from benign to life-threatening. Understanding the pathophysiologic mechanism of the eruption is important for being able to identify the culprit drug and develop an appropriate treatment plan. We present a unique case of serum sickness that presented with a pruritic dermatitis associated with arthralgias and hypocomplementemia, observed shortly after initiation of fluoxetine.

Chest Pain

2014 ◽  
Vol 25 (3) ◽  
pp. 279-283
Author(s):  
Joan E. King ◽  
Kathy S. Magdic
Keyword(s):  
Chest Pain ◽  
Treatment Plan ◽  
Tension Pneumothorax ◽  
Differential Diagnoses ◽  
Coronary Syndrome ◽  
Satisfaction Of Search ◽  
Appropriate Treatment ◽  
Life Threatening ◽  
Valvular Diseases ◽  
Gastric Reflux

When a patient complains of chest pain, the first priority is to establish whether the situation is life threatening. Life-threatening differential diagnoses that clinicians must consider include acute coronary syndrome, cardiac tamponade, pulmonary embolus, aortic dissection, and tension pneumothorax. Nonthreatening causes of chest pain that should be considered include spontaneous pneumothorax, pleural effusion, pneumonia, valvular diseases, gastric reflux, and costochondritis. The challenge for clinicians is not to be limited by “satisfaction of search” and fail to consider important differential diagnoses. The challenge, however, can be met by developing a systematic method to assess chest pain that will lead to the appropriate diagnosis and appropriate treatment plan.

scholarly journals A case of giant ameloblastoma: destructive effect on the facial skeleton and soft tissues of the head and neck

2021 ◽  
Vol 49 (10) ◽  
pp. 030006052110501
Author(s):  
Květuše Lovásová ◽  
Branislav Borza ◽  
Peter Kizek ◽  
Milan Almaši ◽  
David Kachlík ◽  
...  
Keyword(s):  
Soft Tissues ◽  
Treatment Plan ◽  
Facial Skeleton ◽  
Unique Case ◽  
Destructive Effect ◽  
Anatomical Structures ◽  
Precise Knowledge ◽  
Appropriate Treatment ◽  
Facial Swelling ◽  
The Face

Ameloblastoma is a benign odontogenic tumor characterized by slow growth causing painless facial swelling. The tumor can behave locally aggressively, and may have direct destructive effects on the surrounding soft and hard tissues. This paper reports the unique case of a female patient with giant ameloblastoma of the mandible. Computed tomography (CT) revealed an enormous swelling of the left side of the face, resorption of the affected hemi-mandible, left maxilla, and tissues of the temporal, infratemporal, and pterygopalatine fossae. Pressure from the tumor resulted in displacement and destruction of the facial skeleton, upper aero-digestive tract structures, and some structures of the neck. The patient was treated by radical hemimandibulectomy with removal of the tumorous mass. Precise knowledge of the anatomical structures, and their locations and topographical relationships is required in the diagnosis and treatment plan for each surgical procedure in cases of giant ameloblastoma. CT imaging can be used to determine the extent and exact location of the lesion, revealing other important details that may help in selecting appropriate treatment.

TREATMENT OF OMPHALOCELE BASED ON INDIVIDUAL CHARACTERISTICS OF THE DEFECT

PEDIATRICS ◽  
1969 ◽  
Vol 44 (1) ◽  
pp. 101-108
Author(s):  
Conrad W. Wesselhoeft ◽  
Judson G. Randolph
Keyword(s):  
Treatment Plan ◽  
Infectious Complications ◽  
Individual Characteristics ◽  
Skin Closure ◽  
Overall Survival Rate ◽  
Surgical Closure ◽  
Appropriate Treatment ◽  
Life Threatening ◽  
Treatment Plans ◽  
Ruptured Omphalocele

The treatment of 27 infants presenting with omphalocele or gastroschisis was analyzed. Several different methods of therapy were available, but various treatment plans were chosen on an individual basis. The defects were classified according to the size of the anomaly, the presence or absence of sac rupture, and the presence of coexisting abnormalities. Infants with intact omphalocele sacs less than 5 cm in diameter were best treated by surgical closure of the musculofascial defect or by skin closure alone. Intact omphaloceles over 5 cm in diameter or those associated with other life-threatening anomalies were treated conservatively with local applications of mercurochrome. Ruptured omphalocele or gastroschisis required immediate surgical coverage. If skin closure was not possible, a plastic prosthesis of Silastic covered Marlex was useful as a temporary cover for the exposed intestine. Infectious complications from the exposed prosthesis were minimized by the use of 0.5% silver nitrate dressings. An overall survival rate of 70% was obtained using the most appropriate treatment plan for the particular anomaly.

scholarly journals The effects of a preoperative multidisciplinary conference on outcomes for high-risk patients with challenging surgical treatment options: a retrospective study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Masayoshi Koike ◽  
Mie Yoshimura ◽  
Yasushi Mio ◽  
Shoichi Uezono
Keyword(s):  
Patient Safety ◽  
Retrospective Study ◽  
High Risk ◽  
Treatment Plan ◽  
Treatment Options ◽  
High Risk Patients ◽  
Appropriate Treatment ◽  
Risk Patients ◽  
Treatment Plans ◽  
Multidisciplinary Conference

