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2.
Orv Hetil ; 162(3): 116-119, 2021 01 17.
Artigo em Húngaro | MEDLINE | ID: mdl-33459607

RESUMO

Összefoglaló. Egy 46 éves nobeteg esetét ismertetjük, akinél láz és görcsös hasi fájdalom miatt kezdodött kivizsgálás. A hasi ultrahangvizsgálat során a colon transversum területén megvastagodott falú konglomerátum volt látható. A kolonoszkópia során organikus eltérés nem igazolódott. A hasi komputertomográfiás vizsgálat retroperitonealis térfoglalást írt le, ezért onkológiai bizottság javaslata alapján mutét mellett döntöttünk. Egy hónappal a panaszok jelentkezése után megtörtént a mutét, melynek során úgy tunt, hogy egy megközelítoleg 5 × 8 centiméteres, a vékonybélbol kiinduló, a colon ascendenst és a sigmabelet is érinto, daganatnak imponáló terimét találtunk. Jobb oldali hemicolectomiát végeztünk, és reszekáltuk a sigmabélfal részletét. A szövettani vizsgálat malignitást nem igazolt, hanem a bélfallal összefüggést nem mutató, mesenterialis actinomycosist írt le. A hasi, mesenterialis actinomycosis ritka kórkép, mégis fontos, hogy gondoljunk rá mint differenciáldiagnosztikai lehetoségre, így a beteg a leheto leghamarabb megkaphatja a megfelelo kezelést. Esettanulmányunk bemutatásával a kórkép ismeretének fontosságára szeretnénk felhívni a figyelmet. Orv Hetil. 2021; 162(3): 116-119. Summary. We present the case of a 46-year-old female, who presented with fever and abdominal pain. Abdominal ultrasound revealed a thickened-walled conglomerate near the transvers colon. Colonoscopy did not show any organic abnormality. Abdominal computed tomography described a retroperitoneal mass, so we decided on surgery based on the multidisciplinary team decision. One month after the onset of symptoms, laparotomy was performed, and it seemed that we found an approximately 5 × 8 centimetre tumour attached to the small intestine involving the ascending and sigmoid colon. We performed right hemicolectomy and sigmoid colon wall resection. Histology result showed mesenteric actinomycosis with no connection to the intestinal wall, no malignancy was revealed. Although the abdominal, mesenteric actinomycosis is a rare disease, it is important to think of it as a differential diagnostic option, so the patient can get proper treatment and cured sooner. Our aim with presenting this case report is to highlight the significance of this disease. Orv Hetil. 2021; 162(3): 116-119.


Assuntos
Dor Abdominal/diagnóstico por imagem , Actinomicose/diagnóstico , Dor Abdominal/etiologia , Actinomicose/cirurgia , Colectomia , Feminino , Febre/etiologia , Humanos , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ultrassonografia
4.
Internist (Berl) ; 62(1): 3-16, 2021 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-33331949

RESUMO

Upper gastrointestinal symptoms are among the most common reasons for medical consultation and represent a challenge for general practitioners in the outpatient care setting. History taking, symptom evaluation and physical examination are the crucial steps toward establishing an initial working diagnosis. The subsequent abdominal ultrasound and laboratory analyses are essential tools for the differential diagnosis.


Assuntos
Dor Abdominal/diagnóstico por imagem , Medicina Interna , Atenção Primária à Saúde , Ultrassonografia/métodos , Dor Abdominal/etiologia , Diagnóstico Diferencial , Humanos , Exame Físico
5.
BMC Surg ; 20(1): 332, 2020 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-33317482

RESUMO

BACKGROUND: Benign foregut cysts usually develop in the thorax most of all in the mediastinum. Rare cases involving various abdominal organs, such as liver, stomach or pancreas have been previously published, mostly occurring in the retroperitoneum. CASE PRESENTATION: We herein present an adenocarcinoma of a foregut cyst involving the left side of the diaphragm, left lower lobe of the lung, and left lobe of the liver, successfully removed through multivisceral resection. In between drug holidays, postoperative oncological treatment has been ongoing for nearly 4 years. In terms of chemotherapy, FOLFOX 4 regime, capacitabine monotherapy and later on next generation sequencing has been attempted, although the patient refused the later treatment option. Despite multimodality (combined surgical and oncological) treatment, local- and later on loco-regional recurrence has been detected on follow-up staging, influencing further chemotherapy regime. Taking both the fairly unknown type of the tumor and uncertain response rate to oncological therapy into account, prolonged tumor pace with fairly stable general patient state was reached throughout the course of the disease. CONCLUSION: Through surgical tumor resection, and postoperative chemotherapy the patient managed to maintain an acceptable quality of life without major symptoms during ongoing treatment. During our own case, with multiple organ involvement, multivisceral resection, with multimodality treatment had considerable effect in prolonging the lifespan of the patient.


