scholarly journals Thermography as a means for quantitative assessment of stump and phantom pains

1984 ◽  
Vol 8 (2) ◽  
pp. 76-81 ◽  
Author(s):  
H. Kristen ◽  
G. Lukeschitsch ◽  
F. Plattner ◽  
R. Sigmund ◽  
P. Resch
Keyword(s):  
Quantitative Assessment ◽  
Operative Intervention ◽  
Phantom Pain ◽  
Appropriate Treatment ◽  
Thermographic Image ◽  
Rule Out

Exact differentiation into stump and phantom pain is required when pain is reported after amputation. In a majority of cases appropriate treatment can improve the pain. Thermography is simple and gives a good indication of the circulation in the stump without operative intervention. It provides a key to the nature of the pain in stump and phantom. Although typical patterns occur for pain in the stump or phantom, in this study the thermographic image could confirm the presence of phantom pain, but it could not rule out errors or false statements.

scholarly journals Bee sting presumed endophthalmitis: a devastating ocular outcome

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Mohammed Al Amry ◽  
Huda Al Ghadeer ◽  
Ahmed R. Al Gethami
Keyword(s):  
Ocular Injury ◽  
Microbial Culture ◽  
Rare Type ◽  
Visual Evoked Response ◽  
Case Presentation ◽  
Aeromonas Veronii ◽  
Bee Sting ◽  
Appropriate Treatment ◽  
Patient Presentation ◽  
Rule Out

Abstract Background To report a rare case of bee sting presumed endophthalmitis that resulted in a devastating ocular outcome. Case presentation A 43-year-old patient presented 24 h after bee sting ocular injury in his left eye. He had a mild inflammatory sign at presentation, and he underwent surgical exploration to rule out a scleral defect, which revealed a sealed defect. During his hospital course, he developed signs of endophthalmitis 48 h following trauma for which he received vitreous tap and intravitreal antibiotic. Microbial culture revealed gram-negative rods, Pseudomonas aeruginosa, and Aeromonas veronii. Condition escalated to reach the panophthalmitis stage and cellulitis like picture with visual acuity of no light perception. Visual evoked response (VER) demonstrated a flat response. Infection was controlled by evisceration of the globe at the end as salvage therapy against the spreading of infection Conclusions Bee sting ocular injury is an exceedingly rare type of ocular trauma. Concomitant infection can happen, and severity depends on the pathogen involved. It is crucial to have insight and start appropriate treatment based on to the patient presentation.

scholarly journals Pitfalls in the Diagnostic Evaluation of Hyperprolactinemia

2019 ◽  
Vol 109 (1) ◽  
pp. 7-19 ◽  
Author(s):  
Lucio Vilar ◽  
Clarice Freitas Vilar ◽  
Ruy Lyra ◽  
Maria da Conceição Freitas
Keyword(s):  
Renal Failure ◽  
Pituitary Adenomas ◽  
Primary Hypothyroidism ◽  
Diagnostic Evaluation ◽  
Drug Induced ◽  
Hook Effect ◽  
Appropriate Treatment ◽  
Asymptomatic Subjects ◽  
Sample Dilution ◽  
Rule Out

An appropriate diagnostic evaluation is essential for the most appropriate treatment to be performed. Currently, macroprolactinemia is the third most frequent cause of nonphysiological hyperprolactinemia after drugs and prolactinomas. Up to 40% of macroprolactinemic patients may present with hypogonadism symptoms, infertility, and/or galactorrhea. Thus, the screening for macroprolactin is indicated not only for asymptomatic subjects but also for those without an obvious cause for their prolactin (PRL) elevation. Before submitting patients to macroprolactin screening and pituitary magnetic resonance imaging, one should rule out pregnancy, drug-induced hyperprolactinemia, primary hypothyroidism, and renal failure. The magnitude of PRL elevation can be useful in determining the etiology of hyperprolactinemia. PRL values >250 ng/mL are highly suggestive of prolactinomas and virtually exclude nonfunctioning pituitary adenomas (NFPAs) and other sellar masses as the etiology of hyperprolactinemia. However, they can also be found in subjects with macroprolactinemia, drug-induced hyper­prolactinemia or chronic renal failure. By contrast, most patients with NFPAs, drug-induced hyperprolactinemia, macroprolactinemia, or systemic diseases present with PRL levels <100 ng/mL. However, exceptions to these rules are not rare. Indeed, up to 25% of patients harboring a microprolactinoma or a cystic macroprolactinoma may also have PRL <100 ng/mL. Falsely low PRL levels may result from the so-called “hook effect,” which should be considered in all cases of large (≥3 cm) pituitary adenomas associated with normal or mildly elevated PRL levels (≤250 ng/mL). The hook effect may be unmasked by repeating PRL measurement after a 1:100 serum sample dilution.

