scholarly journals Round Table on Malignant Hyperthermia in Physically Active Populations: Meeting Proceedings

2017 ◽  
Vol 52 (4) ◽  
pp. 377-383 ◽  
Author(s):  
Yuri Hosokawa ◽  
Douglas J. Casa ◽  
Henry Rosenberg ◽  
John F. Capacchione ◽  
Emmanuel Sagui ◽  
...  
Keyword(s):  
Malignant Hyperthermia ◽  
Athletic Training ◽  
Task Force ◽  
Case Reports ◽  
Heat Stroke ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Round Table ◽  
Expert Consensus ◽  
Physically Active

Context:  Recent case reports on malignant hyperthermia (MH)-like syndrome in physically active populations indicate potential associations among MH, exertional heat stroke (EHS), and exertional rhabdomyolysis (ER). However, an expert consensus for clinicians working with these populations is lacking. Objective:  To provide current expert consensus on the (1) definition of MH; (2) history, etiology, and pathophysiology of MH; (3) epidemiology of MH; (4) association of MH with EHS and ER; (5) identification of an MH-like syndrome; (6) recommendations for acute management of an MH-like syndrome; (7) special considerations for physically active populations; and (8) future directions for research. Setting:  An interassociation task force was formed by experts in athletic training, exercise science, anesthesiology, and emergency medicine. The “Round Table on Malignant Hyperthermia in Physically Active Populations” was convened at the University of Connecticut, Storrs, September 17–18, 2015. Conclusions:  Clinicians should consider an MH-like syndrome when a diagnosis of EHS or ER cannot be fully explained by clinical signs and symptoms presented by a patient or when recurrent episodes of EHS or ER (or both) are unexplained. Further research is required to elucidate the genetic and pathophysiological links among MH, EHS, and ER.

scholarly journals Challenges in Management of Bartholin gland Leiomyoma: A Case Report

2020 ◽  
Author(s):  
Angela Vinturache ◽  
Lamiese Ismail ◽  
Stephen Damato ◽  
Hooman Soleymani Maid
Keyword(s):  
Case Report ◽  
Case Reports ◽  
Symptom Control ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Postoperative Recovery ◽  
Long Term Follow Up ◽  
Vulvar Mass

Abstract Background: Leiomyomas are uncommon vulvar neoplasms often misdiagnosed as other Bartholin gland pathology. Due to their rarity and the absence of guidelines, their diagnosis and management remain challenging, largely based on expert opinion and evidence from case reports. Case Presentation: This case report describes a 44-year-old woman presenting with accelerating growth of a vulvar mass. Based on clinical signs and symptoms, the initial diagnosis was Bartholin cyst. Surgical excision was provided for symptom control and aesthetic reasons. The histopathologic diagnosis was vulvar leiomyoma. The postoperative recovery was complicated by secondary haematoma and dehiscence of the surgical site. There was no recurrence at two years follow up. Therefore, we discuss the dilemma posed by physical examination of a vulvar mass, the challenges of the management, and report on secondary morbidity and long-term follow up, aspects of care for patients with vulvar pathology not commonly addressed in the literature. Conclusions: Bartholin gland neoplasms are rare tumors, commonly misdiagnosed as Bartholin’s cysts. Excision is the treatment of choice. Short time follow up allows prompt management of potential postoperative complications. Continuing long term follow up is recommended due to recurrence risk.

scholarly journals Primary hydatid cyst in the adductor magnus muscle

2020 ◽  
Vol 6 (3) ◽  
pp. 20200019
Author(s):  
Meltem Özdemir ◽  
Rasime Pelin Kavak ◽  
Nezih Kavak ◽  
Noyan Can Akdur
Keyword(s):  
Hydatid Cyst ◽  
Case Reports ◽  
Critical Role ◽  
False Negative ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
High Rate ◽  
Adductor Magnus ◽  
Primary Hydatid Cyst ◽  
Adductor Magnus Muscle

Human hydatid cyst is a zoonotic disease caused by the larvae of the Echinococcus species, most commonly the Echinococcus granulosus. Although hydatid cyst can cause disease almost anywhere in the human body, it most commonly affects the liver and lungs. Primary musculoskeletal hydatid involvement is a very rare occurrence even in endemic regions. Musculoskeletal hydatid disease shows no pathognomonic clinical signs and symptoms. And the contribution of serology to the diagnosis is negligible due to the high rate of false-negative results. Therefore, radiological imaging studies have a critical role in the diagnosis of the disease. To the best of our knowledge, there are only a few case reports of primary hydatid involvement of the adductor magnus muscle in the current literature. Here we present a 55-year-old female patient with primary hydatid cyst in the adductor magnus muscle and discuss the case in terms of imaging.