Assuntos
Dor Abdominal/etiologia , Adenocarcinoma/patologia , Cistos/patologia , Diafragma/patologia , Dor Abdominal/diagnóstico por imagem , Adenocarcinoma/cirurgia , Idoso , Biópsia por Agulha Fina , Cistos/diagnóstico por imagem , Diafragma/diagnóstico por imagem , Feminino , Humanos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Qualidade de Vida
7.
Einstein (Sao Paulo) ; 18: eRC5831, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33084795

RESUMO

The COVID-19 became a pandemic in early 2020. It was found, at first, that the main manifestations of this new virus occur through respiratory and constitutional symptoms. Therefore, chest tomography was elected as the best imaging test to assess the extent of pulmonary involvement and as a good prognostic predictor for the disease. However, as new studies were produced, the gastrointestinal involvement of COVID-19 becomes more evident, with reports from patients who manifested mainly or only gastrointestinal symptoms in the course of the disease. Thus, in some cases, the initial investigation is carried out at the emergency department with an abdominal computed tomography. We report a case series of ten patients who came to the emergency department of our institution with a chief gastrointestinal complaint, and were initially submitted to an abdominal computed tomography as the first investigation. Although most of the patients did not have significant changes in the abdominal images, most reported patients had pulmonary findings visualized at the lung bases, which were later designated as typical COVID-19 pulmonary findings on chest computed tomography. Only one patient had atypical COVID-19 lung changes on chest computed tomography. All patients had a positive real-time polymerase chain reaction for COVID-19. It is imperative to alert radiologists, especially abdominal radiologists, with the possibility of COVID-19 isolated gastrointestinal symptoms. Besides, it must become a habit to radiologists to assess the pulmonary basis on abdominal scans, a site commonly affected by the new coronavirus.


Assuntos
Dor Abdominal/diagnóstico por imagem , Infecções por Coronavirus/diagnóstico , Coronavirus/isolamento & purificação , Pulmão/diagnóstico por imagem , Pneumonia Viral/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Dor Abdominal/etiologia , Betacoronavirus , Técnicas de Laboratório Clínico , Coronavirus/genética , Humanos , Pandemias , Reação em Cadeia da Polimerase em Tempo Real
8.
Rev. cuba. cir ; 59(3): e961, jul.-set. 2020. tab, graf
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1144436

RESUMO

RESUMEN Introducción: La ultrasonografía es un procedimiento que utiliza ondas de sonido de alta energía para estudiar tejidos y órganos, formándose imágenes que permiten diagnosticar enfermedades. La eficacia en su implementación es útil para determinar acciones de intervención en procesos de salud. Objetivo: Determinar la eficacia del uso de la ultrasonografía asociada a características clínicas y epidemiológicas en pacientes con dolor abdominal agudo por apendicitis en el Centro Médico "Popular" Vinces. Métodos: Se realizó un estudio correlacional, descriptivo, de cohorte retrospectivo realizado durante 7 meses (enero a julio del 2019). La población estuvo constituida por 162 pacientes, se incluyó, además, a derivados con dolor abdominal agudo diagnosticados con apendicitis a través de la clínica y/o ultrasonografía del Centro Médico "Popular" Vinces. Resultados: De los 162 pacientes observados se intervinieron 157, diagnóstico anatomopatológico de apendicitis en 130. La sensibilidad de la ecografía con criterio de certeza y sospecha fue 96,7 por ciento. La muestra aleatoria piloto contenía 162 participantes de un total de 180 pacientes, mujeres (16,67 por ciento) y hombres (83,33 por ciento). Conclusiones: Se demostró que la ecografía abdominal es el método diagnóstico eficaz, de elección para este estudio por su sensibilidad y criterio de certeza, fácil acceso y costo mínimo, permitiéndose un control adecuado y seguimiento preventivo de las complicaciones, más aún en los casos, con cuadro clínico y laboratorio dudoso, con el fin de evitar posibles complicaciones y reducir los costos económicos durante su diagnóstico(AU)


