scholarly journals The Diagnostic Dilemma of Ascites in Women

2021 ◽  
Vol 6 (3) ◽  
Keyword(s):  
Clinical Presentation ◽  
Demographic Data ◽  
Case Series ◽  
Vascular Occlusion ◽  
Total Abdominal Hysterectomy ◽  
Endometrial Biopsy ◽  
Diagnostic Dilemma ◽  
Female Patients ◽  
Pathologic Features ◽  
Common Clinical Presentation

Introduction: Ascites is the pathological accumulation of fluid within the peritoneal cavity. The most common causes of ascites are liver disease, vascular occlusion, congestive heart failure, pericarditis or nephrotic syndrome. We present to you case series of ascites as a common presentation in women, but each case with a different etio-pathogenesis related to gynecological benign disease. This case series highlights the importance, to consider gynecological problems among the potential differential diagnoses in women with ascites for early diagnosis and timely intervention. Methods: We identified 5 female patients older than 18 years who presented with ascites as a common clinical presentation and we reviewed their medical records to assess demographic data, clinical presentation, imaging findings, co-morbid conditions, histo-pathologic features, pharmacologic therapies and surgical intervention. Results: In all the five female patients, ascites was clinically diagnosed and confirmed with ultrasound of pelvis and abdomen. One of them noted to have pelvic tuberculosis, which was confirmed with endometrial biopsy and treated with antitubercular medication. One patient was diagnosed with adenomyosis and one other patient was diagnosed with leiomyoma, both patients were treated with total abdominal hysterectomy. One of the patients was diagnosed with endometriosis on laparotomy who was treated with gonadotrophin releasing hormone analogues. One of them was diagnosed with right sided ovarian fibroma, treated with right oophorectomy. All these patients had ascites as a common clinical presentation but with different underlying gynecological etiopathogeneses. The appropriate diagnosis and timely intervention in the above 5 cases resulted in complete resolution of symptoms. Conclusion: As a healthcare worker, initial evaluation of a female patient with ascites, should rely on a detailed history and physical examination. In women with ascites, gynecologic problems should be considered among the potential differential diagnosis for appropriate management and timely intervention.

scholarly journals Brain Tuberculoma Management Challenges: A Series of 5 Cases

2019 ◽  
Vol 9 (1) ◽  
pp. 64-68
Author(s):  
Md Rashidoon Nabi Khan ◽  
Mostafa Taufiq Ahmed ◽  
SM Asaduzzaman Juel ◽  
Mesbah Uddin Ahmed
Keyword(s):  
Clinical Presentation ◽  
Tertiary Care ◽  
Case Series ◽  
Mass Effect ◽  
Neurological Deficits ◽  
Care Hospital ◽  
Diagnostic Dilemma ◽  
Common Clinical Presentation ◽  
Almost All ◽  
Management Challenge

Although intracranial tuberculomas are not rare & account for a significant number of ICSOLs; Its clinical presentation &neuro-radiological findings sometimes lead us to a diagnostic dilemma and management challenge. Here, in this case series we are presenting diagnostic as well as management challenges we’ve faced managing patients with tuberculoma at a tertiary care hospital of Bangladesh. Intracranial tuberculomas can be situated in various locations and can mimic any lesion.Extracranial involvement is not always common, clinical presentation &neuroradiological findings sometimes not conclusive. Medical management indicated in almost all cases, as well as surgical intervention indicated in cases with neurological deficits & mass effect. Bang. J Neurosurgery 2019; 9(1): 64-68

Clinico-Pathological Co-relation in Diagnosis and Management of Abnormal Uterine Bleeding

2019 ◽  
Vol 17 (2) ◽  
pp. 52-54
Author(s):  
Durga BC ◽  
Nirmala Sharma
Keyword(s):  
Clinical Presentation ◽  
Abnormal Uterine Bleeding ◽  
Endometrial Biopsy ◽  
Uterine Bleeding ◽  
Diagnostic Tools ◽  
Age Group ◽  
Diagnosis And Management ◽  
Histopathological Evaluation ◽  
Endometrial Pattern ◽  
Common Clinical Presentation