Abstract Background Surgical options for patients vary with age and comorbidities, advances in medical technology and patients’ wishes. This complexity can make it difficult for surgeons to determine appropriate treatment plans independently. At our institution, final decisions regarding treatment for patients are made at multidisciplinary meetings, termed High-Risk Conferences, led by the Patient Safety Committee. Methods In this retrospective study, we assessed the reasons for convening High-Risk Conferences, the final decisions made and treatment outcomes using conference records and patient medical records for conferences conducted at our institution from April 2010 to March 2018. Results A total of 410 High-Risk Conferences were conducted for 406 patients during the study period. The department with the most conferences was cardiovascular surgery (24%), and the reasons for convening conferences included the presence of severe comorbidities (51%), highly difficult surgeries (41%) and nonmedical/personal issues (8%). Treatment changes were made for 49 patients (12%), including surgical modifications for 20 patients and surgery cancellation for 29. The most common surgical modification was procedure reduction (16 patients); 4 deaths were reported. Follow-up was available for 21 patients for whom surgery was cancelled, with 11 deaths reported. Conclusions Given that some change to the treatment plan was made for 12% of the patients discussed at the High-Risk Conferences, we conclude that participants of these conferences did not always agree with the original surgical plan and that the multidisciplinary decision-making process of the conferences served to allow for modifications. Many of the modifications involved reductions in procedures to reflect a more conservative approach, which might have decreased perioperative mortality and the incidence of complications as well as unnecessary surgeries. High-risk patients have complex issues, and it is difficult to verify statistically whether outcomes are associated with changes in course of treatment. Nevertheless, these conferences might be useful from a patient safety perspective and minimize the potential for legal disputes.

scholarly journals Unilateral mydriasis in a child with a ventriculoperitoneal shunt for obstructive hydrocephalus: a diagnostic dilemma

2020 ◽  
Vol 13 (12) ◽  
pp. e237257
Author(s):  
Monidipa Banerjee ◽  
Eiman Haj Ahmed ◽  
Kathryn Foster ◽  
Arundoss Gangadharan
Keyword(s):  
Ipratropium Bromide ◽  
Obstructive Hydrocephalus ◽  
Sudden Onset ◽  
Unique Case ◽  
Diagnostic Dilemma ◽  
Vp Shunt ◽  
Life Threatening ◽  
Unilateral Mydriasis ◽  
The Brain ◽  
Rule Out

There are several causes for sudden onset unilateral mydriasis, however impending transtentorial uncal herniation needs to be ruled out. This unique case highlights an uncommon adverse response to a common mode of treatment that leads to a diagnostic dilemma. A 3-year-old boy with a ventriculoperitoneal (VP) shunt for an obstructive hydrocephalus presented with an acute respiratory distress. He developed unilateral mydriasis with absent light reflex during treatment with nebulisers. An urgent CT scan of the brain did not show any new intracranial abnormality. A case of pharmacological anisocoria was diagnosed that resolved completely within 24 hours of discontinuation of ipratropium bromide. Although ipratropium-induced anisocoria has been reported in children, but to our knowledge none in a child with VP shunt for hydrocephalus. This emphasises the urgency in evaluating unilateral mydriasis to rule out life-threatening conditions. Clinicians should remember that ipratropium administered through ill-fitting face masks could cause this completely reversible adverse effect.

Of Love and Laetrile: Medical Decision Making in a Child's Best Interests

1979 ◽  
Vol 5 (3) ◽  
pp. 269-294
Author(s):  
Eve T. Horwitz
Keyword(s):  
Decision Making ◽  
Medical Treatment ◽  
Burden Of Proof ◽  
State Intervention ◽  
Convincing Evidence ◽  
State Agency ◽  
Best Interests ◽  
Medical Decision ◽  
Appropriate Treatment ◽  
Life Threatening

AbstractTwo recent cases have raised important questions concerning the appropriateness of state intervention in parental choices of unorthodox medical treatment for children with life-threatening conditions. This Note first discusses whether, and if so, when, state intervention in a child's treatment selection by its parents is appropriate, and then analyzes the tests a court should apply in deciding upon an appropriate treatment. The Note recommends a decision-making approach that requires the appropriate state agency to prove, by clear and convincing evidence, that the parents' choice of medical treatment either is directly or is indirectly harming their child. Under this approach, if the state meets its burden of proof the court then must apply the ‘best interests’ test, rather than the ‘substituted judgment’ test, to choose an appropriate medical treatment for the child.