scholarly journals PREVALENCE OF LEIOMYOSARCOMA OF UTERUS: A THREE YEAR RETROSPECTIVE STUDY

2021 ◽  
Vol 5 (2) ◽  
Author(s):  
Saket Sarswat ◽  
D. P. Soni ◽  
Saurabh Soni ◽  
Vimlesh . ◽  
Qadir Fatima
Keyword(s):  
Retrospective Study ◽  
Uterine Fibroid ◽  
Poor Prognosis ◽  
Malignant Tumors ◽  
Uterine Fibroids ◽  
Uterine Leiomyosarcoma ◽  
Appropriate Treatment ◽  
Relative Rarity ◽  
Optimum Management ◽  
Rule Out

Background: leiomyosarcoma of uterus are notorious for their aggressive nature and poor prognosis. The relative rarity of uterine leiomyosarcomas, as well as their pathological diversity, hinders studies aimed at improving understanding of the disease and makes it difficult to define the optimum management. Methods: This retrospective study is conducted over a period of three year from January 2017 to December 2020. All the hysterectomy specimens received at the Department of Pathology were processed and included in the study during the study period. We report here the Prevalence of leiomyosarcoma of uterus at Bikaner region. Results: We received a total of 952 hysterectomy specimens at Department of Pathology during the study period. Out of which 546 were operated and sent with the clinical diagnosis of uterine fibroid. Two patients were diagnosed with histopathological features of leiomyosarcoma which is 0.37% of all uterine fibroids and 0.21% of all hysterectomies at Bikaner region. Conclusion: Uterine leiomyosarcomas are rare but highly malignant tumors which are difficult to diagnose preoperatively and mostly mimic clinical features of benign uterine fibroids. The leiomyosarcomas show poor prognosis. This makes it important to investigate uterine malignancies histopathologically to rule out leiomyosarcomas so that appropriate treatment can be started early. Keywords: Uterine leiomyosarcoma, uterine fibroid.

scholarly journals Krokodil (Desomorphine)-induced osteonecrosis of the maxilla: a case report and literature review

2019 ◽  
Vol 25 (3) ◽  
pp. 26
Author(s):  
Jean-François Sergent ◽  
Gérard Bader ◽  
Julien Hamon ◽  
Lucie Peigne ◽  
Sophie Lejeune
Keyword(s):  
Case Report ◽  
Bone Resorption ◽  
Literature Review ◽  
Web Of Science ◽  
Necrotic Tissue ◽  
Total Excision ◽  
Appropriate Treatment ◽  
Bone Exposure ◽  
Radiological Examinations ◽  
Rule Out

Introduction: Desomorphine is an opioid formerly used to treat acute pain. It is simple to manufacture, which has recently led to an increase in its clandestine production under the name “Krokodil”. This article presents a case of oral problems related to its use first ever reported in France. Observation: A 36-year-old male patient presented with bone exposure in sector 1. He admitted to actively consuming “Krokodil IV” for several years. In the course of the clinical and radiological examinations, the patient was diagnosed with osteochemonecrosis of the maxillary induced by krokodil, considering that severe intrinsic and extrinsic adverse effects have been attributed to the drug. Discussion: A systematic literature review was conducted using articles from the Medline and Web of Science databases. To treat such a condition, two authors have described a process consisting of total excision of the necrotic tissue with 0.5 cm margins, combined with discontinuing the intake of the drug. However, these observations should be considered with caution because of the absence of any prospective studies. Conclusion: There are a number of etiologies for osteonecrosis in the context of radiotherapy, intake of bisphosphonates, and administration of bone resorption inhibitors. Unfortunately, in the case of krokodil, its high addictive nature makes it difficult for the patient to wean off the drug. Further, the heterogeneity of its manufacturing make it challenging to pharmacokinetically analyze its prolonged use. In view of the current literature, surgical therapy associated with weaning appears to be the most appropriate treatment, without being able to rule out addiction or necrotic relapses.

scholarly journals Types, differences and prognosis of colonic polyps

2022 ◽  
Author(s):  
Rahmathulla Safiyul Rahman ◽  
Ali Saeed Alharbi ◽  
Bassam Ahmed Basaben ◽  
Ahmad Adnan Alsalman ◽  
Anas Sulaiman Aljohani ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Treatment Plan ◽  
Colonic Polyps ◽  
Colorectal Polyps ◽  
The Other ◽  
Colon Polyps ◽  
Other Hand ◽  
Appropriate Treatment ◽  
Lymphoid Aggregates ◽  
Rule Out

