scholarly journals Aggressive Surgical Management of Spontaneous Intramuscular Haematomas in Patients with Cirrhosis is an Important Therapeutic Option

2019 ◽  
pp. 57-59
Keyword(s):  
Case Reports ◽  
Therapeutic Option ◽  
Case Series ◽  
Gastrointestinal Haemorrhage ◽  
Sporadic Case ◽  
Sudden Onset ◽  
Medical Complication ◽  
Life Threatening ◽  
Recent Case Report ◽  
Spontaneous Haemorrhage

One known medical complication in patients with cirrhosis of the liver is sudden onset gastrointestinal haemorrhage which is usually variceal in nature and can be life threatening [1]. On occasion spontaneous haemorrhage from varices in other locations may also occur [2]. In addition, episodes of either intraabdominal or intrapulmonary haemorrhage are also associated with poor clinical outcomes in cirrhotic patients [3,4]. In comparison relatively, few cases of spontaneous intramuscular haemorrhage in patients with cirrhosis have been reported up to now. This particular clinical entity has been predominantly the subject of sporadic case reports or case series. Apart from one small case series [5], the majority of the cases were summarised in a published review in 2015 [6]. Hence the most recent case report from Mongelli et al published recently in this journal [7], now becomes the 25th case. Keywords: Cirrhosis; Spontaneous; Haemorrhage; Intramuscular; Management; Surgery

scholarly journals COVID-19 in HIV: a Review of Published Case Reports

2020 ◽  
Vol 2 (12) ◽  
pp. 2647-2657
Author(s):  
Zoya Morani ◽  
Saumil Patel ◽  
Sudeshna Ghosh ◽  
Falah Abu Hassan ◽  
Shriya Doreswamy ◽  
...  
Keyword(s):  
Morbid Obesity ◽  
Web Of Science ◽  
Case Reports ◽  
Case Series ◽  
Hiv Patients ◽  
High Burden ◽  
Cardiovascular Comorbidities ◽  
Life Threatening ◽  
The Mean ◽  
Immunocompromised State

AbstractPatients with COVID-19 present with a myriad of comorbidities. An immunocompromised state like HIV in patients with COVID-19 can be life-threatening. We searched PubMed/Medline, Scopus, and Web of Science for case reports and case series about COVID-19 in HIV patients. We finally reviewed 20 case reports including cases of 43 patients with HIV and COVID-19. The mean age of 43 adult patients was 51.56 ± 27.56 years (range 24–76 years). Of these, 30 were male (69.77%), 11 were female (25.58%), and 2 were transgender (4.65%). A total of 25 patients (58.14%) were above 50 years of age. The most common cardiovascular comorbidities were hypertension and hyperlipidemia (48.8%), diabetes (20.93%), and morbid obesity (11.63%). Out of 43 HIV patients with COVID-19, 6 resulted in death (13.95%). All the patients who died were elderly above 50 years and required mechanical ventilation. HIV patients infected with COVID-19 had a high mortality rate. A high burden of pre-existing comorbidities and an advanced age in these patients make them prone to disease progression and worse outcomes.

scholarly journals Application of flow diverters in the treatment of aneurysms in the internal carotid artery bifurcation region

2020 ◽  
Vol 33 (4) ◽  
pp. 297-305
Author(s):  
Mostafa Mahmoud ◽  
Ahmed Farag ◽  
Mostafa Farid ◽  
Ahmed Elserwi ◽  
Amr Abdelsamad ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Case Reports ◽  
Therapeutic Option ◽  
Case Series ◽  
Flow Diversion ◽  
Occlusion Rate ◽  
Flow Diverters

