RESUMO
Crossed renal ectopia is a rare congenital abnormality, in which the two kidneys are located in the same side. One of the ureters, whose length is adapted to the kidney seat, crosses the median line to implant in the bladder on the opposite side. Renal fusion of the two parenchymas is common and this abnormality is most often asymptomatic and fortuitously discovered. We report the case of a 36-year old patient with no previous pathological history, presenting with crossed renal ectopia incidentally discovered after acute cholecystitis complicated by perivescicular abscess. On the basis of this observation and of the data from the literature, we here discuss the etiopathogenic, clinical, radiological and therapeutic features of this malformation.
Assuntos
Colecistite Aguda/diagnóstico por imagem , Rim/anormalidades , Ureter/anormalidades , Abscesso/diagnóstico por imagem , Adulto , Humanos , Achados Incidentais , Rim/diagnóstico por imagem , Masculino , Ureter/diagnóstico por imagemRESUMO
Gastrointestinal stromal tumors (GISTs) are a rare group of mesenchymal tumors mainly occurring in the gastrointestinal tract. Previously, GISTs were classified as smooth muscle tumors also known as leiomyomas, leiomyosarcomas or leiomyoblastomas. However, since the advent of immunohistochemistry, GISTs have been diagnosed on the basis of the identification of c-kit-positive cells. We here report a case of stromal tumor of the small intestine in order to analyze it in the light of literature data and imaging results, which may suggest prebiopsy diagnosis as well as its therapeutic and prognostic peculiarities.
Assuntos
Tumores do Estroma Gastrointestinal/diagnóstico , Neoplasias Intestinais/diagnóstico , Intestino Delgado/patologia , Feminino , Tumores do Estroma Gastrointestinal/patologia , Humanos , Imuno-Histoquímica , Neoplasias Intestinais/patologia , Pessoa de Meia-Idade , Prognóstico , Proteínas Proto-Oncogênicas c-kit/análiseRESUMO
Spinal anesthesia (SA) is the first locoregional anesthesia. It can cause side effects and carry risks that need to be avoided, prevented or treated early. We here report the case of a female patient operated under spinal anesthesia who had intense headache associated with nausea and vomiting evolving in the context of fever within a few days after surgeryLumbar puncture showed cloudy liquid revealing Gram + cocci on direct examination. This allowed the diagnosis of bacterial meningitis. Patient's evolution was favorable after antibiotic therapy.
Assuntos
Raquianestesia/efeitos adversos , Infecções por Bactérias Gram-Positivas/etiologia , Meningites Bacterianas/etiologia , Raquianestesia/métodos , Antibacterianos/uso terapêutico , Feminino , Febre/etiologia , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Meningites Bacterianas/tratamento farmacológico , Meningites Bacterianas/microbiologia , Pessoa de Meia-Idade , Náusea/etiologia , Vômito/etiologiaRESUMO
Mirizzi's syndrome is a rare complication of chronic vesicular lithiasis with prevalence ranging from 0.7% to 1.4% among patients who have undergone cholecystectomy. It is characterized by cholestatic icterus associated with compression of the common bile duct due to lodged calculus in the vesicular neck or in the cystic duct. The disease can evolve toward the erosion through the common hepatic duct wall and, therefore, it can cause the formation of a gallbladder-biliary fistula. We here report a case of Mirizzi's syndrome type I in order to highlight the role of preoperative diagnosis which is made easier by endoscopic retrograde cholangiography or by cholangio-MRI, allowing to avoid iatrogenic bile duct injuries. We conducted a review of the available literature on various aspects of this syndrome, including its pathogenesis, diagnosis and management.
Assuntos
Colestase/diagnóstico , Ducto Colédoco/patologia , Síndrome de Mirizzi/diagnóstico , Colangiopancreatografia Retrógrada Endoscópica/métodos , Colestase/patologia , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Síndrome de Mirizzi/patologiaRESUMO
The objectives of this study are to describe prescribing practices, to evaluate their appropriateness and their compliance with guidelines and to examine their influencing factors. We conducted a cross-sectional study of antibiotic prescriptions data of 105 patients in the medical and surgical Emergency Department of the Military Hospital of Instruction Mohammed V in Rabat over a period of one month. Data were collected by means of a questionnaire including demographic and anamnestic data, patient's history, allergies, specific clinical examination data, paraclinical data, detailed antibiotic prescription. Collected data were then evaluated by a referring physician, who was responsible for detecting any treatment error. Among infections requiring the prescription of antibiotics, respiratory and urinary system diseases were at the forefront, the most commonly used antibiotic families were penicillins, quinolones and cephalosporins. 74 prescriptions (70.5%) were both pertinent and compliant versus 9 prescriptions (8.6%) justified but nonpertinent and 6 prescriptions (5.7%) which were considered unjustified by the referring physician due to absence of infection. The evaluation of the existing medical practice is rarely conducted in health facilities; with this in mind, our case study aims to improve appropriate antibiotic prescribing and to optimize its compliance with guidelines.