From Endodontic Therapy to Regenerative Endodontics: New Wine in Old Bottles

2020 ◽  
Vol 15 ◽  
Author(s):  
Ghee Seong Lim ◽  
Mang Chek Wey ◽  
Noor Hayati Azami ◽  
Nora Sakina Mohd Noor ◽  
May Nak Lau ◽  
...  
Keyword(s):  
Stem Cells ◽  
Root Canal ◽  
Case Reports ◽  
Clinical Signs ◽  
Mineral Trioxide Aggregate ◽  
Signs And Symptoms ◽  
Regenerative Endodontics ◽  
Immature Teeth ◽  
Clinical Signs And Symptoms ◽  
The 1960S

: The concept of regenerative endodontics wherein one can replace damaged pulp structures and recuperate the functionality in erstwhile necrotic and infected root canal systems has been a cutting-edge technology. Though the notion started as early as the 1960s even before the discovery of stem cells and regenerative medicine, it was in the 2000s, this procedure gained momentum. Ever since then, researchers continue to discover its essential benefit to immature teeth and its ability to overcome the caveats of endodontic therapy which is commonly known as root canal treatment. Further, through this therapy, one can redevelop root even in immature teeth with necrotic pulps which overall helps in maintaining skeletal and dental development. Past literature indicates that regenerative endodontic procedures seem to be successful especially when compared with other conventional techniques such as Mineral Trioxide Aggregate apexification. Besides, many clinicians have begun to apply regenerative endodontic procedures to mature teeth in adult patients with several clinical case reports that have shown complete resolution of signs and symptoms of pulp necrosis. Generally, three most desirable outcomes anticipated by clinicians from this procedure namely resolution of clinical signs and symptoms, root maturation and redevelopment of neurogenesis process. Despite this, whether these objectives and true regeneration of the pulp/dentin complex are achieved is still a question mark. Following the discovery that regenerative endodontics indeed is a stem cell-based treatment, addressing the fundamental issue surrounding stem cells might assist in achieving all identified clinical outcomes, while favoring tissue formation that closely resembles pulp-dentin complex.

Medically important trombiculids: a systematic review of the global distribution and clinical consequences of their bites

2021 ◽  
Vol 5 (2) ◽  
pp. 67-76
Author(s):  
Julián F. Porras-Villamil ◽  
Mario Javier-Olivera
Keyword(s):  
Systematic Review ◽  
Human Health ◽  
Case Reports ◽  
Clinical Signs ◽  
Case Series ◽  
Clinical Importance ◽  
Signs And Symptoms ◽  
Publication Date ◽  
Rickettsial Infections ◽  
Clinical Consequences

