摘要
Spontaneous intramural hematoma is a rare complication of oral anticoagulants, and its incidence is expected to increase because of the increasing number of elderly patients undergoing anticoagulant therapy. Clinical manifestations of spontaneous intramural hematoma vary from mild abdominal pain to intestinal obstruction or acute abdomen. Early diagnosis is important because most patients can be treated successfully without surgery. The role of endoscopy in the diagnosis of intramural hematoma is not well established because almost all cases are diagnosed non-invasively with computed tomography scans. However, confirmation of the intramural hematoma through direct visualization of the involved bowel mucosa is helpful, if the imaging diagnosis is uncertain. We report a case of anticoagulant-induced spontaneous intramural hematoma, which was diagnosed using endoscopy, with relevant literature review.
Subject(s)
Aged , Humans , Abdomen, Acute , Abdominal Pain , Anticoagulants , Diagnosis , Early Diagnosis , Endoscopy , Hematoma , Incidence , Intestinal Obstruction , Intestine, Small , Mucous Membrane摘要
An inflammatory myofibroblastic tumor (IMT) is a rare disease that can occur in a variety of locations, including the lung, orbit, parotid, pleura, and stomach. Despite multiple reports in various organs, a duodenal IMT is rare with limited case reports. We encountered a case of a 49-year-old male with a duodenal IMT. The patient underwent a laparoscopic wedge resection under the impression of a duodenal mesenchymal tumor, such as gastrointestinal stromal tumor, but the final diagnosis was a duodenal IMT. The patient was treated successfully with an oral nonsteroidal anti-inflammatory drug for the residual lesions. He was free of recurrence during the 12 month follow-up period.
Subject(s)
Humans , Male , Middle Aged , Diagnosis , Duodenum , Follow-Up Studies , Gastrointestinal Stromal Tumors , Lung , Myofibroblasts , Orbit , Pleura , Rare Diseases , Recurrence , Stomach摘要
Mucormycosis is a rare invasive disease with high mortality rates caused by fungi of the zygomycetes class and Mucorales order. Mucormycosis is manifested by a variety of clinical presentations according to the involved site and occurs in immunocompromised conditions such as diabetes mellitus and other conditions. Rhino-orbital-cerebral and pulmonary infection is known as commonly involved areas. Primary gastrointestinal mucormycosis is a very rare and life-threatening invasive fungal infection. Gastrointestinal mucormycosis may occur in any alimentary tract, with the stomach being most involved part. The early diagnosis and appropriate treatment including surgical debridement of involved tissues and antifungal agents is needed to improve survival rates. We report a case of gastric mucormycosis successfully treated with radical debridement and antifungal agents in a 45-year-old man with diabetic ketoacidosis.
Subject(s)
Humans , Middle Aged , Antifungal Agents , Debridement , Diabetes Mellitus , Diabetic Ketoacidosis , Early Diagnosis , Fungi , Mortality , Mucorales , Mucormycosis , Stomach , Stomach Ulcer , Survival Rate摘要
Sclerosing mesenteritis is a rare disease presenting as chronic inflammation and fibrosis of mesentery around the small and large intestine. And in most cases, it shows indolent and benign clinical course resulting in favorable prognosis. It is often diagnosed through characterized radiologic finding in abdominal examinations including computed tomography scan. However, it is important to rule out other conditions involving mesentery when diagnosing sclerosing mesenteritis. In the case of malignancy, the method of treatment and prognosis can be completely different therefore thorough examinations are essential. We herein report a 75-year-old male who suffered from frequent diarrhea and weight loss. Initially, he was diagnosed with sclerosing mesenteritis through abdominal computed tomography scan showing "misty" soft-tissue attenuation around the mesenteric vessel. However, follow up positron emission tomography scan and biopsy finding confirmed the common bile duct cancer with lymph node metastasis.
Subject(s)
Aged , Humans , Male , Biopsy , Cholangiocarcinoma , Common Bile Duct , Diarrhea , Fibrosis , Follow-Up Studies , Inflammation , Intestine, Large , Lymph Nodes , Mesentery , Methods , Neoplasm Metastasis , Panniculitis , Panniculitis, Peritoneal , Positron-Emission Tomography , Prognosis , Rare Diseases , Weight Loss摘要
Sclerosing mesenteritis is a rare disease presenting as chronic inflammation and fibrosis of mesentery around the small and large intestine. And in most cases, it shows indolent and benign clinical course resulting in favorable prognosis. It is often diagnosed through characterized radiologic finding in abdominal examinations including computed tomography scan. However, it is important to rule out other conditions involving mesentery when diagnosing sclerosing mesenteritis. In the case of malignancy, the method of treatment and prognosis can be completely different therefore thorough examinations are essential. We herein report a 75-year-old male who suffered from frequent diarrhea and weight loss. Initially, he was diagnosed with sclerosing mesenteritis through abdominal computed tomography scan showing "misty" soft-tissue attenuation around the mesenteric vessel. However, follow up positron emission tomography scan and biopsy finding confirmed the common bile duct cancer with lymph node metastasis.
