scholarly journals Imperforate Hymen: A Comprehensive Systematic Review

2019 ◽  
Vol 8 (1) ◽  
pp. 56 ◽  
Author(s):  
Keum Lee ◽  
Ji Hong ◽  
Hyuk Jung ◽  
Hyun Jeong ◽  
Seo Moon ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Urinary Retention ◽  
Case Reports ◽  
Female Genital Tract ◽  
Case Series ◽  
Treatment Modalities ◽  
Vaginal Septum ◽  
Imperforate Hymen ◽  
Ascending Infection ◽  
Surgical Methods

Imperforate hymen (IH) is an uncommon congenital anomaly of the female genital tract, with the hymen completely obstructing the vaginal opening. Despite the simple diagnosis and treatment of IH, missed or delayed diagnosis is often a clinical problem owing to its low incidence, nonspecific symptoms, or insufficient physical examination. The aim of this study is to identify the characteristics, clinical presentations, treatment modalities, and outcomes of imperforate hymen patients. In this study, a literature search of PubMed databases was performed for sources published up to 3 July 2018 for English-language studies with the term “imperforate hymen”. The literature review identified 251 citations and 155 articles (143 case reports, 12 case series) containing 253 patients who were finally included (two papers were not written in English). Among 236 postnatal patients, the mean age of the patients was 10.7 ± 4.7 years. Abdominal pain (54.2%), urinary retention (20.3%), abnormal menstruation (14.0%), dysuria (9.7%), increased urinary frequency (5.1%), severe presentation of renal failure (n = 5, 2.1%), and urinary tract infection (n = 1, 0.4%) were presented. Most patients diagnosed with the condition underwent surgical treatment (83.5%), most of whom were treated via a hymenotomy (35.2%) and hymenectomy (36.4%), and the use of prophylactic antibiotics were only used in 7 patients. There were no differences in outcomes between two surgical methods. In addition, 141 (59.7%) patients showed improvement and 5 deceased patients were not related to IH or the operation itself; Complications, such as vaginal adhesion, were only noted in 6.6% of patients. In addition, among 17 cases of newborns with a diagnosis of IH before birth, hymenectomy (n = 5, 29.4%) and hymenotomy (n = 9, 52.9%) were the main treatment modalities and showed improved prognosis in 52.9% of newborns. Because IH diagnosis is easy and postsurgical prognosis is good, clinicians should carefully examine every female patient at birth. IH should be considered regarding adolescent girls with abdominal pain, lower back pain, or urinary retention, and perform appropriate physical examinations of the genital introitus. In addition, accurate diagnosis as IH, not misdiagnosing as vaginal septum or agenesis, is important to prevent severe complications such as stricture and ascending infection.

Imperforate hymen mimicking acute appendicitis in an adolescent woman: a rare presentation

2021 ◽  
Vol 14 (3) ◽  
pp. e238547
Author(s):  
Victoria Rose Russell ◽  
Mohamed Ibrahim ◽  
Georgina Phillips ◽  
Tom Setchell ◽  
Sanjay Purkayastha
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Iliac Fossa ◽  
Female Genital Tract ◽  
Delayed Diagnosis ◽  
Rare Presentation ◽  
Left Iliac Fossa ◽  
Imperforate Hymen ◽  
Retrograde Menstruation ◽  
Low Incidence

Imperforate hymen is a rare congenital malformation of the female genital tract. The condition poses several diagnostic challenges owing to its low incidence and often atypical presentation. Classical symptoms include amenorrhoea and cyclical abdominal pain. Delayed diagnosis leads to potentially irreversible and lifechanging sequelae including infertility, endometriosis and renal failure. A premenarchal 13-year-old girl with a background of chronic constipation presented with symptoms mimicking acute appendicitis. The underlying cause was imperforate hymen and retrograde menstruation. The diagnosis was made during diagnostic laparoscopy. As with this patient, pre-existing symptoms are often troublesome long before the true diagnosis is made. This case report highlights the importance of recognising imperforate hymen as a potential cause of acute abdominal pain in premenarchal adolescent girls. The clinical picture may present as right or left iliac fossa pain. Early identification reduces the risk of adverse complications and avoids unnecessary and potentially harmful interventions.

