scholarly journals Boerhaave syndrome: A rare cause of retrosternal pain

2020 ◽  
Vol 17 (2) ◽  
pp. 83-88
Author(s):  
Adna Kafedžić ◽  
Nedim Katica
Keyword(s):  
Chest Pain ◽  
Case Reports ◽  
Treatment Options ◽  
Acute Chest Pain ◽  
Rare Condition ◽  
Individual Case ◽  
Retrosternal Pain ◽  
Specialist Treatment ◽  
Boerhaave Syndrome ◽  
High Level

Acute chest pain is one of the biggest challenges in diagnostic and therapeutic terms due to a number of differential diagnostic options. Boerhaave syndrome is a rare condition, but at the same time one of the most lethal diseases of the gastrointestinal tract. For this reason, a high level of suspicion is required in patients with presenting retrosternal pain. Classic symptoms such as vomiting, chest pain, and subcutaneous emphysema may not always be present. The approach to the patient with Boerhaave syndrome is multidisciplinary. The patient needs urgent rehydration, antibiotic treatment and consultation with a surgery specialist. Treatment is based on the clinical picture of the patient, the location and size of the perforation, but the most important prognostic factor is the time of diagnosis. There are still no official guidelines for the treatment of this condition, and knowledge of treatment options is based on individual case reports from the literature.

scholarly journals Novel Blood Biomarkers for a Diagnostic Workup of Acute Aortic Dissection

Diagnostics ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 615
Author(s):  
Anja Forrer ◽  
Felix Schoenrath ◽  
Michael Torzewski ◽  
Jens Schmid ◽  
Urlich F. W. Franke ◽  
...  
Keyword(s):  
Chest Pain ◽  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Troponin T ◽  
Acute Chest Pain ◽  
Rare Condition ◽  
Interleukin 10 ◽  
Diagnostic Workup ◽  
Aortic Tissue ◽  
Plasminogen Activator Inhibitor 1

Acute aortic dissection (AAD) is a rare condition, but together with acute myocardial infarction (AMI) and pulmonary embolism (PE) it belongs to the most relevant and life-threatening causes of acute chest pain. Until now, there has been no specific blood test in the diagnostic workup of AAD. To identify clinically relevant biomarkers for AAD, we applied Proseek® Multiplex assays to plasma samples from patients with AAD, AMI, PE, thoracic aortic aneurysm (TAA), and non-cardiovascular chest pain (nonCVD). Subsequently, we validated top hits using conventional immunoassays and examined their expression in the aortic tissue. Interleukin 10 (IL-10) alone showed the best performance with a sensitivity of 55% and a specificity of 98% for AAD diagnosis. The combination of D-dimers, high-sensitive troponin T (hs-TnT), interleukin 6 (IL-6), and plasminogen activator inhibitor 1 (PAI1) correctly classified 75% of AAD cases, delivering a sensitivity of 83% and specificity of 95% for its diagnosis. Moreover, this model provided the correct classification of 77% of all analyzed cases. Our data suggest that IL-10 shows potential to be a rule-in biomarker for AAD. Moreover, the addition of PAI1 and IL-6 to hs-TnT and D-dimers may improve the discrimination of suspected AAD, AMI, and PE in patients presenting with acute chest pain.

scholarly journals Remdesivir for Early COVID-19 Treatment of High-Risk Individuals Prior to or at Early Disease Onset—Lessons Learned

Viruses ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 963
Author(s):  
Lars Dölken ◽  
August Stich ◽  
Christoph D. Spinner
Keyword(s):  
Clinical Trials ◽  
Clinical Efficacy ◽  
Case Reports ◽  
Antiviral Treatment ◽  
Treatment Options ◽  
Disease Onset ◽  
Antiviral Agent ◽  
Individual Case ◽  
Lessons Learned ◽  
Disease Stage

After more than one year of the COVID-19 pandemic, antiviral treatment options against SARS-CoV-2 are still severely limited. High hopes that had initially been placed on antiviral drugs like remdesivir have so far not been fulfilled. While individual case reports provide striking evidence for the clinical efficacy of remdesivir in the right clinical settings, major trials failed to demonstrate this. Here, we highlight and discuss the key findings of these studies and underlying reasons for their failure. We elaborate on how such shortcomings should be prevented in future clinical trials and pandemics. We suggest in conclusion that any novel antiviral agent that enters human trials should first be tested in a post-exposure setting to provide rapid and solid evidence for its clinical efficacy before initiating further time-consuming and costly clinical trials for more advanced disease. In the COVID-19 pandemic this might have established remdesivir early on as an efficient antiviral agent at a more suitable disease stage which would have saved many lives, in particular in large outbreaks within residential care homes.