Background: Mites are among the smallest arthropods that can be seen without magnification, were the use of dermatoscopy is an invaluable tool. They are a cosmopolitan pest, and at the moment more than 250 species have been shown to produce problems for humans and animals alike. These mites are capable of producing a wide array of clinical signs and symptoms, from local to systemic, from mild to severe, as well as transmitting pathogens. This study aimed to provide an update to the clinical impact on human health, the distribution and species involved in the clinical conditions produced by trombiculids through a systematic review. Background: Mites are among the smallest arthropods that can be seen without magnification, were the use of dermatoscopy is an invaluable tool. They are a cosmopolitan pest, and at the moment more than 250 species have been shown to produce problems for humans and animals alike. These mites are capable of producing a wide array of clinical signs and symptoms, from local to systemic, from mild to severe, as well as transmitting pathogens. This study aimed to provide an update to the clinical impact on human health, the distribution and species involved in the clinical conditions produced by trombiculids through a systematic review. Methods: A systematic literature review was conducted in Medline, Lilacs, Redalyc, Scopus, SciELO and Google Scholar, were we use as a threshold of publication date the year 2008. We limited the search strategy to articles published in Portuguese, French, English and Spanish. Eligible studies were case reports and case series that reported outcomes in humans caused by trombiculid bites. Patient-level and study-level information was extracted. Results: The literature search yielded 832 studies; 13 were case reports, 4 case series and 2 descriptive studies reporting a total of 49 cases. Most patients were male, and the median age was 33.7±6.4 years old. The most frequently reported symptoms were local erythema, pruritus and papules. No deaths were documented. Trombiculids from the genera Trombicula, Eutrombicula and Leptotrombidium appear to be the most commonly reported. Discussion: Trombiculiasis is an infestation caused by the larval stage of various types of mites, known as chiggers, they belong to the class Arachnida and the family Trombiculidae. This systematic review provides an overview of the trombiculids of clinical importance, their distribution and effects of the bite on human health. Our results show that there are different species of mites that can have important consequences for human health. No fatal cases owere registered.Even so, the transmission of scrub typhus is important and remains one of the most life-threatening rickettsial infections in some regions of Asia. Conclusions: The bite of different species of trombiculids around the world can cause a wide array of clinical consequences to human health. Even as mortality appear to be nonexistent, trombiculid bites must be adequately diagnosed and treated properly: A systematic literature review was conducted in Medline, Lilacs, Redalyc, Scopus, SciELO and Google Scholar, were we use as a threshold of publication date the year 2008. We limited the search strategy to articles published in Portuguese, French, English and Spanish. Eligible studies were case reports and case series that reported outcomes in humans caused by trombiculid bites. Patient-level and study-level information was extracted. Results: The literature search yielded 832 studies; 13 were case reports, 4 case series and 2 descriptive studies reporting a total of 49 cases. Most patients were male, and the median age was 33.7±6.4 years old. The most frequently reported symptoms were local erythema, pruritus and papules. No deaths were documented. Trombiculids from the genera Trombicula, Eutrombicula and Leptotrombidium appear to be the most commonly reported. Discussion: Trombiculiasis is an infestation caused by the larval stage of various types of mites, known as chiggers, they belong to the class Arachnida and the family Trombiculidae. This systematic review provides an overview of the trombiculids of clinical importance, their distribution and effects of the bite on human health. Our results show that there are different species of mites that can have important consequences for human health. No fatal cases owere registered.Even so, the transmission of scrub typhus is important and remains one of the most life-threatening rickettsial infections in some regions of Asia. Conclusions: The bite of different species of trombiculids around the world can cause a wide array of clinical consequences to human health. Even as mortality appear to be nonexistent, trombiculid bites must be adequately diagnosed and treated properly.

Investigations on the Relationship Between the Autonomic Nervous System and the Triggering of Malignant Hyperthermia: A State-of-the-Science Review

2014 ◽  
Vol 32 (1) ◽  
pp. 135-154 ◽  
Author(s):  
Susan M. Perry
Keyword(s):  
Nervous System ◽  
Autonomic Nervous System ◽  
Malignant Hyperthermia ◽  
Case Reports ◽  
Signs And Symptoms ◽  
Autonomic Nervous ◽  
Anesthesia Providers ◽  
Malignant Hyperthermia Susceptible ◽  
Primary Disorder ◽  
State Of The Science

Early research in malignant hyperthermia (MH) focused on the autonomic nervous system (ANS) as a primary trigger of the syndrome. This hypothesis was based on the initial signs and symptoms of MH such as tachycardia, cardiac arrhythmias, hypertension, and signs of increased metabolism in patients who developed MH. Supporting these early links between MH and the ANS were case reports from anesthesia providers who reported that patients who subsequently developed MH after a nontriggering previous anesthetic had appeared unusually stressed prior to the surgical procedure in which they triggered. There is no disagreement in the scientific community that a primary disorder in MH lies in the inability to control myoplasmic calcium levels in skeletal muscles. However, considering the variability in genetic and clinical presentation, the timing of intraoperative triggering, and the unexplained phenomenon of nonanesthetic triggering, the identification of cofactors in MH triggering remains paramount. A careful review of existing research supports the hypothesis that the autonomic nervous system plays a significant role as a cofactor in the triggering and progression of an MH episode. If a differentiation can be made and a link can be demonstrated between abnormalities in receptor sensitivity for or release, reuptake, or metabolism of catecholamines in malignant hyperthermia susceptible individuals, we may be able to use these as additional markers/predictors of disease.

scholarly journals Malignant melanoma metastasis in the ileum: Two case reports

2020 ◽  
Vol 77 (3) ◽  
pp. 344-348
Author(s):  
Mirjana Zivojinov ◽  
Tanja Lakic ◽  
Jelena Ilic-Sabo ◽  
Sandra Trivunic-Dajko ◽  
Dejan Ivanov ◽  
...  
Keyword(s):  
Malignant Melanoma ◽  
Imaging Techniques ◽  
Case Reports ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Radical Resection ◽  
Skin Tumor ◽  
Depth Of Invasion ◽  
Melanoma Metastasis ◽  
Regional Lymph Nodes