Pyriform sinus rupture caused by blunt trauma

2020 ◽  
pp. 197140092097516
Author(s):  
Emil Jernstedt Barkovich ◽  
M Reza Taheri
Keyword(s):  
Blunt Trauma ◽  
Pyriform Sinus ◽  
Significant Heterogeneity ◽  
Cervical Trauma ◽  
Specific Location ◽  
Appropriate Treatment ◽  
Threatening Condition ◽  
Pharyngeal Perforation ◽  
Life Threatening ◽  
Foreign Body Impaction

Hypopharyngeal perforation (HP) is a potentially life-threatening condition most associated with iatrogenic injury and foreign body impaction. Additionally, a number of cases of posterior HP have been reported following blunt cervical trauma. We present a case of a construction accident causing lateral hypopharyngeal rupture. Visceral perforation was initially diagnosed on computed tomography (CT) imaging and managed conservatively. We speculate this region may be particularly vulnerable to injury due to an anatomic transition in adjacent fascial support. A review of 29 prior cases suggests that this may be the first reported case of blunt trauma causing rupture of the pyriform sinus. However, significant heterogeneity exists in diagnostic approach. Radiography and CT are rapid, sensitive modalities for suggesting pharyngeal perforation, while fluoroscopy and endoscopy can better assess injury size and location and monitor resolution. Early radiologic recognition of hypopharyngeal injury is essential to initiate appropriate treatment. In certain cases, including our own, both the presence and specific location of perforation may be identified on initial CT images.

Systemic Diseases Associated with Nasal Symptoms

1987 ◽  
Vol 1 (1) ◽  
pp. 33-44 ◽  
Author(s):  
Guy A. Settipane
Keyword(s):  
Differential Diagnosis ◽  
Fungal Infections ◽  
Systemic Disease ◽  
Systemic Diseases ◽  
Proper Treatment ◽  
Csf Rhinorrhea ◽  
Nasal Symptoms ◽  
Appropriate Treatment ◽  
Life Threatening ◽  
Careful History

Many systemic diseases are associated with nasal symptoms, Rhinitis associated with asthma is probably the most common with leprosy and fungal infections being the rarest. A careful history and nasal examination in a patient with rhinitis may lead to the discovery of more significant systemic diseases. Proper treatment of systemic disease will often cure or improve the associated rhinitis. Similarly, appropriate treatment of the rhinitis/sinusitis may reduce systemic complaints such as asthma. At times, identification of the cause of rhinitis as in CSF rhinorrhea, Wegeners’ syndrome, etc., alerts one to a life-threatening entity. Thus, it is apparent that the nose is an excellent mirror of some systemic diseases and identifying and understanding the differential diagnosis of nasal symptoms may be a tremendous help in diagnosing the disease and treating the whole patient.

Traumatic Penile Pseudoaneurysm After Straddle Injury Presenting With Life Threatening Anemia: A Unique Case and a Diagnostic Challenge

Urology ◽  
2019 ◽  
Vol 125 ◽  
pp. 210-212 ◽  
Author(s):  
Muhannad Alsyouf ◽  
Phillip Stokes ◽  
Jason Smith ◽  
Akin Amasyali ◽  
David Chamberlin
Keyword(s):  
Diagnostic Challenge ◽  
Unique Case ◽  
Life Threatening

Updates in insomnia diagnosis and treatment

2019 ◽  
Vol 54 (4-5) ◽  
pp. 275-289 ◽  
Author(s):  
Scott Bragg ◽  
JJ Benich ◽  
Natalie Christian ◽  
Josh Visserman ◽  
John Freedy
Keyword(s):  
Drug Therapy ◽  
Behavioral Therapy ◽  
Treatment Plan ◽  
Treatment Options ◽  
First Line ◽  
Safety Concerns ◽  
Diagnostic And Statistical Manual ◽  
First Line Therapy ◽  
Appropriate Treatment ◽  
Central Nervous System Depression

Introduction Insomnia is the most commonly reported sleep disorder and remains undertreated in many patients. New changes to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, have changed the way insomnia is diagnosed. In patients who suffer from insomnia, a number of available treatment options exist including both behavioral therapy and medications. Literature Review: First line therapy for insomnia should always include behavioral modifications such as sleep hygiene and insomnia-oriented cognitive behavioral therapy. In patients deemed to need pharmacotherapy, first line medications include nonbenzodiazepine hypnotics (i.e., z-drugs) and antidepressants depending on the patients’ needs and comorbidities. The risk of next day impairment, parasomnias, and central nervous system depression are some of the most feared side effects with z-drugs. Second line drug therapy includes melatonin and suvorexant. Several concerns exist for suvorexant similar to other insomnia medications, but melatonin remains one of the safest medication alternatives. Other medication options such as benzodiazepines, antihistamines, and antipsychotics should rarely be used because of weak effectiveness data or serious safety concerns. Discussion The most appropriate treatment plan needs to be tailored to meet the needs of individual patients. Many patient factors (e.g., age, other comorbidities, specific problems with sleep) need to be considered before prescribing drug therapy for patients suffering from insomnia. Medications with the best evidence and fewest safety concerns should be prioritized when clinicians work with patients to determine the most appropriate treatment plan. Conclusions Nondrug treatment should be the emphasis for managing insomnia, but several options exist for patients needing multimodal therapy to improve their symptoms and maximize their quality of life. Z-drugs and antidepressants are first line medications options, but other options may be considered when tailored to individual patients. Medications should only be used intermittently and short term until nondrug treatments help to change a patient’s sleep routine.

Sign in / Sign up

Export Citation Format

Share Document