Subject(s)
Aged , Humans , Male , Biopsy , Cholangiocarcinoma , Common Bile Duct , Diarrhea , Fibrosis , Follow-Up Studies , Inflammation , Intestine, Large , Lymph Nodes , Mesentery , Methods , Neoplasm Metastasis , Panniculitis , Panniculitis, Peritoneal , Positron-Emission Tomography , Prognosis , Rare Diseases , Weight Loss摘要
Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited renal disease. The main causes of death in ADPKD are cardiovascular disease as well as infections and neurological reasons. ADPKD is causing vasculopathy including aortic root dilation, cerebral artery aneurysm, coronary aneurysm, and aortic dissection. In this case report, we describe a 37-year-old female ADPKD patient with non-ST elevation MI (NSTEMI) caused by coronary artery focal spasm.
Subject(s)
Adult , Female , Humans , Aneurysm , Cardiovascular Diseases , Cause of Death , Cerebral Arteries , Coronary Aneurysm , Coronary Vessels , Myocardial Infarction , Polycystic Kidney, Autosomal Dominant , Spasm摘要
Acute abdominal pain as a common complaint in elderly patients may differ from that in younger patients. In elderly patients, the diagnostic accuracy of acute abdominal pain is lower compared to that in younger patients. On the other hand, the mortality in elderly patients with acute abdominal pain is far higher than that in the younger patients. Therefore, early and correct diagnosis of acute abdominal pain for the elderly patients could significantly influence the outcome. In this report, we describe a case of a 84-year-old man with a ruptured small bowel gastrointestinal stromal tumor who presented at the Emergency Department with acute abdominal pain. Laparotomy was performed because perforation of a tumor in the jejunum was found by computed tomography. Diagnosis was confirmed by histopathology and immunohistochemistry. Therefore, small bowel disease should be considered when exploring the cause of acute abdominal pain in elderly patients.
Subject(s)
Aged , Aged, 80 and over , Humans , Abdominal Pain , Diagnosis , Emergency Service, Hospital , Gastrointestinal Stromal Tumors , Hand , Immunohistochemistry , Jejunum , Laparotomy , Mortality摘要
OBJECTIVE: To identify the relationship between the location of motor points of gastrocnemius and soleus and the skin surface landmarks. METHOD: Compound muscle action potentials (CMAPs) of each lattice of gastrocnemius and soleus in 11 healthy subjects were recorded. Standardized reference lines were made as follows: 1) a horizontal reference line (popliteal crease) and 2) a vertical reference line drawn between mid-points of the horizontal reference line and inter-malleolus connection line. The CMAPs were mapped horizontally and vertically 1cm width to the standardized reference lines. Location of motor points was mapped to the skin surface in the ratio of length of the vertical and horizontal reference lines. RESULTS: The motor point of medial head of gastrocnemius was located at 41.0+/-6.1% distal and 54.6+/-19.2% medial to the mid-point of horizontal reference line. The location of the motor point of the lateral head of gastrocnemius was 35.7+/-5.2% distal and 48.5+/-15.1% lateral, respectively. In the soleus, the motor point was at 68.6+/-8.0% distal and 10.5+/-9.0% lateral, respectively. CONCLUSION: The motor point of the lateral head of gastrocnemius was located more proximally relative to medial head, and the motor point of soleus was located at slightly lateral side of the vertical reference line. The author concluded that mapping of motor points of the gastro-soleus muscles would increase accessibility in performing phenol motor point block or botulinum toxin injection for management of spasticity or abnormal tonicity of the ankle.
