Epigastric Discomfort
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Author(s):  
Bindu Challa ◽  
Keluo Yao ◽  
Patricia Allenby ◽  
Charles L. Hitchcock ◽  
Youri Ivanov ◽  
...  

Context.— Esophageal fistula formation is one of the most feared complications of radiofrequency catheter ablation. This procedure and its many variations, such as the “maze,” are becoming the mainstream treatment for atrial fibrillation owing to limitations of antiarrhythmic drugs. The incidence of this complication rate has been reported to be from 0.01% to 1%. Objective.— To delineate the importance of using the en bloc Letulle method of dissection for identifying esophageal fistulas for cases with a history of radiofrequency catheter ablation. Design.— Six autopsy cases with a history of radiofrequency catheter ablation for atrial fibrillation were selected from 1736 autopsies performed between 2009 and 2020. Results.— The initial presenting symptoms included neurologic symptoms, chest pains, epigastric discomfort, and sepsis. Transesophageal echocardiogram of 4 cases showed no evidence of thrombus or vegetation, however, 2 cases had evidence of atrial esophageal fistula. The autopsy findings included 5 atrial esophageal fistulas and 1 esophagopericardial fistula. Atrial esophageal fistulas were small and could be detected without difficulty when the en bloc Letulle technique was used and would have been easily missed by the Virchow method. The immediate causes of the deaths were myocardial ischemia, septic emboli to brain and heart, hypovolemic shock secondary to exsanguination, stroke, and coagulopathy. Conclusions.— To date, this is the largest collection of autopsy cases showing esophageal fistula associated with prior radiofrequency catheter ablation. The Letulle dissection method is preferable in this setting.


Author(s):  
Jo Ann Wong

Leptospirosis is a zoonotic infection caused by the pathogenic Leptospira interrogans. Humans acquire the infection either through direct contact with the urine of infected animals, commonly rats or indirect contact of contaminated water or soil. It is a rare cause of acute hepatitis in the UK with fewer than 100 reported cases a year and hence diagnosis is commonly delayed. A 51-year-old fit Caucasian gentleman was admitted with a one-week history of painless jaundice, dark urine and pale-coloured stools. This was associated with feeling unwell, anorexia, nausea and intermittent epigastric discomfort. He binges on alcohol on a weekend. He works as a telephone engineer which occasionally exposes him to sewage water. On clinical examination, he was icteric with mild right hypochondriac tenderness. Liver biopsy was performed and histologically it was suggestive of leptospirosis. He was started on a five-day course of intravenous ceftriaxone followed by two days course of oral doxycycline. His IgM leptospirosis result finally came back as positive. Due to the rarity of leptospirosis in the UK, the serological testing of leptospirosis is only performed in the Rare and Imported Pathogens Laboratory in Porton Down, Salisbury leading to a delay in getting the result. The patient underwent an invasive procedure which can be avoided if the leptospirosis serology was ordered early and result available quickly. Fortunately, the patient made a full recovery after two months. Leptospirosis should be considered in an individual with acute hepatitis and a history of exposure to sewage.International Journal of Human and Health Sciences Supplementary Issue-2: 2021 Page: S22


2021 ◽  
Vol 11 (5) ◽  
pp. 8-10
Author(s):  
Santreena Simon K ◽  
Serene Maria ◽  
Cyril Tom