Introduction The treatment of aneurysms in the internal carotid bifurcation region (ICABR), including aneurysms of the true internal carotid artery (ICA) terminus, those inclined on the proximal A1 or M1 segments or at the most distal pre-bifurcation (ICA) segment, is often challenging in microsurgical clipping and endovascular surgery. Few reports had discussed flow diversion as a therapeutic option for this group. Methods This was a retrospective study analysing flow diversion in treating ICABR aneurysms. Seven patients harbouring eight aneurysms in the ICABR were treated with flow diversion. Five aneurysms were inclined on the proximal A1 segment, and three were located at the most distal pre-bifurcation segment. Patients’ demographics, presentation, procedure technical description, angiographic and clinical follow-up were recorded. PubMed and Ovid MEDLINE were also reviewed for articles published in English, including case series or case reports, for ICABR aneurysms treated with flow diverters. Results All patients except one underwent angiographic follow-up. The Karman–Byrne occlusion scale was used to determine the occlusion rate. All six patients with documented angiographic follow-up had a class IV occlusion score. No permanent or transient neurological or non-neurological complications were encountered in this study. Conclusion Treating ICABR aneurysms using flow diversion is feasible, with a promising angiographic occlusion rate. Further studies are needed to analyse long-term clinical and angiographic results.

Clinical Toxicology of Yew Poisoning

2018 ◽  
Vol 52 (6) ◽  
pp. 591-599 ◽  
Author(s):  
Alexander W. Labossiere ◽  
Dennis F. Thompson
Keyword(s):  
English Language ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Case Reports ◽  
Data Extraction ◽  
Case Series ◽  
Therapeutic Interventions ◽  
Plant Materials ◽  
Search Terms ◽  
Life Threatening

Objectives: Yew plant materials contain highly toxic taxine alkaloids. Serious ingestions can result in life-threatening toxicity. The purpose of this article is to summarize the literature on the treatment of acute yew poisoning. Data Sources: PubMed (January 1946 to November 2017) was searched using the search terms “taxus/po”. EMBASE (1980 to November 2017) was searched using the search terms “taxus/to” and “yew.mp.” Web of Science (1945 to November 2017) was searched using the text words taxus, taxine, and yew. Study Selection and Data Extraction: Available English language articles involving case reports, epidemiology, treatment, and outcomes were included. Data Synthesis: Although not uncommon, unintentional yew poisoning rarely results in significant morbidity or mortality. A total of 26 case reports of yew poisoning were evaluated along with 4 case series articles (totaling 22 additional cases). Only 4 of the 48 total cases (8%) were accidental poisonings, the rest being deliberate ingestions. In 20 patients (42%), it resulted in fatalities. Severe, acute yew poisoning results in symptomatology largely resistant to pharmacotherapy intervention. Conclusions: Most nonintentional ingestions of yew plant constituents are asymptomatic and require little intervention. Severe poisoning can result in life-threatening cardiac toxicity and require aggressive supportive care. Therapeutic interventions, such as sodium bicarbonate, digoxin immune fab, and hemodialysis that have been utilized in case studies and case series in the literature have little proven benefit. Extracorporeal life support should be considered in severe yew poisoning.

scholarly journals Mucormycosis coinfection associated with global COVID-19: a case series from India

2021 ◽  
Vol 7 (5) ◽  
pp. 815
Author(s):  
Deepthi Satish ◽  
Divya Joy ◽  
Anita Ross ◽  
Balasubramanya .
Keyword(s):  
Fungal Infection ◽  
Fungal Infections ◽  
Case Reports ◽  
Case Series ◽  
Retrospective Case ◽  
High Dependency ◽  
Life Threatening ◽  
Immunocompromised Status ◽  
Retrospective Case Study

<p><strong> </strong></p><p class="abstract"><strong>Background: </strong>Mucormycosis is a life-threatening fungal infection that occurs in immunocompromised patients. There has been increasing number of mucormycosis cases during COVID-19 pandemic and also as post COVID-19 sequelae. Our study aimed at scrutinizing a possible coinfection of invasive mycoses and COVID-19 and also its management</p><p class="abstract"><strong>Methods: </strong>We did a retrospective case study of 25 patients presenting as invasive fungal infection from March -December 2020. Majority of patients were immunocompromised, since they presented during the pandemic, all patients were subjected to rapid antigen and RT -PCR testing for COVID-19.</p><p class="abstract"><strong>Results: </strong>11 patients tested COVID-19 positive out of 25. Diagnosis of mucormycosis was based on clinical features, culture, and histopathology from sinus biopsy. COVID-19 positive patients were managed in the high dependency units and COVID-19 wards. Severe COVID-19 positive patients were empirically started on IV Amphotericin based on clinical suspicion of mucormycosis and were taken up for debridement once stable. Negative patients underwent surgical debridement and were started on IV Amphotericin postoperatively.</p><p class="abstract"><strong>Conclusions: </strong>There have been lot of case reports from India showing COVID-19 recovered patients presenting with invasive fungal infections, this could be because of their immunocompromised status and long-term corticosteroid use. In our case series we had three patients with post COVID-19 mucormycosis. There was a surge in COVID-19 positive mucor cases during August and September which also coincided with the maximum peak of cases in India, thereafter, there has been a declining trend. There have been significant challenges in treatment modality and outcome due to the pandemic.</p>