scholarly journals Management of Acquired Bilateral Masseteric Hypertrophy-A Case Report

2015 ◽  
Vol 9 (2) ◽  
pp. 92-95
Author(s):  
S Yadav ◽  
V Dhupar ◽  
A Dhupar ◽  
F Akkara ◽  
HC Mittal
Keyword(s):  
Case Report ◽  
Masseter Muscle ◽  
Muscle Hypertrophy ◽  
Case Reports ◽  
Treatment Options ◽  
Young Male ◽  
Rare Condition ◽  
Mandibular Angle ◽  
Square Configuration ◽  
Prominent Mandibular Angle

ABSTRACT Masseter muscle hypertrophy is a rare condition of unknown cause, which is important due to growing cosmetic concern. A hypertrophied masseter may cause prominent mandibular angle, alter facial lines and characteristic square configuration of face, which may be unacceptable to the patient. Several treatment options reported for masseter hypertrophy, which range from conservative treatment options to invasive surgical procedure. The botulinum therapy offers good results but it's expensive and requires repeated injections with the chances of antibodies development. However, surgical treatment though invasive provides quick and permanent treatment for masseter muscle hypertrophy. The present case reports surgical management of young male patient with masseter hypertrophy due to cosmetic reasons.

Bibliometric Analysis of Hidradenitis Suppurativa Publication Trends from Asia and Australasia

2021 ◽  
pp. 1-4
Author(s):  
Devea R. De ◽  
Alyssa M. Thompson ◽  
Justine Seivright ◽  
Swetha Atluri ◽  
Amanda Ederle ◽  
...  
Keyword(s):  
Bibliometric Analysis ◽  
Hidradenitis Suppurativa ◽  
Case Reports ◽  
Treatment Options ◽  
Publication Trends ◽  
Level Of Evidence ◽  
Asian Patients ◽  
Pubmed Database ◽  
High Level ◽  
Study Type

<b><i>Introduction:</i></b> Hidradenitis suppurativa (HS), once an orphan disease, has gained increased interest world-wide. The most highly cited works in HS are from North America and Europe despite known phenotypic and epidemiological differences globally. Herein, we perform a bibliometric analysis to characterize HS publication trends in Asia and Australasia (AA) over the last decade. <b><i>Methods:</i></b> PubMed database was searched to identify HS-related articles and were analyzed for senior authorship, country of origin, article topic, and study design. <b><i>Results:</i></b> The search criteria yielded 163 articles from AA. Rapid increase in publications started in 2015 with 75% (123/163) of total articles published in the last half of the decade. Case reports/series were consistently the most published study type yearly and overall (49%, 80/163). Efforts were made to increase high level of evidence publications with both randomized controlled trials from Japan and Turkey including all Asian patients. China, Japan, and India were the leading publishing countries with Australia, Israel, and Turkey increasingly contributing in the last half of the decade. <b><i>Conclusions:</i></b> Advancements in HS research are encouraging with increases in publication numbers and diversity; however, more geographical diversity is needed in order to garner a better understanding of the disease and treatment options.

scholarly journals Primary Malignant Parotid Lymphoma: Two Case Reports with Different Disease Progression and Treatment

2011 ◽  
Vol 26 (1) ◽  
pp. 31-33
Author(s):  
Noor Dina Hashim ◽  
Mohd Razif Mohamad Yunus ◽  
Asma Abdullah ◽  
Marina Mat Baki ◽  
Salina Husain ◽  
...  
Keyword(s):  
Case Report ◽  
Malignant Lymphoma ◽  
Conservative Management ◽  
Case Reports ◽  
Treatment Options ◽  
Individual Case ◽  
The Other ◽  
Superficial Parotidectomy ◽  
Design Case ◽  
Management Approaches

  Objective: To describe our experience in managing two cases of primary malignant parotid lymphoma.   Methods: Design: Case Report Setting: Tertiary University Referral Center Patients: Two   Results: Both patients underwent superficial parotidectomy. Despite recurrence in one, the disease was controlled with conservative management. However, the disease was more aggressive in the other, requiring additional chemo-radiotherapy.   Conclusion: Malignant parotid lymphoma may present with varying stages, grades and clinical courses, requiring different management approaches. The treatment options are based on grading and staging at diagnosis and should be implemented depending on individual case.   Keywords: Parotid neoplasms, malignant lymphoma

scholarly journals Primary Aortoesophageal Fistula: Is a High Level of Suspicion Enough?