Colon polyps might originate from the submucosa including lymphoid aggregates, carcinoids and lipomas. On the other hand, most polyps usually arise from the mucosa and include various types, whether neoplastic or not. The prognosis and treatment of these lesions depend on establishing an adequate diagnosis to rule out the presence of malignancy. Therefore, clinicians should be aware of each subclassification's different types and presentations to achieve the best outcomes. When conducting colonoscopy screening for colorectal cancer, colorectal polyps are commonly discovered. The prevalence of these lesions is high. However, most of them do not have any clinical significance. On the other hand, evidence shows that some polyps might have premalignant characteristics, which are usually challenging to manage in clinical practice. Therefore, evidence shows that the most appropriate approach to managing these lesions and achieving the best prognosis would be identifying and treating them as early as possible before complications appear to intervene against potential morbidities and mortality. Clinicians should consider the wide variations of colorectal cancer to establish the most appropriate diagnosis. A histological diagnosis is essential in these events to exclude malignancy and decide the most appropriate treatment plan.

scholarly journals Thyroid-Like Low-Grade Nasopharyngeal Papillary Adenocarcinoma

2019 ◽  
Vol 152 (5) ◽  
pp. 582-589 ◽  
Author(s):  
Fengbo Huang ◽  
Xueping Xiang ◽  
Bo Hong ◽  
Jie Min ◽  
Jinfan Li
Keyword(s):  
Hot Spot ◽  
Gene Mutations ◽  
Papillary Adenocarcinoma ◽  
Morphological Characterization ◽  
Low Grade ◽  
Ki 67 ◽  
Appropriate Treatment ◽  
Rule Out

Abstract Objectives Thyroid-like low-grade nasopharyngeal papillary adenocarcinoma (TLLGNPPA) is a relatively rare nasopharyngeal tumor. We performed morphological characterization, immunohistochemical profiling, and investigated gene mutations. We also provide clinical follow-up data and brief review of the literature. Methods Immunohistochemistry was used to evaluate the expression of TTF-1, CK19, CK7, EMA, TG, Pax-8, CK5/6, S100, and Ki-67. Additionally, in situ hybridization was utilized to identify the presence of EBV. We investigated mutations in hot-spot exons of KRAS/NRAS/BRAF to rule out common mutations seen in thyroid tumors. Results Histopathologic examination of four cases identified tumors that were mainly occupied by papillary architectures. One case had a predominantly glandular structure. The tumors expressed TTF-1 and CK19, while TG and Pax-8 were negative. S100 was moderately expressed focally in three cases. Conclusions While TLLGNPPA displays a morphological resemblance to papillary thyroid carcinoma (PTC), it is vital to differentiate nasopharyngeal metastasis from PTC for appropriate treatment.

scholarly journals Detection of Aortic Dissection by a Combined Abdominal Sonogram and Computed Tomography Angiogram

2016 ◽  
Vol 33 (1) ◽  
pp. 58-62
Author(s):  
Samantha Simpson ◽  
Kelsy Loren Fisher
Keyword(s):  
Computed Tomography ◽  
Aortic Dissection ◽  
Gallbladder Disease ◽  
Appropriate Treatment ◽  
Combined Use ◽  
Diagnosis And Classification ◽  
Computed Tomography Angiogram ◽  
Proper Diagnosis ◽  
Rule Out

Aortic dissection is a rare pathology of the aorta involving separation of the layers of the aortic wall—specifically, the tunica intima and the tunica media. The type of aortic dissection involved is classified by where the separation occurs on the aorta. This case study presents the instrumental significance of performing complete versus limited abdominal sonographic examinations, including abdominal aorta evaluation. Initially, a limited abdominal sonogram was ordered to rule out gallbladder disease. The sonogram was reordered as a complete abdominal study, which led to the diagnosis of aortic dissection. The diagnosis was supported through sonographic features and computed tomography evaluation. The combined use of these two imaging modalities provided an accurate diagnosis and classification regarding the type of aortic dissection. A proper diagnosis and classification facilitated the appropriate treatment related to this type of aortic dissection.