Abnormal uterine bleeding is the third most common clinical presentation in gynecology OPD. Histopathological evaluation of the endometrial tissue plays a significant role in diagnosis and management of Abnormal Uterine Bleeding. Aim: To find out cause of abnormal uterine bleeding with the help of histopathological report of endometrial biopsy. Methodology: This is retrospective observational study done at NGMC from ( 1st June 2018 to -30th June 2019) of 100 patients endometrial biopsy sent for histopathological evaluation and diagnosis reports were correlated with age and bleeding pattern and patients were managed accordingly. Result: A total of 100 endometrial specimens submitted with clinical diagnosis of Abnormal Uterine Bleeding were studied. Patients age group ranged from 18 – 65 yrs and most of them were seen in the age group of 41–50 yrs (43%).The commonest complaint was menorrhagia i.e. 48% .The commonest endometrial pattern observed in the study was, proliferative phase endometrium (38%). Conclusion: Endometrial biopsy is one of the most useful diagnostic tools to find out cause of uterine bleeding in AUB cases and also helps in management of AUB patient.  

scholarly journals PATH-18. HIGH-GRADE NEUROEPITHELIAL TUMOR (HGNET) IN A PEDIATRIC CASE-SERIES

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii428-iii428
Author(s):  
Felipe Hada Sanders ◽  
Alessandra Azambuja ◽  
Fernando Frasseto ◽  
Sergio Rosemberg ◽  
Hamilton Matushita
Keyword(s):  
Young Patients ◽  
Case Series ◽  
Medical Community ◽  
Molecular Entity ◽  
High Grade ◽  
Pediatric Case ◽  
Dismal Prognosis ◽  
Pathologic Features ◽  
Common Clinical Presentation ◽  
The Central Nervous System

Abstract The central nervous system (CNS) high-grade neuroepithelial tumor is a recently described molecular entity. We report 2 new CNS HGNET cases sharing common clinical presentation and pathologic features. In summary, CNS HGNET represents a rare tumor occurring in young patients with dismal prognosis. We think it is important to report these cases to spread the experience and raise the knowledge of the medical community.

scholarly journals Seroprevalence and Clinical Features of Scrub Typhus among Febrile Patients Attending a Referral Hospital in Kathmandu, Nepal

2021 ◽  
Vol 6 (2) ◽  
pp. 78
Author(s):  
Anil Pokhrel ◽  
Binod Rayamajhee ◽  
Saroj Khadka ◽  
Sandeep Thapa ◽  
Samjhana Kapali ◽  
...  
Keyword(s):  
Blood Serum ◽  
Clinical Presentation ◽  
Scrub Typhus ◽  
Serological Test ◽  
Demographic Data ◽  
Outbreak Detection ◽  
Serum Samples ◽  
Diagnostic Dilemma ◽  
Serological Tests ◽  
Test Kit

(1) Background: Scrub typhus (ST) is endemic to Nepal. It is often underdiagnosed and misdiagnosed due to non-specific clinical presentation coupled with limited microbiological facilities, leading to adverse clinical outcomes. This study aimed to assess the seroprevalence of scrub typhus in febrile patients attending Sukraraj Tropical and Infectious Disease Hospital (STIDH), Nepal, from August 2018 to April 2019. (2) Materials and Method: Blood/serum samples and clinical and demographic data of adult febrile patients (≥19 years) who attended or were referred to the hospital were collected after obtaining written informed consent from the participants excluding immunocompromised individuals. Collected blood/serum samples were subjected to hematological, biochemical, and serological tests. A serological test for scrub typhus was performed using the ImmuneMed scrub typhus rapid diagnostic test kit. Data generated were analyzed using SPSS software version 24.0. (3) Results: Amongst the 2070 febrile patients, 462 (22.3%) were seropositive to at least one etiological agent of febrile illnesses (scrub typhus: 253 cases, dengue: 101 cases, leptospirosis: 9, brucellosis: 52, malaria: 9 and kala-azar: 20 cases). Scrub typhus accounted for 12.2% (n = 253) of total febrile illnesses followed by dengue (4.9%, n = 101). Mixed seropositivity of scrub typhus with dengue, brucellosis, and typhoid was found in 12 (0.6%), 9 (0.4%), and 5 (0.2%) cases, respectively. Among 253 scrub typhus patients, 53.4% were female. Among the 154 patients, the most common symptoms were fever (100%), headache (79.2%), sweating (70.1%), breathing difficulty (51.3%), redness of the eye (43.5%), and pathognomonic eschar was observed in 9.1% patients. Fifty percent of scrub typhus patients had low platelet count and >30% of patients had an elevated level of liver enzymes (such as serum glutamic oxaloacetic transaminase (SGPT) and serum glutamic pyruvic transaminase (SGOT). (4) Conclusion: Scrub typhus is a considerable cause of febrile illness in Nepal. Females apparently have a higher chance of acquiring scrub typhus. ST presents nonspecific clinical presentation. The diagnostic dilemma of typhus patients can be minimized by the early monitoring of ST-associated symptoms. The country’s health system needs to be strengthened for early outbreak detection, and immediate response actions against scrub typhus to control the future outbreak of ST.