2020 ◽  
Author(s):  
Ana Sara Monteiro ◽  
Rute Martins ◽  
Catarina Martins da Cunha ◽  
Jorge Moleiro ◽  
Henrique Patrício
Keyword(s):  
Chest Pain ◽  
Emergency Room ◽  
Fatal Outcome ◽  
Rare Condition ◽  
Massive Bleeding ◽  
Aortoesophageal Fistula ◽  
Thoracic Pain ◽  
Ct Findings ◽  
High Level ◽  
Work Up

Aortoenteric fistula (AEF) is a rare condition with a high mortality rate. AEFs are classified according to their primary and secondary causes, the former being less frequent. Primary AEFs occur in a native aorta and their causes include aneurysms, foreign bodies, tumours, radiotherapy and infection. The classic triad of aortoesophageal fistulas, a subtype of AEFs, are mid-thoracic pain and sentinel haemorrhage, followed by massive bleeding after a symptom-free interval. We present the case of a 41-year-old male patient who presented in the emergency room after successive episodes of abundant haematemesis. He was hypovolemic, hypothermic and acidotic at presentation. His medical history included an emergency room visit the week before with chest pain but no relevant anomalies on work-up, active intravenous drug use and chronic hepatitis. Esophagogastroduodenoscopy (EGD) showed a bulging ulcerated lesion suspicious for aortoesophageal fistula, confirmed by computed tomography (CT) angiography, which revealed a saccular aortic aneurysm with a bleeding aortoesophageal fistula. The patient underwent urgent thoracic endovascular aortic repair. The sentinel chest pain, leucocytosis and CT findings hinted at the presence of a mycotic aneurysm, despite the negative blood cultures. It was most likely caused by a septic embolus due to the patient’s risk factors. While a high level of suspicion for aortoesophageal fistula is needed to prompt a fast diagnosis, EGD and CT findings were crucial to establish it and allow a life-saving intervention. We conclude that chest pain cannot be disregarded in a patient aged 41 years with multiple comorbidities, despite normal work-up, to prevent a fatal outcome.

scholarly journals Not Every Hot, Tender, Inflamed Joint is Infected (or Gout)!

2020 ◽  
Vol 2 (2) ◽  
pp. 1-5
Author(s):  
Etleva Bejko ◽  
◽  
Angela Gupta ◽  
Maya Mattar ◽  
◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Platelet Rich Plasma ◽  
Case Reports ◽  
Treatment Options ◽  
White Blood Cells ◽  
Rare Condition ◽  
Extracorporeal Shock Wave Therapy ◽  
Calcific Tendinitis ◽  
Extracorporeal Shock Wave ◽  
Acute Calcific Tendinitis

Calcific tendinitis is a rare condition that classically involves the rotator cuff. Only isolated case reports exist of the disease affecting other anatomical locations. Our case is noteworthy because it describes calcific tendinitis in an uncommon location; the flexor pollicis longus of the thumb. Calcific tendinitis has a prevalence of 3-10% in the general population, and is most commonly seen among women in their 4th to 6th decade of life. Calcific tendinitis is best diagnosed by imaging where plain radiography and ultrasound are both helpful for detecting calcifications. Blood tests are generally not used for making the diagnosis. However, elevated white blood cells and inflammatory markers (e.g. sedimentation rate and C-reactive protein) may be seen in the acute phase of calcific tendinitis, but are usually normal. Although the exact pathophysiology of calcific tendinitis is unknown. Calcific tendinitis condition is often self-limited and interventions (i.e. anti-inflammatory medications, analgesics, glucocorticoid injections, physical therapy) are used with a “try it and see” mindset. Other treatment options (extracorporeal shock wave therapy, therapeutic ultrasound, iontophoresis, platelet rich plasma) have been tried. Acute calcific tendinitis should be on the differential diagnosis for acute musculoskeletal pain—even pain that is not at the rotator cuff. This case demonstrates that pain that is associated with a tender, inflamed joint can be more than either infection or gout. It is important to recognize calcific tendinitis as a potential diagnosis, as this could prevent unnecessary interventions and therapy such as intravenous antibiotics.