Assuntos
Antibacterianos/uso terapêutico , Fidelidade a Diretrizes , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/estatística & dados numéricos , Adulto , Antibacterianos/administração & dosagem , Estudos Transversais , Serviço Hospitalar de Emergência , Feminino , Hospitais Militares , Humanos , Prescrição Inadequada/prevenção & controle , Masculino , Pessoa de Meia-Idade , Marrocos , Padrões de Prática Médica/normasRESUMO
INTRODUCTION: Intranasal fentanyl provides rapid and powerful analgesia which is particularly interesting in patients without intravenous access. We propose to use it for analgesia in adults presenting renal colics. METHODS: A prospective study was conducted from the 2nd January to February 2013 in our emergency department. Patients aged up to 18 years old who presented with renal colic were included in this audit. Patients were excluded if they had loss of consciousness, cognitive impairment, acute or chronic nasal problems. A formal written consent was obtained from patients. The research team was alerted by medical and nursing staff. A member of the research team would check with medical or nursing staff whether administration of Intra nasal (IN) fentanyl was required. It was administered at a pre-calculated dose of 1.5 mg/kg and 50 mg/ml concentration was used. Data was prospectively collected by one of the researchers at various intervals during the patient's presentation and recorded on a pre-formatted data sheet. Pain scores were collected at 5, 15, 30, 45 and 60 minutes following IN fentanyl using a visual analogue scale pain. Observations routinely collected for patients receiving IV opiates and any adverse events were also recorded. RESULTS: 23 eligible patients were enrolled; median age was 51,3 years. 47,8% were women and the mean weight was 73 kg. Median dose of IN fentanyl was 106 µg. Two patients have required morphinic analgesia despite having received adapted dose of IN fentanyl. The initial pain scores before IN fentanyl were high with a median of 82,2 mm (59-100). Five minutes after IN fentanyl administration the median pain score dropped to 48 mm(36-63) and achieved the lowest score of 8mm(0-22) at 30 min. Pain scores were significantly lower at 5 min (P < 0.001) and at all subsequent time points (P < 0.001). No side effects were recorded. CONCLUSION: Intranasal fentanyl seems to be efficient for analgesia in adult patients with renal colic.
Assuntos
Analgésicos Opioides/administração & dosagem , Fentanila/administração & dosagem , Dor/tratamento farmacológico , Cólica Renal/tratamento farmacológico , Administração Intranasal , Adulto , Idoso , Analgésicos Opioides/uso terapêutico , Relação Dose-Resposta a Droga , Serviço Hospitalar de Emergência , Feminino , Fentanila/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Medição da Dor , Estudos ProspectivosAssuntos
Cateterismo Venoso Central/efeitos adversos , Enfisema Mediastínico/etiologia , Pneumoperitônio/etiologia , Pneumotórax/etiologia , Enfisema Subcutâneo/etiologia , Adulto , Feminino , Humanos , Veias Jugulares , Enfisema Mediastínico/diagnóstico por imagem , Pneumoperitônio/diagnóstico por imagem , Pneumotórax/diagnóstico por imagem , Radiografia , Enfisema Subcutâneo/diagnóstico por imagemAssuntos
Acidentes de Trânsito , Infarto/etiologia , Rim/irrigação sanguínea , Artéria Renal/lesões , Adulto , Humanos , Infarto/patologia , MasculinoAssuntos
Neoplasias do Colo/diagnóstico , Obstrução Intestinal/etiologia , Complicações Neoplásicas na Gravidez/diagnóstico , Doença Aguda , Adulto , Neoplasias do Colo/complicações , Neoplasias do Colo/patologia , Colostomia/métodos , Feminino , Humanos , Obstrução Intestinal/diagnóstico , Gravidez , Complicações Neoplásicas na Gravidez/patologia , Tocolíticos/administração & dosagemAssuntos
Imunocompetência , Meningoencefalite/patologia , Infecções Estreptocócicas/patologia , Streptococcus agalactiae , Idoso , Humanos , Masculino , Meningoencefalite/imunologia , Meningoencefalite/microbiologia , Infecções Estreptocócicas/imunologia , Infecções Estreptocócicas/microbiologia , Streptococcus agalactiae/isolamento & purificaçãoAssuntos
Acidentes Domésticos/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Acidentes Domésticos/mortalidade , Adolescente , Criança , Mortalidade da Criança , Pré-Escolar , Feminino , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Lactente , Masculino , Marrocos/epidemiologia , Índices de Gravidade do TraumaRESUMO
We report the observation of a septic arthritis of the knee complicated within first 36 hours by multiorgan failure including acute respiratory distress syndrome (ARDS), heart failure, acute renal failure and disseminated intravascular coagulation (DIC). A diagnosis of staphylococcal arthritis was suspected confirmed by direct examination, and culture showed a Staphylococcus aureus sensitive to methicillin. The sample sent to the National Reference Centre for Staphylococci (Lyon, France) for genetic analysis confirmed the isolate positive for the PVL gene expression. The fulminating evolution of a septic S. aureus arthritis in an otherwise healthy man should probably evoke the possibility of LPV strain. Anti-PLV antibiotics with anti-staphylococcal activity, such as clindamycin and linezolid should be started without waiting for typing of the S. aureus strain.