Diagnosing Heart Failure – Experience and ‘Best Pathways’

2010 ◽  
Vol 6 (3) ◽  
pp. 10 ◽  
Author(s):  
Clare Taylor ◽  
Richard Hobbs ◽  
◽  
Keyword(s):  
Heart Failure ◽  
Hospital Admissions ◽  
Clinical Decision ◽  
Clinical Syndrome ◽  
Lung Pathology ◽  
Appropriate Treatment ◽  
Patients With Heart Failure ◽  
Chest X Ray ◽  
Electrocardiogram Ecg ◽  
Rule Out

Heart failure is a clinical syndrome associated with high rates of morbidity and mortality and associated healthcare costs. The burden of heart failure is likely to increase with time, but effective treatments that improve quality of life and survival are available. Accurate and timely diagnosis is crucial to ensure patients receive appropriate treatment and avoid hospital admissions. However, diagnosing heart failure can be difficult as symptoms and signs commonly overlap with other conditions. A chest X-ray can be useful to identify evidence of heart failure or other lung pathology; however, a normal result does not rule out a diagnosis of heart failure. An electrocardiogram (ECG) is often abnormal in patients with heart failure, although up to 10% of patients may have a normal ECG. Natriuretic peptides are a useful biomarker for heart failure and a negative result can rule out the diagnosis. This can be helpful in determining who should be referred for echocardiogram. A new clinical-decision rule (CDR) could help clinicians to achieve a more timely and accurate diagnosis of heart failure.

Flu Viral Multiplex Testing and its Implication for COVID-19 Testing

2020 ◽  
Vol 01 ◽  
Author(s):  
Aaron Han ◽  
Janet Hicban
Keyword(s):  
Viral Agent ◽  
Testing Strategy ◽  
Rt Pcr ◽  
Chain Reaction ◽  
Parallel Testing ◽  
Appropriate Treatment ◽  
Simultaneous Testing ◽  
Polymerase Chain ◽  
The Impact ◽  
Rule Out

Background: The diagnosis of viral causes for flu-like syndromes have been positively impacted by the availability of molecular assays. In recent years, syndromic multiplex panels have been able to give rapid turn-around-times and highly accurate results. We examine the use of this test during the first four months of 2020 during the COVID-19 pandemic. Methods: Retrospective review of 2145 patient results from multiplex syndromic flu panel using Biofire RP2 was performed. Cases in which parallel testing for COVID-19 by real-time polymerase chain reaction (RT-PCR) was compared. Results: 53% of the patients tested identified a viral agent. 13% of the positive cases were coinfection with more than a single virus. The most frequently detect virus(es) were rhinovirus/enterovirus, followed by coronaviruses (non-MERS, non COVID-19). One hundred patients had simultaneous testing for COVID-19. Seventeen (17%) had positive COVID-19 by RT-PCR. Three of these patients had coinfection with rhinovirus/enterovirus and COVID-19. The negative predictive value for COVID-19 based on a positive non-COVID agent was 95% in our sample. Conclusions: Viral syndromic panels are useful for rapid detection and appropriate treatment of patients. Our results suggest coinfection is infrequent, and we discuss the impact of COVID-19 on patient testing strategy. The use of multiplex panels is useful to provide accurate diagnosis and rule out important pathogens that have different treatment approaches.

scholarly journals Imaging findings and 4 years follow-up of adrenal cavernous hemangioma: a case report

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Valentina Testini ◽  
Laura Eusebi ◽  
Willy Giannubilo ◽  
Vincenzo Ferrara ◽  
Francesco Bartelli ◽  
...  
Keyword(s):  
Cavernous Hemangioma ◽  
Mass Effect ◽  
Histopathological Diagnosis ◽  
Case Presentation ◽  
First Case ◽  
Appropriate Treatment ◽  
Cavernous Hemangiomas ◽  
Adrenal Masses ◽  
Rule Out

Abstract Background Adrenal hemangioma is a rare and non-functional benign tumor. Since the first case in 1955, approximately 90 cases have been reported in literature frequently presenting as a large and incidentally discovered retroperitoneal mass or as a result of hemorrhage caused by spontaneous rupture. Case presentation A 69-year-old man was admitted to our hospital for right hypocondrium pain and anemia. A computed tomography (CT) scan was performed and a large right adrenal mass measured 18 cm was found. The patient underwent laparoscopic right adrenalectomy. Histopathological diagnosis revealed a cavernous adrenal hemangioma. Conclusion Cavernous hemangiomas are uncommon tumors. We reported a case of adrenal cavernous hemangioma incidentally discovered by ultrasound and CT. In the case of finding adrenal masses, cavernous hemangiomas, although rare, should be considered a possible diagnosis. The appropriate treatment is surgical resection to rule out any potential for malignancy, to relieve symptoms secondary to the mass effect, and to prevent complications such as retroperitoneal bleeding.

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