Introduction. Malignant melanoma is a tumor that develops from melanocytes, so this type of tumor can occur in any part of body containing the cells. Melanoma is less common than other skin tumors. It is very aggressive type of skin tumor with very early metastases and accounts for 75% of cases of death due to skin tumor. In the initial phase the tumor growth is horizontal. Early detection of changes is very important. Over time, as the tumor gets the vertical growth phase, occurrence of metastases depends on the depth of invasion (Breslow). Malignant melanoma metastasizes to regional lymph nodes, but also in the liver, lung, brain and almost any place that can be populated by the haematogenous route. Case report. We reported two cases of patients who were urgently surgically treated in the Emergency Center of Vojvodina, Serbia, with the clinical signs and symptoms of ileus. In both cases, the ileum resection was performed with terminal ileostomy. Histological analysis was performed and through morphology and immunohistochemical profile, in both cases, the diagnosis was metastatic malignant melanoma in the ileum. Conclusion. In patients with diagnosed malignant melanoma of the skin with symptoms of abdominal pain and/or anemia, application of modern imaging techniques is imperative in order to obtain an early diagnosis of gastrointestinal metastases of this tumor, because the rapid detection and radical resection may contribute to the overall survival of these patients.

scholarly journals Presentation and management of N-acetylglutamate synthase deficiency: a review of the literature

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Aileen Kenneson ◽  
Rani H. Singh
Keyword(s):  
Current Knowledge ◽  
Case Reports ◽  
Management Strategies ◽  
Clinical Signs ◽  
Case Series ◽  
Signs And Symptoms ◽  
Protein Restriction ◽  
Therapeutic Trials ◽  
Acetylglutamate Synthase ◽  
Clinical Signs And Symptoms

Abstract Background N-Acetylglutamate synthase (NAGS) deficiency is an extremely rare autosomal recessive metabolic disorder affecting the urea cycle, leading to episodes of hyperammonemia which can cause significant morbidity and mortality. Since its recognition in 1981, NAGS deficiency has been treated with carbamylglutamate with or without other measures (nutritional, ammonia scavengers, dialytic, etc.). We conducted a systematic literature review of NAGS deficiency to summarize current knowledge around presentation and management. Methods Case reports and case series were identified using the Medline database, as well as references from other articles and a general internet search. Clinical data related to presentation and management were abstracted by two reviewers. Results In total, 98 cases of NAGS deficiency from 79 families, in 48 articles or abstracts were identified. Of these, 1 was diagnosed prenatally, 57 were neonatal cases, 34 were post-neonatal, and 6 did not specify age at presentation or were asymptomatic at diagnosis. Twenty-one cases had relevant family history. We summarize triggers of hyperammonemic episodes, diagnosis, clinical signs and symptoms, and management strategies. DNA testing is the preferred method of diagnosis, although therapeutic trials to assess response of ammonia levels to carbamylglutamate may also be helpful. Management usually consists of treatment with carbamylglutamate, although the reported maintenance dose varied across case reports. Protein restriction was sometimes used in conjunction with carbamylglutamate. Supplementation with citrulline, arginine, and sodium benzoate also were reported. Conclusions Presentation of NAGS deficiency varies by age and symptoms. In addition, both diagnosis and management have evolved over time and vary across clinics. Prompt recognition and appropriate treatment of NAGS deficiency with carbamylglutamate may improve outcomes of affected individuals. Further research is needed to assess the roles of protein restriction and supplements in the treatment of NAGS deficiency, especially during times of illness or lack of access to carbamylglutamate.

scholarly journals Early Detection of Age-Associated Cellular Decline: Report of an Expert Consensus

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 764-764
Author(s):  
Jack Guralnik ◽  
Matteo Cesari ◽  
Ariel Beresniak ◽  
Leocadio Rodriguez-Manas ◽  
Antonio Cherubini
Keyword(s):  
Clinical Signs ◽  
Signs And Symptoms ◽  
Expert Consensus ◽  
Study Group ◽  
Surrogate Markers ◽  
Cellular Processes ◽  
Age Related ◽  
Organ Specific ◽  
Clinical Signs And Symptoms ◽  
Initial Framework