Zidovudine is the oldest anti-retroviral agent that is in clinical use. It’s common adverse effects are headaches (42-62.5%), nausea (46-61%), anorexia (11-20%), vomiting (6-25%), anemia (1.1-29%), granulocytopenia (1.8-37%) and neutropenia (3%). This study is to increase awareness of Zidovudine induced pancytopenia. This is an observational type of case report of a 40 year old man with known complaints of HIV on anti-retroviral therapy since 8 years who came with complaints of easy fatigability since 1 year which was aggravated since 1 week, epigastric discomfort, constipation since 2 weeks, chest pain retrosternal in position which was radiating to both upper limbs, sweating, palpitations, decreased appetite since 1 week and cough with expectoration. He was given tablet ZLN (Zidovudine 300 mg + Lamivudine 150 mg + Nevirapine 200 mg) twice daily regularly for the past 8 years. His last CD4 count was 300 cell/mm3. He had pallor. His laboratory results were: hemoglobin (6.6 g/dL), TLC (2400/μL), platelets (18,000/μL), neutrophil (36%) and MCV (107.4fL). He was diagnosed with pancytopenia (dimorphic anemia + leucopenia + thrombocytopenia) and neuropathic pain. It was confirmed to be Zidovudine induced pancytopenia by objective analysis and Naranjo score suggesting “probable” interpretation. Pancytopenia improved after withholding Zidovudine along with Oxcarbazepine. Suggestion was made to change his anti-retroviral regimen once his counts improve.  Tenofovir + Lamivudine (or Emtricitabine) + Efavirenz is the preferred first line combination therapy according to latest WHO guidelines (2013 and 2015). In case Zidovudine is used in first line combination therapy (2009 WHO guidelines), physicians should monitor for its toxicity. A clinical pharmacist can help in such situations by creating awareness among prescribers regarding latest WHO and other recommended guidelines, checking whether the prescriptions follow these guidelines and also by monitoring patients for toxicities. Keywords: Zidovudine, Drug induced pancytopenia, Adverse drug reaction


2021 ◽  
Vol 59 (241) ◽  
pp. 910-912
Author(s):  
Barkadin Khan ◽  
Anjan Kumar Basnet

Cardiovascular disease, including ischemic heart disease, is one of the most common causes of death and disability in both sexes. The traditional concept of ischemic heart disease as a “man’s disease” is debunked. Yentl syndrome is used to describe the underdiagnosis of ischemic heart disease in females and its associated effects. This article reports a 48-year-old female presented to the emergency department with acute epigastric discomfort. Her initial diagnostic tests did not reveal any abnormalities, and she was discharged. Subsequently, after four days, she again visited the emergency department with chest pain, the evaluation of which furthermore revealed no abnormalities. However, we admitted her. After 40 hours of hospitalization, her evaluation revealed anterior wall ST elevation myocardial infarction, and she underwent emergent reperfusion via coronary catheterization. This combination of atypical signs and symptoms and chances of delayed manifestations in the diagnostic investigations provides evidence for a need for thorough assessment in a female with chest pain.


2021 ◽  
Vol 1 (2) ◽  
pp. 41-46
Author(s):  
Imelda Krisnasari ◽  
Sasmojo Widito ◽  
Ardian Rizal

Introduction: Ebstein’s anomaly is a rare abnormality of the heart associated with atrialization right ventricle and apical (downward) displacement of the tricuspid valve functional annulus. Twenty percents of patients with Ebstein’s anomaly accompanied with accessory pathway. The dilatation of atrium and aging process may develop atrial fibrillation (AF).Case Description: A 35 years old patient with recurrency palpitation, accompanied with dizziness and epigastric discomfort. He had history of taking propafenone 3 x 150 mg for long time while the palpitation recurrent. He was hospitalization due to propafenone could not suppress the palpitation. During monitor in hospital revealed haemodynamic stable with heart rate 160-180 beats/minute irregularly irregular. The electrocardiography showed atrial fibrillation with pre-excitation WPW syndrome. We performed electrical cardioversion 100 joule. Then the atrial fibrillation was convert to sinus rhythm with WPW pattern. The propafenone 3 x 150mg was continued. The patient was performed catheter radiofrequency ablation of the accessory pathway. Electrophysiology showed AV fusion at right anteroseptal pathway and preexcited atrial fibrillation with shortest RR interval 220 ms that converted by cardioversion. The ablation was successfully performed. Discussion: The accessory pathway is a complication of ebstein anomaly. Digoxin, beta-blockers, diltiazem, verapamil, and amiodarone are potentially harmful in pre-excited atrial fibrillation. Propafenone reduces fast inward potential by sodium channels, reduces spontaneous automaticity and prolongs the effective refractory periode so could be used in this case. Catheter ablation of accessory pathway in Ebstein anomaly with WPW syndrome was class I recommendation. In our case, the accessory pathway was successfully ablated.