scholarly journals Bilateral Adrenalectomy in Congenital Adrenal Hyperplasia: A Systematic Review and Meta-Analysis

2018 ◽  
Vol 103 (5) ◽  
pp. 1767-1778 ◽  
Author(s):  
Diana MacKay ◽  
Anna Nordenström ◽  
Henrik Falhammar
Keyword(s):  
Congenital Adrenal Hyperplasia ◽  
Cushing Syndrome ◽  
Case Reports ◽  
Therapeutic Option ◽  
Meta Analysis ◽  
Case Series ◽  
Adverse Outcomes ◽  
Bilateral Adrenalectomy ◽  
Adrenal Hyperplasia

Abstract Context Management of congenital adrenal hyperplasia (CAH) involves suppression of the hypothalamic–pituitary–adrenal axis using supraphysiological doses of exogenous glucocorticoids. This can pose a challenge, with Cushing syndrome a frequent complication of adequate suppression. Bilateral adrenalectomy, with subsequent replacement of glucocorticoids and mineralocorticoids at physiological doses, has been proposed as an alternative therapeutic strategy. Objective To review the outcomes after bilateral adrenalectomy for CAH. Data Sources A systematic search of PubMed/MEDLINE and Web of Science, identifying relevant reports published up to 10 January 2018. Study Selection Case reports or case series were included if they reported individual patient data from patients with CAH who had undergone bilateral adrenalectomy. Data Extraction Information regarding the following was extracted: first author, country, sex, age at adrenalectomy, year of adrenalectomy, diagnosis, molecular abnormality, pre- and postoperative biochemistry, pre- and postoperative medications, pre- and postoperative body mass index, indication for adrenalectomy, surgical technique, gross and microscopic adrenal characteristics, follow-up duration, and short- and long-term postoperative outcomes. Data Synthesis We identified 48 cases of bilateral adrenalectomy for CAH, with patients aged from 4 months to 56 years at surgery. The most common indication for surgery was the inability to control hyperandrogenism/virilization and/or Cushing syndrome (n = 30; 62%). Most patients (n = 34; 71%) reported symptomatic improvement postoperatively, with some cases of short-term (n = 5; 10%) and long-term (n = 13; 27%) adverse outcomes. Conclusions Bilateral adrenalectomy for CAH appears to be a reasonable therapeutic option for carefully selected patients who have had unsatisfactory outcomes with conventional medical management.

scholarly journals Lemierre’s Syndrome: A Thing of the Past?

2020 ◽  
Author(s):  
Nehal Dhaduk ◽  
Sudeepti Vedula ◽  
Aparna Govindan ◽  
Evelyne Kalyoussef
Keyword(s):  
Mortality Rate ◽  
Case Reports ◽  
Case Series ◽  
Lemierre’S Syndrome ◽  
Female Ratio ◽  
Clinical Presentations ◽  
Life Threatening ◽  
Lemierre's Syndrome ◽  
High Index Of Suspicion ◽  
Male To Female