scholarly journals Acute Pancreatitis: An Atypical Presentation

2017 ◽  
Vol 11 (2) ◽  
pp. 359-363 ◽  
Author(s):  
Omar Nadhem ◽  
Omar Salh
Keyword(s):  
Acute Pancreatitis ◽  
Abdominal Pain ◽  
Case Reports ◽  
Case Series ◽  
Normal Serum ◽  
Intravenous Fluids ◽  
Serum Enzyme ◽  
Serum Lipase ◽  
Upper Abdominal ◽  
Symptoms And Signs

Acute pancreatitis is an important cause of acute upper abdominal pain. Because its clinical features are similar to a number of other acute illnesses, it is difficult to make a diagnosis only on the basis of symptoms and signs. The diagnosis of acute pancreatitis is based on 2 of the following 3 criteria: (1) abdominal pain consistent with pancreatitis, (2) serum lipase and/or amylase ≥3 times the upper limit of normal, and (3) characteristic findings from abdominal imaging. The sensitivity and specificity of lipase in diagnosing acute pancreatitis are undisputed. However, normal lipase level should not exclude a pancreatitis diagnosis. In patients with atypical pancreatitis presentation, imaging is needed. We experienced two cases of acute pancreatitis associated with normal serum enzyme levels. Both patients were diagnosed based on clinical and radiological evidence. They were successfully treated with intravenous fluids and analgesics with clinical and laboratory improvement. The importance of this case series is the unlikely presentation of acute pancreatitis. We believe that more research is needed to determine the exact proportion of acute pancreatitis patients who first present with normal serum lipase, since similar cases have been seen in case reports.

scholarly journals Retenção Urinária Como Manifestação de Hematocolpos

2020 ◽  
Vol 33 (13) ◽  
Author(s):  
Íris Santos Silva ◽  
Renata Martello ◽  
António Mendes ◽  
Albertino Chaves
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Case Report ◽  
Urinary Retention ◽  
Genital Tract ◽  
Rare Condition ◽  
Tanner Stage ◽  
Imperforate Hymen ◽  
Uncommon Condition ◽  
Rare Symptom

Hematocolpos is an obstruction of the menstrual flow due to an anomaly of the genital tract, with imperforate hymen being the most common one. It is an uncommon condition, with a prevalence of 1:1000 – 1:16 000. It is usually an asymptomatic condition until the onset of menarche, when there is accumulation of blood in the vagina (hematocolpos) or in the uterus (hematometra). A rare symptom of hematocolpos could be urinary retention. Our case report is about a 12-year-old girl, with no menarche and Tanner stage M4/P5, who was admitted to our emergency department with abdominal pain and urinary retention. A brief review of this rare condition is presented, in order to remind clinicians about its existence, so that it can be diagnosed and treated as quickly as possible.

scholarly journals Emergency Management of Paraphimosis

2003 ◽  
Vol 10 (4) ◽  
pp. 253-257 ◽  
Author(s):  
Ch Chung
Keyword(s):  
Case Reports ◽  
Data Extraction ◽  
Treatment Options ◽  
Case Series ◽  
Treatment Modalities ◽  
Invasive Treatment ◽  
Manual Search ◽  
Study Selection ◽  
Library Network ◽  
Randomised Controlled