2021 ◽  
Author(s):  
Wei Ge ◽  
Li-hua Shao ◽  
Hai-yan Gong ◽  
Gang Chen

Abstract Background: Lead poisoning is a rare but serious disease. The clinical manifestations of lead poisoning are various and nonspecific such as abdominal pain, headache, dizziness, nightmare, fatigue and so on. Rapid diagnosis of lead poisoning is challenging because it does not have special symptoms and the morbidity is very low.Case presentation: A 31-year-old woman presented with epigastric discomfort without any obvious cause. The patient was diagnosed with lead poisoning, as the blood levels of heavy metals were detected and the lead was 463.17ug/L, which was very high (normal value was less than 100 ug/L). The patient was treated with intravenous drip of calcium sodium edentate and got better. The patient achieved good recovery and there was no recurrence.Conclusion: Lead poisoning is a rare disease and easy to be misdiagnosed as acute abdomen disease when present with abdominal pain. Lead poisoning should be considered when common causes of abdominal pain are excluded, especially patients with anemia and abnormal liver function. The diagnosis of lead poisoning is mainly replied on the blood or urine lead concentrations. Then we should firstly cut off the contact with lead and use metal complexing agent to facilitate lead excretion.


Gastrointestinal Stromal Tumors account for 1% - 2% of all gastrointestinal (GI) tract tumors. Among GISTs, duodenal localization occurs in less than 5% and usually presents with upper GI bleeding. A 45-year-old man presented in the outpatient department with complaints of epigastric discomfort, intermittent melena and undocumented weight loss for the preceding 3 months. Initial upper GI endoscopy showed mild duodenitis and no other upper GI pathology. For unexplained symptoms, a CT Scan was performed which demonstrated a well-defined solid lesion along the second part of the duodenum. An endoscopic ultrasound (EUS)-guided biopsy of a subepithelial lesion at D2 was performed. Immunohistochemistry findings were suggestive of GIST. Wedge resection of the duodenal mass was done. Duodenal GIST should be considered as a differential in cases of GI bleeding when other differentials have been ruled out. Limited resection of duodenal GIST should be considered over pancreaticoduodenectomy, in case of small size tumors.


2020 ◽  
pp. flgastro-2020-101578
Author(s):  
Shigetsugu Takano ◽  
Akihiro Suzuki ◽  
Yoshio Masuya ◽  
Hiroshi Suzuki ◽  
Masayuki Ohtsuka

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Takeshi Okamoto ◽  
Koichi Takagi ◽  
Katsuyuki Fukuda

A 64-year-old Japanese man with no significant medical history presented with epigastric discomfort of 2-weeks’ duration. He was diagnosed with metastatic HER2-positive gastric cancer. Chemotherapy with capecitabine, oxaliplatin, and trastuzumab was initiated. During the eighth cycle, he suddenly complained of electric shock-like pain in both legs upon neck flexion, consistent with Lhermitte’s sign. Oxaliplatin was discontinued, and Lhermitte’s sign resolved after 3 months. Neurotoxicity is commonly observed in platinum-based chemotherapy, but Lhermitte’s sign is rare. This is the first report of oxaliplatin-induced Lhermitte’s sign in a gastric cancer patient.


Author(s):  
Giovana Ennis ◽  
Gabriela Venade ◽  
Joana Silva Marques ◽  
Paulo Batista ◽  
Ana Abreu Nunes ◽  
...  

The authors present the case of a 51-year-old woman with no history of surgical or traumatic injury or accident, who presented with right hypochondrium and epigastric discomfort, malaise, nausea, loss of appetite and episodes of dark urine and greenish stools. Initial laboratory work-up revealed elevated inflammatory markers including leucocytosis with left shift and C-reactive protein, and a slight elevation of gamma-glutamyltransferase and alkaline phosphatase, with no other significant alterations. Computed tomography (CT) showed intrathoracic acute cholecystitis with a large diaphragmatic hernia. A literature search revealed only one other case of acute cholecystitis complicated by intrathoracic gallbladder due to a non-traumatic diaphragmatic hernia. Symptoms are uncharacteristic and the absence of pain or fever, explained by the altered location of the gallbladder, makes the diagnosis a challenge.


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