Abstract Introduction: Lemierre’s syndrome (LS), infectious thrombophlebitis of the internal jugular vein, is a rare, life-threatening complication of oropharyngeal infections underrepresented in literature. We reviewed the etiology, clinical characteristics, treatment regiments and prognosis of LS in pediatric patients.Methods: PubMed and MEDLINE were searched from February 10, 2018 to July 28, 2018 for relevant studies. A systematic review was performed using the terms LS and pediatric case. Our criteria included reviews, case reports, and case series with patients under 18 years with a diagnosis of LS. Results: 70 cases of pediatric LS were identified. The male to female ratio was 1:1.7 with an average age of 10.7 years (5 weeks to 17 years). The most common initial clinical presentations were fever (90.0%), sore throat (38.6%), and neck pain or tenderness (35.7%), while the most frequent findings on physical exam were fever (31.4%) and neck involvement (28.6%). F. necrophorum was the predominant organism cultured (62.9%). Septic emboli were seen in 51.4% of cases with the lungs affected in 40 patients. Most commonly used treatments were antibiotics (91.4%) followed by anticoagulation (50.0%) and the overall mortality rate was 8.6%. The average time from initial presentation to diagnosis was 4.9 days. Conclusion: LS is a deadly condition with a staggering mortality rate despite the advent of antibiotic measures. Early identification and a high index of suspicion are necessary to prevent complications associated with LS. Despite its rarity it should remain on the differential for any patient with toxic signs and localized neck findings.

scholarly journals Different Manifestations of Rare Cases of Unruptured Sinus of Valsalva Aneurysm—Case Series and Literature Review

2018 ◽  
Vol 28 (03) ◽  
pp. 202-206 ◽  
Author(s):  
Bhagya Narayan Pandit ◽  
Siva Subramaniyan ◽  
Tarun Kumar ◽  
Richa Agrawal ◽  
Deepankar Vatsa
Keyword(s):  
Case Reports ◽  
Case Series ◽  
Individual Case ◽  
Sinus Of Valsalva ◽  
Aortic Sinus ◽  
Sinus Of Valsalva Aneurysm ◽  
Severe Aortic Regurgitation ◽  
First Case ◽  
Threatening Condition ◽  
Life Threatening

AbstractSinus of Valsalva aneurysm (SVA) is rare, and aneurysm of the left sinus of Valsalva is extremely rare cardiovascular disease. Clinical presentation can vary from mostly asymptomatic to catastrophic life-threatening emergency. We report four extremely rare cases of SVA with different manifestations of which one case involved left aortic sinus with large unruptured aneurysm causing severe mitral regurgitation (MR) and severe aortic regurgitation (AR). The second case aneurysm was from right sinus presented with trifascicular block with intermittent complete heart block (CHB). Third was a diagnosed case of unruptured right SVA and while awaiting for surgery he had sudden cardiac death (SCD) at home. Therefore, SVA can present from asymptomatic to life-threatening condition, such as SCD. To the best of our knowledge, there are individual case reports in literature, and this is the first case series of unruptured SVA in literature highlighting the rarity of this disease.

Long-term Efficacy of Rituximab Treatment in Thrombotic Thrombocytopenic Purpura

2011 ◽  
Vol 07 (02) ◽  
pp. 143
Author(s):  
Jens M Chemnitz ◽  
Michael Hallek ◽  
Christof Scheid ◽  
◽  
◽  
...  
Keyword(s):  
Plasma Exchange ◽  
Thrombotic Thrombocytopenic Purpura ◽  
Case Reports ◽  
Therapeutic Option ◽  
Case Series ◽  
Current Data ◽  
Thrombocytopenic Purpura ◽  
Long Term Follow Up

The use of therapeutic plasma exchange has reduced mortality rates in thrombotic thrombocytopenic purpura (TTP) from 90 to 10–20%. However, TTP is a potentially lethal disorder, and management of patients with TTP refractory to plasma exchange or frequently recurrent disease is difficult. In those cases, rituximab might be a therapeutic option, although current data are based primarily on case reports and smaller case series. While initial response rates to rituximab are reported to be high, long-term follow-up data of patients treated with rituximab are rare; however, it is important to estimate the safety and benefit of this treatment. In this article we focus on current experience with rituximab in the treatment of TTP, including recent results with long-term follow-up.

scholarly journals Spontaneous retroclival hematoma in pituitary apoplexy: case series

2015 ◽  
Vol 123 (3) ◽  
pp. 808-812 ◽  
Author(s):  
Avetis Azizyan ◽  
Joseph M. Miller ◽  
Ramzi I. Azzam ◽  
Marcel M. Maya ◽  
Pouyan Famini ◽  
...  
Keyword(s):  
Pituitary Apoplexy ◽  
Clinical Symptoms ◽  
Case Reports ◽  
Brain Mri ◽  
Cranial Nerves ◽  
Case Series ◽  
Visual Disturbance ◽  
Sudden Onset ◽  
Laboratory Findings ◽  
Presenting Symptoms