Objective To review the treatment modalities available for paraphimosis, with special emphasis on those applicable to the emergency department. Data source Relevant medical literature was searched through MEDLINE, EMBASE, CINAHL, and Cochrane Database. Manual search was performed in books on Urology, General Surgery and Emergency Medicine available in the Hospital Library. Further information was obtained through the Internet at < www.infoseek.com >. References cited in articles were also retrieved. Study selection Key words for the literature, Internet and textbook search were ‘paraphimosis’ and ‘treatment’. All available years of study were reviewed. Data extraction Relevant full text articles were obtained through the hospital library network. Original articles, review papers, medical practice, case reports, and relevant book chapters were reviewed. Data synthesis There were no prospective, randomised, controlled studies available. The majority were case series and expert experience or opinions only. Currently, a multitude of non-invasive and invasive treatment options are available, including manual reduction, help of non-crushing tissue forceps, puncture technique and dorsal slit. Conclusion All treatment methods are within the capability of the emergency physician. Hospitalization should rarely be required, unless there are serious complications.

scholarly journals Efficacy of Ayurveda Interventions Specifically on Weight Gain in the Management of Protein Energy Malnutrition in Children: A Systematic Review Protocol

2021 ◽  
pp. 252-258
Author(s):  
Sumod Khedekar ◽  
Renu Rathi ◽  
Bharat Rathi ◽  
Heramb Hattikar ◽  
Suraj Patlekar ◽  
...  
Keyword(s):  
Systematic Review ◽  
Weight Gain ◽  
Case Reports ◽  
Protein Energy Malnutrition ◽  
Case Series ◽  
Clinical Work ◽  
Treatment Modalities ◽  
Public Health Issue ◽  
Future Research ◽  
Protein Energy

Background: In India, Protein Energy Malnutrition (PEM)remains a significant and challenging public health issue despite implementing different nutritional policies over the period. It is also accompanying with aggravated risk of all-cause morbidity, as well as fatality Ayurveda mentions about various nutritional disorders such as karshya, balashosha, phakka, yakshma which are having similar symptomatology and treatment approach as that of the PEM. Several clinical studies have been conducted and some are under trial but systematic review is still pending to explore an effective treatment modality to combat PEM in Children. Aim: A systematic review to evaluate the efficacy of Ayurveda Interventions specifically on weight gain in the Management of Protein Energy Malnutrition in Children. Materials and Methods: A systematic review which will evaluate published clinical work of Ayurveda treatment modalities specifically for weight gain in the management of PEM in children that will involve “The randomized controlled trials (RCTs), multiple-arms clinical trials, quasi-experimental trials, observational studies (case series and case reports) through databases like PubMed, COCHRANE, AYUSH Research Portal, DHARA; Google Scholar; etc. and Ayurveda compendia to fetch complete available literature.” Observations and Discussion: The work of selection of the studies, data extraction, and synthesis will be taken up. Established guidelines for study selection, quality assessment, and narrative synthesis will be followed. Risk of bias assessment will be performed. A protocol will be designed that will ensure transparency for the completed review. Results of the study will be elaborately synthesized. The data will be presented in percentage, count and frequency; and if we find the data to be sufficiently homogeneous then meta-analysis will be carried out. Conclusion: The results obtained from this systematic review will be useful in identifying the evidence-based efficacy of Ayurveda interventions on weight gain in the Management of PEM. It will also provide substratum for future research studies for generating good-quality evidence that can be helpful to design new health policy to combat PEM effectively.

Beyond the Guidelines: Treatment of Allergic Bronchopulmonary Aspergillosis in Cystic Fibrosis

2021 ◽  
pp. 106002802110220
Author(s):  
Madeline G. Tompkins ◽  
Rebecca Pettit
Keyword(s):  
Cystic Fibrosis ◽  
Clinical Practice ◽  
Alternative Treatment ◽  
Case Reports ◽  
Allergic Bronchopulmonary Aspergillosis ◽  
High Risk Patient ◽  
Case Series ◽  
Care Plan ◽  
Treatment Modalities ◽  
Treatment Approaches