scholarly journals CHRONIC BREAST INFECTIONS: CHALLENGING CONDITION TO DIAGNOSE AND TREAT; AN OVERVIEW OF 70 CASES

2021 ◽  
Vol 71 (2) ◽  
pp. 401-04
Author(s):  
Razia Bano ◽  
Sohail Saqib Chatha ◽  
Faiza Sana ◽  
Humaira Latif ◽  
Umar Farooq Chatha ◽  
...  
Keyword(s):  
Clinical Features ◽  
Clinical Presentation ◽  
Management Strategies ◽  
Case Series ◽  
Military Hospital ◽  
Granulomatous Mastitis ◽  
Idiopathic Granulomatous Mastitis ◽  
Diverse Range ◽  
Incision And Drainage ◽  
Common Clinical Presentation

Objective: To share our experience of clinical features and management strategies for treatment of chronic breast infections. Study Design: Case series. Place and Duration of Study: Combined Military Hospital Rawalpindi, from Feb 2016 to Feb 2018. Methodology: We prospectively enrolled patients with diagnosis of chronic breast infections over a period of two years. All patients with infections (less than one month old) were excluded from the study. We studied the demographic characteristics like age, clinical presentation, histopathological features, treatment given and response to the treatment. Results: A total of 70 patients were enrolled in the study. Patients age was between 21-75 years with mean age of 42 ± 5 years. Most common clinical presentation was lump and in duration with abscess in 23 (33%) cases, mass with discharging sinuses in 16 (23%) cases, while 7 (10%) cases had recurrent abscess. Diagnosis was made on core biopsy in 21 cases and in remaining cases with incision and drainage. Histopathology confirmed diagnosis of Idiopathic Granulomatous mastitis in 30 (43%) cases, acute on chronic mastitis in 27 (38%) and chronic granulomatous mastitis in 13 (18%) cases. Out of all cases 29 (41%) showed response to antibacterial treatment while 27 (38%) cases responded to anti tuberculous treatment. Spontaneous resolution occurred in 11 (16%) cases while 3 (4%) cases responded to antifungal treatment. Conclusion: Chronic breast infections are a challenging condition to diagnose and treat for breast surgeons and can present with diverse range of clinical features.

scholarly journals Gastrointestinal duplication cysts: experience from a tertiary care center in North India and review of literature

2020 ◽  
Vol 8 (1) ◽  
pp. 180
Author(s):  
Divya Aggarwal ◽  
Kim Vaiphei
Keyword(s):  
Congenital Malformations ◽  
Clinical Presentation ◽  
Care Center ◽  
Demographic Data ◽  
Tertiary Care ◽  
Case Series ◽  
North India ◽  
Male Predominance ◽  
High Index Of Suspicion ◽  
Age Range

Background: Duplication cysts (DC) are uncommon congenital malformations which predominantly present in infants and young children. Owing to their variable clinical presentation, radiology and/or histopathology are often required to clinch the diagnosis. We present a case series of 66 patients, which is the largest series reported so far.Methods: A search of prospectively maintained institutional database was carried out to identify patients who were diagnosed and operated for gastrointestinal DC between January 2013 and August 2018. For all cases, the demographic data, site of DC, details of clinical presentation, associated conditions and histopathology findings were recorded. The slides of all cases were retrieved and re-examined.Results: The age range was 1 day to 47 years, with a slight male predominance (1.3:1). Ileum was the most common site followed by jejunum. Ectopic mucosae noted were gastric, pancreatic, biliary and respiratory. One case showed glial heterotopia. Perforation, gangrene and intussusception were among the co-existing pathologies noted.Conclusions: Duplication cysts are rare congenital malformations. The variability in clinical presentation makes the diagnosis elusive. Timely diagnosis and appropriate management require a high index of suspicion and a holistic diagnostic approach with clinical, radiological and histopathological inputs. 

scholarly journals Acute abdomen in pregnancy: a case series on clinical presentation and diagnostic dilemma