Plasma Fibrinopeptide A and Beta-Thromboglobulin in Patients with Chest Pain

1983 ◽  
Vol 50 (02) ◽  
pp. 541-542 ◽  
Author(s):  
J T Douglas ◽  
G D O Lowe ◽  
C D Forbes ◽  
C R M Prentice
Keyword(s):  
Myocardial Infarction ◽  
Chest Pain ◽  
Unstable Angina ◽  
Plasma Levels ◽  
Thrombin Generation ◽  
Acute Chest Pain ◽  
Fibrinopeptide A ◽  
Control Hospital ◽  
Hospital Patients ◽  
Platelet Release

SummaryPlasma levels of β-thromboglobulin (BTG) and fibrinopeptide A (FPA), markers of platelet release and thrombin generation respectively, were measured in 48 patients within 3 days of admission to hospital for acute chest pain. Twenty-one patients had a confirmed myocardial infarction (MI); 15 had unstable angina without infarction; and 12 had chest pain due to noncardiac causes. FPA and BTG were also measured in 23 control hospital patients of similar age. Mean plasma BTG levels were not significantly different in the 4 groups. Mean plasma FPA levels were significantly higher in all 3 groups with acute chest pain when compared to the control subjects (p < 0.01), but there were no significant differences between the 3 groups. Increased FPA levels in patients with acute chest pain are not specific for myocardial infarction, nor for ischaemic chest pain.

Herpetic Whitlow of the Hand in Infants

2020 ◽  
Author(s):  
Mohammad M. Al-Qattan ◽  
Nada G. AlQadri ◽  
Ghada AlHayaza
Keyword(s):  
Bacterial Infection ◽  
Case Reports ◽  
Case Series ◽  
Individual Case ◽  
Senior Author ◽  
Secondary Bacterial Infection ◽  
Clinical Appearance ◽  
History Of ◽  
Mode Of Transmission ◽  
Time Of Presentation

Abstract Introduction Herpetic whitlows in infants are rare. Previous authors only reported individual case reports. We present a case series of six infants. Materials and Methods This is a retrospective study of six cases of herpetic whitlows in infants seen by the senior author (MMA) over the past 23 years (1995–2017 inclusive). The following data were collected: age, sex, digit involved in the hand, mode of transmission, time of presentation to the author, clinical appearance, presence of secondary bacterial infection, presence of other lesions outside the hand, method of diagnosis, treatment, and outcome. Results All six infants initially presented with classic multiple vesicles of the digital pulp. In all cases, there was a history of active herpes labialis in the mother. Incision and drainage or deroofing of the vesicles (for diagnostic purposes) resulted in secondary bacterial infection. Conclusion The current report is the first series in the literature on herpetic whitlows in infants. We stress on the mode of transmission (from the mother) and establishing the diagnosis clinically. In these cases, no need for obtaining viral cultures or polymerase chain reaction; and no medications are required. Once the vesicles are disrupted, secondary bacterial infection is frequent and a combination of oral acyclovir and intravenous antibiotics will be required.

Fournier's gangrene as Amyand's hernia complication

2019 ◽  
Vol 98 (7) ◽  
pp. 291-296
Keyword(s):  
Case Report ◽  
Case Reports ◽  
Rare Condition ◽  
Sporadic Case ◽  
Fournier’S Gangrene ◽  
Amyand’S Hernia ◽  
Fournier's Gangrene ◽  
Randomized Controlled Studies ◽  
Based Medicine ◽  
Hernia Complication

Introduction: Fournier’s gangrene is a rare but fast deteriorating and serious condition with high mortality. In most cases, it is characterized as necrotizing fasciitis of the perineum and external genitals. Amyand’s hernia is a rare condition where the appendix is contained in the sac of an inguinal hernia. Inflammatory alterations in the appendix account only for 0.1 % of the cases when Amyand’s hernia is verified. Fournier’s gangrene as a complication of a late diagnosis of appendicitis located in the inguinal canal is described in the literature as rare case reports. Case report: The case report of a 70-year-old patient with Fournier’s gangrene resulting from gangrenous appendicitis of Amyand’s hernia. Conclusion: Fournier’s gangrene as a complication of Amyand’s hernia is a rare condition. Only sporadic case reports thereof can be found in the literature. Because of the rarity of this pathology and the lack of randomized controlled studies, it is difficult to determine the optimal treatment according to the principles of evidence-based medicine. An appropriate approach for this condition appears to be the combination of guidelines developed in Amyand’s therapy according to Losanoff and Basson, along with the recommended “gold standard” therapy for Fournier’s gangrene. This means early and highly radical surgical debridement, adequate antibiotic therapy and intensive care.

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