Objective: To review the available literature addressing alternative allergic bronchopulmonary aspergillosis (ABPA) treatment options for patients with cystic fibrosis (CF). Data Sources: A literature search of PubMed was performed (January 2002 to April 2021) using the following search terms: allergic bronchopulmonary aspergillosis, aspergillus-related lung disease, cystic fibrosis. Manufacturer prescribing information, clinical practice guidelines, and data from ClinicalTrials.gov were incorporated in the reviewed data. Study Selection and Data Extraction: Relevant English-language studies or those conducted in humans were considered for inclusion. Data Synthesis: Available literature for alternative ABPA treatments in CF is lacking randomized controlled trials, but there is considerable support in case reports and case series describing the benefits in pediatric and adult patients. Recent literature has begun to explore the place in therapy for novel, corticosteroid-sparing treatment approaches. The alternative therapies summarized in this review all resulted in clinical improvement and subsequent discontinuation or dose reductions of oral corticosteroids, with minimal reported adverse drug effects. Relevance to Patient Care and Clinical Practice: Although corticosteroids are the cornerstone of ABPA management, the toxicities can be significant limitations in an already high-risk patient population. Patients may fail or become intolerant to guideline-recommended therapies and require alternative treatment approaches. Conclusions: Alternative treatment modalities for ABPA in patients with CF, including azole antifungals, pulsed intravenous glucocorticoids, omalizumab, mepolizumab, and inhaled amphotericin, appear to be efficacious and well tolerated. Pharmacological properties including route of administration, storage and stability, beyond use dating, and adverse effects of the various treatment modalities must be considered when selecting a practical care plan for patients.

scholarly journals Adult primary liver sarcoma: systematic review

2020 ◽  
Vol 47 ◽  
Author(s):  
ANTONIO CAVALCANTI DE ALBUQUERQUE MARTINS ◽  
DUÍLIO CABRAL DA COSTA NETO ◽  
JÚLIO DOURADO DE-MATOS E SILVA ◽  
YGOR MONTEIRO MORAES ◽  
CRISTIANO SOUZA LEÃO ◽  
...  
Keyword(s):  
Systematic Review ◽  
Prognostic Factors ◽  
Case Reports ◽  
Treatment Options ◽  
Case Series ◽  
Epithelioid Hemangioendothelioma ◽  
Treatment Modalities ◽  
R0 Resection ◽  
Rare Type ◽  
Degree Of Differentiation

ABSTRACT Introduction: primary liver sarcoma is a rare type of tumor, more common in children. Among adults, it represents a spectrum of neoplasms with reserved prognosis. There is no consensus on the treatment of choice of these lesions, justifying a systematic review of the literature on treatment options, prognostic factors, and survival. Material/Methods: a systematic review of articles published in Pubmed, Medline, LiLacs e SciElo, from 1966 to March/2019, presenting the keywords: primary-liver-sarcoma and primary-hepatic-sarcoma was undertaken. Studies including patients older than 18 years, and published in English, Portuguese and Spanish were included. Case reports, metastatic tumors and multiple oncologic diagnosis were excluded. The initial search listed 1,318 articles. 1,206 did not meet the inclusion criteria. After reviewing 112 eligible articles, 15 were selected (14 case series and 1 retrospective-cohort). Results: proposed treatment modalities for primary liver sarcoma included surgery and/or chemotherapy and/or radiotherapy or liver transplantation. The most common histological types were angiosarcoma (32%), leiomyosarcoma (29%), epithelioid hemangioendothelioma (15%) and embryonal sarcoma (7%). Histology, degree of differentiation and R0 resection were mentioned positive prognostic factors. Median survival ranged from two to 23 months. Five-year survival rate varied from 0% to 64%, on average 21%. Conclusion: surgical resection (R0 resection) is the main treatment for primary liver sarcomas. Development of effective systemic therapies are required to improve prognosis of patients harboring this type of tumor.

scholarly journals Clinical features, Diagnosis, and Treatment of COVID-19: A systematic review of case reports and case series