Subject(s)
Action Potentials , Ankle , Botulinum Toxins , Head , Muscle Spasticity , Muscle, Skeletal , Muscles , Phenol , Skin摘要
When recovery of specific reflexes after acute spinal cord injury are delayed or absent, we should consider an acute local complication or other factors that influence reflex function. We observed three spinal cord injury cases with a long-standing delayed plantar reflex and no evolution of Babinski sign despite enough recovery time had passed for the flexor spasm and all deep tendon reflexes of the lower extremities. In these cases we confirmed common peroneal nerve neuropathy at the fibular head by the nerve conduction study and electromyography. Long-standing delayed plantar reflex without evolution of Babinski sign, beyond expected recovery period, would be considered as a sign of local complication such as common peroneal nerve injury.
Subject(s)
Electromyography , Head , Lower Extremity , Neural Conduction , Peroneal Nerve , Reflex , Reflex, Babinski , Reflex, Stretch , Spasm , Spinal Cord Injuries , Spinal Cord摘要
OBJECTIVE: To investigate waveform changes of compound muscle action potentials (CMAPs) related to voluntary muscle contraction and alteration of muscle length and to evaluate the effect of peripheral neuropathy on temporal and spatial summations of CMAPs. METHOD: The influence of voluntary muscle contraction and alteration of muscle length on CMAP was studied in 37 median nerves of 21 patients with median neuropathy. RESULTS: In patients with no apparent axonopathy, temporal summation was partially disturbed without significant change of spatial summation. Shortening of muscle length or voluntary contraction produced a physiologic improvement of spatial and temporal summations. There was a decrease in temporal and spatial summations, more prominent in temporal summation, with lengthening of the muscle. In axonopathy, spatial summation was markedly deteriorated with partial reduction of temporal summation. Spatial summation was not affected by the change of muscle length or voluntary contraction. Temporal summation was improved by muscle shortening or voluntary contraction and was decreased by muscle lengthening. CONCLUSION: Peripheral neuropathy has an effects on physiological spatial and temporal summations of CMAPs. Temporal summation is preferentially decreased in cases without axonopathy. When axonopathy is apparent, spatial summation is profoundly disturbed with partial reduction of temporal summation.
Subject(s)
Humans , Action Potentials , Median Nerve , Median Neuropathy , Muscle Contraction , Muscle, Skeletal , Peripheral Nervous System Diseases摘要
OBJECTIVE: To determine whether cystometry performed by bladder filling stimulation using furosemide (DCMG) reveals different findings compared to conventional cystometry (CCMG) in the neurogenic bladder. METHOD: The maximum intravesical pressure (MPves) and compliance of the bladder in CCMG and DCMG were compared in 24 patients with neurogenic bladder after spinal cord injury. The MPves was estimated by urethral leak pressure or intravesical pressure at 600 ml filling. Compliance was calculated from the cystometric bladder capacity and the MPves. For CCMG, the bladder was filled with 32oC normal saline via 10 F urethral catheter at 50 ml/min until the patient leaked or filled 600 ml. Three hours later, 20 mg of furosemide was injected intravenously after intravenous infusion of 300 ml normal saline for DCMG. Ultrasound measuring of filled urine volume was made at least every 5 minutes until defined MPves. RESULTS: Significant differences were found between DCMG and CCMG in hyperreflexic neurogenic bladders with respect to: decrease in MPves (p0.05). CONCLUSION: We have found DCMG provides a more effective and near physiological diagnostic method of detrusor characteristics than CCMG in evaluating both genuine MPves and compliance in patients with hyperreflexic neurogenic bladder.
Subject(s)
Humans , Compliance , Diuretics , Furosemide , Infusions, Intravenous , Spinal Cord Injuries , Spinal Cord , Ultrasonography , Urinary Bladder , Urinary Bladder, Neurogenic , Urinary Catheters摘要
OBJECTIVE: To evaluate the effect of a transrectal probe on the opening of internal urethral sphincter. METHOD: Twenty-five patients with a neurogenic bladder dysfunction were included in this study. For the transrectal ultrasonography (TRUS), a transrectal probe was inserted into the rectum before the bladder was filled. Internal urethral sphincter opening was investigated during the filling and voiding phases. The bladder was emptied and the probe was introduced intrarectally after the bladder filling for the investigation of internal urethral sphincter opening. Twelve subjects underwent an additional cystometry for the recording of maximal intravesical pressure with and without transrectal probe. RESULTS: There was no significant difference in the sensitivity of TRUS for the opening of internal urethral sphincter with insertion of the probe before or after the bladder filling. There was no significant change of the maximal intravesical pressure with or without the probe in the rectum. CONCLUSION: The results demonstrate that transrectal probe for TRUS does not cause a reflex effect on the opening of internal urethral sphincter.