Abstract Cellular processes often decline with age and cells lose their ability to function optimally, which may lead to organ-specific dysfunction and the development of systemic age-related diseases. The cellular hallmarks of aging are associated with clinical signs and symptoms and can be termed Age Associated Cellular Decline. An expert consensus study group was convened to provide an initial framework for the development of a tool for adults over 50 years old, which identifies self-reported symptoms and observable signs likely to be early and/or surrogate markers of age associated cellular decline. A total of 16 potential early signs and symptoms of age associated cellular decline were identified and need to be validated in further research.

scholarly journals Case reports of invasive mucormycosis associated neutropenic enterocolitis in leukemic children: diagnostic and treatment challenges and review of literature

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ali Amanati ◽  
Omid Reza Zekavat ◽  
Hamidreza Foroutan ◽  
Omidreza Azh ◽  
Ali Tadayon ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Fungal Infections ◽  
Case Reports ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Salvage Chemotherapy ◽  
Antimicrobial Treatment ◽  
High Morbidity ◽  
Disease Relapse ◽  
Neutropenic Enterocolitis

Abstract Background Bacterial enterocolitis is one of the most common neutropenic fever complications during intensive chemotherapy. Despite aggressive antibacterial treatments, this complication usually imposes high morbidity and mortality in cancer patients. Management of bacterial neutropenic enterocolitis are well known; however, management of fungal neutropenic enterocolitis may be more challenging and needs to be investigated. Prompt diagnosis and treatment may be life-saving, especially in patients at risk of mucormycosis-associated neutropenic enterocolitis. Case presentation We report two mucormycosis-associated neutropenic enterocolitis cases in pediatric leukemic patients receiving salvage chemotherapy for disease relapse. Both patients' clinical signs and symptoms differ from classical bacterial neutropenic enterocolitis. They were empirically treated as bacterial neutropenic enterocolitis with anti-gram-negative combination therapy. Despite broad-spectrum antimicrobial treatment, no clinical improvement was achieved, and both of them were complicated with severe abdominal pain necessitating surgical intervention. Mucormycosis is diagnosed by immunohistopathologic examination in multiple intraoperative intestinal tissue biopsies. Both patients died despite antifungal treatment with liposomal amphotericin-B and surgical intervention. Conclusion Mucormycosis-associated neutropenic enterocolitis is one of the most unfavorable and untreatable side effects of salvage chemotherapy in leukemic children with disease relapse. This report could be of considerable insight to the clinicians and scientists who counter the enigma of fungal infections during febrile neutropenia and help to understand better diagnosis and management.

Neuroleptic malignant syndrome: risk factors, pathophysiology, and treatment

2004 ◽  
Vol 16 (4) ◽  
pp. 219-228 ◽  
Author(s):  
Jambur Ananth ◽  
Kamala Aduri ◽  
Sharath Parameswaran ◽  
Sarath Gunatilake
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
Heat Stroke ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Active Phase ◽  
Initial Step ◽  
Antipsychotic Agents ◽  
Patient Treatment ◽  
Low Grade ◽  
Dopamine Receptor Antagonists

Neuroleptic malignant syndrome (NMS) is associated with the administration of antipsychotic agents and other drugs such as l-dopa, antidepressants, and antihistaminic agents. Unexpected changes in mental status, new-onset catatonia, episodic tachycardia, tachypnea, hypertension, dysarthria, dysphagia, diaphoresis, sialorrhea, incontinence, low-grade temperature elevations, and rigidity should arouse suspicion. Several lines of evidence provide support for the involvement of dopamine. Most of the drugs implicated in NMS are D2 dopamine receptor antagonists. Central noradrenergic activity is also possibly related to the disorder, as sympathetic hyperactivity is associated with the active phase of NMS. Currently, the definitive role of GABA deficiency in NMS is yet to be established. Differential diagnosis should include malignant hyperthermia, lethal catatonia, lithium toxicity, serotonin syndrome, and heat stroke. A high degree of suspicion and the discontinuation of antipsychotic agents even if the diagnosis is not established are essential for the safety of the patient. Treatment of NMS should be individualized and be based empirically on the character, duration, and severity of the clinical signs and symptoms noted. The initial step in the treatment of NMS is the removal of the offending agent. Full-blown NMS is a serious condition and requires immediate supportive, nutritive, and electrolyte therapies. The administration of drugs that can improve NMS, such as IV dantrolene and/or oral bromocriptine, may also be taken into consideration, based on the severity and nature of the NMS.

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