2020 ◽  
Author(s):  
Azin Tahvildari ◽  
Mahta Arbabi ◽  
Yeganeh Farsi ◽  
Parnian Jamshidi ◽  
Saba Hasanzadeh ◽  
...  
Keyword(s):  
Systematic Review ◽  
Case Reports ◽  
Antiviral Treatment ◽  
Surrogate Marker ◽  
Case Series ◽  
Neuraminidase Inhibitor ◽  
Hiv Protease ◽  
Treatment Modalities ◽  
Cochrane Library ◽  
Novel Coronavirus

AbstractObjectivesThe 2019 novel coronavirus (COVID-19) has been declared a public health emergency worldwide. The objective of this systematic review was to characterize the clinical, diagnostic, and treatment characteristics of patients presenting with COVID-19.MethodsWe conducted a structured search using PubMed/Medline, Embase, Web of Science and the Cochrane Library to collect both case reports and case series on COVID-19 published up to February 30, 2020.ResultsThirty-four articles were included analyzing a total of 99 patients with a mean age of 46.2 years. The most common presenting symptom in patients who tested positive for COVID-19 was fever, reported in up to 83% of patients from 76.4% of the analyzed studies. Other symptoms including rhinorrhea, dizziness, and chills were less frequently reported. Additionally, in studies which reported C-reactive protein (CRP) measurements (44%), a large majority of patients displayed an elevated CRP (73%). Progression to acute respiratory distress syndrome (ARDS) was the most common complication of patients testing positive for COVID-19 (33%). CT images displayed ground-glass opacification (GGO) patterns (80%) as well as bilateral lung involvement (71.0%). The most commonly used antiviral treatment modalities included, lopinavir (HIV protease inhibitor), arbidiol hydrochloride (influenza fusion inhibitor), and oseltamivir (neuraminidase inhibitor).ConclusionsDevelopment of ARDS may play a role in estimating disease progression and mortality risk. Early detection of elevations in serum CRP, combined with a clinical COVID-19 symptom presentation may be used as a surrogate marker for presence and severity of disease. There is a paucity of data surrounding the efficacy of treatments. There is currently not a well-established gold standard therapy for the treatment of diagnosed COVID-19. Further prospective investigations are necessary.

Buccal Mucosal Grafts: Novel Treatment for the Repair of Rectovaginal Fistulas A Study Protocol (Preprint)

2021 ◽  
Author(s):  
Dr. Caitlin Cahill ◽  
Natalia Kruger ◽  
Dr. John Heine
Keyword(s):  
Case Reports ◽  
Case Series ◽  
Treatment Modalities ◽  
Short Term ◽  
Patient Morbidity ◽  
Key Issues ◽  
Technical Details ◽  
Rectovaginal Fistulas ◽  
Prospective Case Series

BACKGROUND Rectovaginal fistulas (RVFs) are abnormal communications between the rectum/anus and the vagina. They are most frequently a result of obstetric injury and have deleterious impacts on patients’ quality of life. Despite several treatment modalities, RVFs remain difficult problems to manage, and many patients fail multiple attempts at surgical repair. Buccal mucosal grafts (BMGs) may be a solution to this problem. A BMG is oral mucosal tissue harvested from the inner cheek. There are two case reports that describe the successful use of BMGs in the repair of RVFs. OBJECTIVE Our objective is to validate these findings with a prospective case series, while also addressing key issues of indication, technical details, procedure safety, and short-term outcomes. METHODS Our objective is to validate these findings with a prospective case series, while also addressing key issues of indication, technical details, procedure safety, and short-term outcomes. RESULTS Two previous case reports have described the successful use of BMGs in the repair of RVFs. We have received ethics approval to attempt to validate these findings through a prospective case series. CONCLUSIONS Rectovaginal fistulas cause significant patient morbidity and are difficult problems to manage. Bolstered by the successful use of BMGs in urologic surgery and the previously published case reports demonstrating success in RVFs, we believe that BMGs may be a solution to RVFs.

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