OBJECT Pituitary apoplexy is a rare and potentially life-threatening disorder that is most commonly characterized by a combination of sudden headache, visual disturbance, and hypothalamic/hormonal dysfunction. In many cases, there is hemorrhagic infarction of an underlying pituitary adenoma. The resulting clinical symptoms are due to compression of the remaining pituitary, cavernous sinuses, or cranial nerves. However, there are only 2 case reports in the literature describing spontaneous retroclival expansion of hemorrhage secondary to pituitary apoplexy. Ten cases of this entity with a review of the literature are presented here. METHODS This is a single-institution retrospective review of 2598 patients with sellar and parasellar masses during the 10-year period between 1999 and 2009. The pituitary and brain MRI and MRI studies were reviewed by 2 neuroradiologists for evidence of apoplexy, with particular attention given to retroclival extension. RESULTS Eighteen patients (13 men and 5 women; mean age 54 years) were identified with presenting symptoms of sudden onset of headache and ophthalmoplegia, and laboratory findings consistent with pituitary apoplexy. Ten of these patients (8 men and 2 women; mean age 55 years) had imaging findings consistent with retroclival hematoma. CONCLUSIONS Retroclival hemorrhage was seen in the majority of cases of pituitary apoplexy (56%), suggesting that it is more common than previously thought.

scholarly journals Fluid Extravasation in Shoulder Arthroscopic Surgery: A Systematic Review

2018 ◽  
Vol 6 (5) ◽  
pp. 232596711877161 ◽  
Author(s):  
Muzammil Memon ◽  
Jeffrey Kay ◽  
Arian Gholami ◽  
Nicole Simunovic ◽  
Olufemi R. Ayeni
Keyword(s):  
Systematic Review ◽  
Case Reports ◽  
Arthroscopic Surgery ◽  
Case Series ◽  
Respiratory Compromise ◽  
Level Of Evidence ◽  
Fluid Extravasation ◽  
Life Threatening ◽  
Life Threatening Complication ◽  
Meta Analyses

Background: Arthroscopic surgery of the shoulder joint has become increasingly more common given its advantages over open surgery; however, one rare but potentially life-threatening complication is fluid extravasation into the surrounding tissues, causing edema, respiratory compromise, abnormal results on laboratory blood tests, and possibly death. Currently, no systematic review exists that summarizes the existing clinical research on this topic. Purpose: To perform a systematic review on fluid extravasation as a complication of shoulder arthroscopic surgery, specifically assessing clinical presentation, risk factors, management, and outcomes. Study Design: Systematic review; Level of evidence, 4. Methods: Two reviewers independently searched 3 databases (PubMed, Ovid [MEDLINE], and Embase) from database inception until July 1, 2017. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist guided the reporting and data abstraction. The methodological quality of these studies was assessed using the Methodological Index for Non-Randomized Studies (MINORS) checklist. The results are presented in a narrative summary fashion using descriptive statistics including ranges and agreement statistics. Results: A total of 26 studies (20 case reports, 4 case series, and 2 prospective comparative studies) encompassing 205 patients (mean age, 50.8 years [range, 15-83 years]) were included. The most common signs of fluid extravasation included chest wall swelling (n = 86) and neck swelling (n = 116). In 32 patients, observation alone was sufficient. Other patients required airway intubation (n = 16), diuretics (n = 7), steroids (n = 1), and percutaneous drainage of fluid (n = 1). Clinical edema resolved after 2 to 48 hours, and patients were discharged 1 to 20 days postoperatively. Serious complications included transfer to the intensive care unit (n = 14), anterior interosseous nerve palsy (n = 4), rhabdomyolysis (n = 1), and death (n = 1). Conclusion: Fluid extravasation has the potential to be a life-threatening complication of shoulder arthroscopic surgery; however, it is most commonly managed nonoperatively, and symptoms typically resolve with no evidence of long-term complications. Intraoperative surgical decisions, such as minimizing the surgical time and volume of irrigation fluid used, may limit fluid extravasation, while careful intraoperative monitoring may facilitate prompt diagnosis and management to optimize patient outcomes.

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