RESUMO
Atraumatic splenic rupture (ASR) is a rare but life-threatening condition. Several underlying pathologies have been associated with a splenic rupture in the absence of trauma, most often malignant-haematological disorders, viral infections or local inflammatory disorders. The management of ASR is similar to traumatic splenic rupture and includes early risk stratification of patients to determine those eligible for non-operative treatment versus those who need immediate surgical intervention. In this report, we discuss a rare case of a non-operatively managed ASR in an otherwise healthy young patient with SARS-CoV-2 as the likely aetiology. The multisystemic nature of the ongoing novel COVID-19 is evident, but not all manifestations are yet known. This case report underlines the challenge for physicians in terms of recognising and treating emergent complications of this new disease.
Assuntos
COVID-19 , Ruptura Esplênica , Humanos , COVID-19/complicações , SARS-CoV-2 , Ruptura Esplênica/diagnóstico por imagem , Ruptura Esplênica/etiologia , Ruptura Esplênica/cirurgia , Esplenectomia/efeitos adversos , Ruptura Espontânea/etiologiaRESUMO
INTRODUCTION: Computerised diagnostic decision support systems (CDDS) suggesting differential diagnoses to physicians aim to improve clinical reasoning and diagnostic quality. However, controlled clinical trials investigating their effectiveness and safety are absent and the consequences of its use in clinical practice are unknown. We aim to investigate the effect of CDDS use in the emergency department (ED) on diagnostic quality, workflow, resource consumption and patient outcomes. METHODS AND ANALYSIS: This is a multicentre, outcome assessor and patient-blinded, cluster-randomised, multiperiod crossover superiority trial. A validated differential diagnosis generator will be implemented in four EDs and randomly allocated to a sequence of six alternating intervention and control periods. During intervention periods, the treating ED physician will be asked to consult the CDDS at least once during diagnostic workup. During control periods, physicians will not have access to the CDDS and diagnostic workup will follow usual clinical care. Key inclusion criteria will be patients' presentation to the ED with either fever, abdominal pain, syncope or a non-specific complaint as chief complaint. The primary outcome is a binary diagnostic quality risk score composed of presence of an unscheduled medical care after discharge, change in diagnosis or death during time of follow-up or an unexpected upscale in care within 24 hours after hospital admission. Time of follow-up is 14 days. At least 1184 patients will be included. Secondary outcomes include length of hospital stay, diagnostics and data regarding CDDS usage, physicians' confidence calibration and diagnostic workflow. Statistical analysis will use general linear mixed modelling methods. ETHICS AND DISSEMINATION: Approved by the cantonal ethics committee of canton Berne (2022-D0002) and Swissmedic, the Swiss national regulatory authority on medical devices. Study results will be disseminated through peer-reviewed journals, open repositories and the network of investigators and the expert and patients advisory board. TRIAL REGISTRATION NUMBER: NCT05346523.
Assuntos
Hospitalização , Projetos de Pesquisa , Humanos , Estudos Cross-Over , Serviço Hospitalar de Emergência , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Multicêntricos como AssuntoRESUMO
Infectious mononucleosis is caused by Epstein.Barr virus (EBV) infection. Although typically self.limiting, complications such as splenic infarction and splenic rupture are described. A 17.year.old man presented in the emergency department due to a 3 days history of fever with chills, soreness, fatigue, and loose stool. Ultrasound examination showed a homoechogenic splenomegaly. Viral enteritis was diagnosed and the patient was dismissed. Six days later, he reassessed due to increasing left upper quadrant abdominal pain. Ultrasound showed inhomogeneous splenomegaly with irregular hypoechogenic subcapsular lesions. Contrast.enhanced ultrasound (CEUS) characterized the lesions as not perfused tissue until the late venous phase, compatible with spleen infarctions. Serologic studies were positive for EBV. In the literature, splenic infarction is considered under.recognized. Contrast.enhanced computed tomography (CECT) and magnetic resonance imaging are associated with costs and radiation (CECT). B.mode ultrasound examination is usually used as the first imaging modality, although showing a poor sensitivity in the question of splenic lesions/infarctions. CEUS has shown instead very good sensitivity and does not harm. Therefore, we recommend CEUS examination as the first imaging modality if suspicion of spleen infarction arises, especially when B.mode ultrasound is normal.
RESUMO
Injuries of the spleen in blunt abdominal trauma are common and can lead to fatal bleeding. The diagnostic of choice to determine severity and treatment is usually made in contrast-enhanced CT. In our case we used contrast-enhanced ultrasound to identify the origin of an intra-abdominal bleeding following a minor trauma in a patient with splenomegaly due to an Epstein-Barr virus infection.
Assuntos
Traumatismos Abdominais/complicações , Infecções por Vírus Epstein-Barr/complicações , Hemorragia/diagnóstico por imagem , Baço/diagnóstico por imagem , Esplenomegalia/etiologia , Ferimentos não Penetrantes/complicações , Traumatismos Abdominais/diagnóstico por imagem , Adolescente , Meios de Contraste , Hemorragia/dietoterapia , Hemorragia/etiologia , Humanos , Masculino , Baço/lesões , Esplenomegalia/diagnóstico por imagem , Resultado do Tratamento , Ferimentos não Penetrantes/diagnóstico por imagemRESUMO
It is known that itch is associated with psychological variables, but it is not known whether personality characteristics, depression or anxiety are predictors of experimentally induced itch in patients with atopic dermatitis (AD). In this study itch was induced in 27 patients with AD and 28 healthy controls by the presentation of an experimental video on crawling insects and skin diseases. Itch intensity was measured by self-ratings and by observing the number of scratch movements. Itch increase was determined by subtracting itch intensity induced by the experimental video from itch intensity induced by a control video. Psychological variables were assessed using validated questionnaires. In patients with AD, depression was a significant predictor of self-rated induced itch (corrected R2 = 0.175); while agreeableness and public self-consciousness were significant predictors of induced scratching (corrected R2 = 0.534). In healthy controls no associations were found. These results imply that a special group of patients with AD might benefit from certain psychological interventions.