2021 ◽  
Vol 10 (2) ◽  
pp. 742
Author(s):  
G. R. Abhirami ◽  
Chennaiahgari Sathyavani ◽  
Ravi N. Patil
Keyword(s):  
Pregnant Women ◽  
Acute Abdomen ◽  
Clinical Presentation ◽  
Case Series ◽  
Diagnostic Dilemma ◽  
Pain Abdomen ◽  
Fetal Complications ◽  
Magnetic Resonance Imaging Mri ◽  
Challenging Situation ◽  
In Pregnancy

Acute abdomen in pregnancy remains one of the most challenging situation in regard with the diagnosis and management. Pregnancy is a unique state in which the female body undergoes both anatomical and physiological changes which can pose a challenge in diagnosis. This may result in delay in management and increase in maternal and fetal morbidity and mortality. This study was to identify the spectrum of causes, the clinical presentation and diagnostic dilemma of acute abdomen in pregnancy. It was an observational study was done over a period of 3 years which included all the pregnant women who presented with acute abdomen. In this study, eighteen pregnant women presented with acute abdomen. Among the study group, 5.5%, 50% and 44.5% presented in first, second and third trimester respectively. The diagnosis included acute appendicitis in 11.1%, acute cholecystitis in 16.6%, acute pancreatitis in 16.6%, malrotation in 11.1%, uterine rupture 11.1%, rudimentary horn rupture in 22.4% and ovarian cyst torsion in 11.1%. The clinical presentation included pain abdomen (16.6%), pain abdomen and vomiting (44.4%), pain abdomen in shock (39%) and abdominal tenderness (33.3%). The diagnosis was confirmed with ultrasonography in 55.6%, 11.1% women required higher imaging like magnetic resonance imaging (MRI) and 33.3% women were diagnosed on table. Majority of them had good outcome, but there was one maternal mortality (6%). Diagnosis and treatment of acute abdomen in pregnancy should be individualized. Good clinical acumen is essential for ordering early diagnostic test in acute abdomen in pregnancy. Appropriate intervention should be undertaken at the earliest to reduce the maternal and fetal complications. 

Long-term outcomes of lumbar microdiscectomy in the pediatric population: a large single-institution case series

2019 ◽  
Vol 24 (5) ◽  
pp. 549-557
Author(s):  
Malia McAvoy ◽  
Heather J. McCrea ◽  
Vamsidhar Chavakula ◽  
Hoon Choi ◽  
Wenya Linda Bi ◽  
...  
Keyword(s):  
Conservative Management ◽  
Functional Outcomes ◽  
Pediatric Patients ◽  
Clinical Presentation ◽  
Case Series ◽  
Csf Leak ◽  
Single Institution ◽  
The Mean

OBJECTIVEFew studies describe long-term functional outcomes of pediatric patients who have undergone lumbar microdiscectomy (LMD) because of the rarity of pediatric disc herniation and the short follow-up periods. The authors analyzed risk factors, clinical presentation, complications, and functional outcomes of a single-institution series of LMD patients over a 19-year period.METHODSA retrospective case series was conducted of pediatric LMD patients at a large pediatric academic hospital from 1998 to 2017. The authors examined premorbid risk factors, clinical presentation, physical examination findings, type and duration of conservative management, indications for surgical intervention, complications, and postoperative outcomes.RESULTSOver the 19-year study period, 199 patients underwent LMD at the authors’ institution. The mean age at presentation was 16.0 years (range 12–18 years), and 55.8% were female. Of these patients, 70.9% participated in competitive sports, and among those who did not play sports, 65.0% had a body mass index greater than 25 kg/m2. Prior to surgery, conservative management had failed in 98.0% of the patients. Only 3 patients (1.5%) presented with cauda equina syndrome requiring emergent microdiscectomy. Complications included 4 cases of postoperative CSF leak (2.0%), 1 case of a noted intraoperative CSF leak, and 3 cases of wound infection (1.5%). At the first postoperative follow-up appointment, minimal or no pain was reported by 93.3% of patients. The mean time to return to sports was 9.8 weeks. During a mean follow-up duration of 8.2 years, 72.9% of patients did not present again after routine postoperative appointments. The total risk of reoperation was a rate of 7.5% (3.5% of patients underwent reoperation for the same level; 4.5% underwent adjacent-level decompression, and one patient [0.5%] ultimately underwent a fusion).CONCLUSIONSMicrodiscectomy is a safe and effective treatment for long-term relief of pain and return to daily activities among pediatric patients with symptomatic lumbar disc disease in whom conservative management has failed.

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