ABSTRACT Introduction: This article is an extensive review of the different aspects of this pathology, acute appendicitis despite being the first cause of emergency abdominal surgery, the delay in diagnosis implies an increase in surgical interventions with perforated appendices and, therefore, an increase in morbidity and mortality. Objective: To present the results of the efficacy of the use of ultrasonography associated with clinical and epidemiological characteristics in patients with acute abdominal pain due to appendicitis at the "popular" Medical Center Vinces-Ecuador. Methods: A correlational, descriptive, Retrospective cohort study conducted for 7 months (January to July 2019), in which the study population included patients referred with acute abdominal pain diagnosed with appendicitis through the clinic and / or ultrasonography of the "popular" Vinces Medical Center, Ecuador. This population is constituted by 162 patients. Results: Of the 162 patients observed, 157 underwent surgery, an anatomopathological diagnosis of appendicitis in 130. The sensitivity of the ultrasound with criteria of certainty and suspicion was 96.7 percent. The pilot random sample contained 162 participants out of a total of 180 patients, women (16.67 percent) and men (83, 33 percent). Conclusion: it was shown that abdominal ultrasound is the effective diagnostic method of choice for this study because of its sensitivity and certainty, easy access and minimal cost, allowing adequate control and preventive monitoring of complications, even more so in cases, with symptoms. clinical and laboratory doubtful, in order to avoid possible complications and reduce economic costs during diagnosis(AU)


Assuntos
Humanos , Masculino , Feminino , Apendicite/diagnóstico , Dor Abdominal/diagnóstico por imagem , Epidemiologia Descritiva , Estudos Retrospectivos , Estudos de Coortes
14.
Praxis (Bern 1994) ; 109(8): 652-657, 2020.
Artigo em Alemão | MEDLINE | ID: mdl-32517594

RESUMO

CME Sonography 91: Differential Diagnosis of Lower Abdominal Pain Abstract. Pain in the lower abdomen is a frequent reason for further imaging clarification by sonography. The most frequent causes are appendicitis and diverticulitis, in addition to ureteral stones, ovarian and tubal pathology as well as various hernias. Appendicitis has a characteristic clinical presentation and can be diagnosed by CT or ultrasound. In children, the differential diagnosis is that of mesenteric lymphadenitis. Diverticulitis, often right-sided, can also be reliably diagnosed with CT or ultrasound. Not to be forgotten is the left-sided diverticulitis, which occurs more frequently in Asian persons. Appendicitis epiploica should be recognized to avoid unnecessary operations. The iliopsoas syndrome, which is diagnosed by sonopalpation, often remains undetected.


Assuntos
Dor Abdominal , Apendicite , Diverticulite , Dor Abdominal/diagnóstico por imagem , Apendicite/diagnóstico por imagem , Criança , Diagnóstico Diferencial , Diverticulite/diagnóstico por imagem , Humanos , Ultrassonografia
15.
Hipertens. riesgo vasc ; 37(2): 86-90, abr.-jun. 2020. ilus, graf, tab
Artigo em Espanhol | IBECS | ID: ibc-189197

RESUMO

El infarto renal bilateral como complicación de la displasia fibromuscular (DFM) es extremadamente raro, y hasta el momento se han informado pocos casos. Reportamos el caso de un hombre de 44 años que presentó dolor abdominal e hipertensión severa. La tomografía computarizada de abdomen reveló infarto renal bilateral, y una angiografía renal confirmó la estenosis bilateral e irregular debida a DFM, en ausencia de vasculitis sistémica y otros factores de riesgo para eventos tromboembólicos. Por lo tanto, se realizó una angioplastia con balón para obtener una buena permeabilidad del vaso y mejorar la permeabilidad en el seguimiento a largo plazo. Después del tratamiento endovascular la presión arterial mejoró notablemente, manteniendo este resultado a los 3 meses de seguimiento. Nuestro caso destaca la importancia de reconocer el infarto renal como una presentación inicial de la DFM


Bilateral renal infarction complicating Fibromuscular Dysplasia (FMD) is extremely rare and has so far been reported only in a handful of cases. We report a 44-year-old man who presented with complaints of abdominal pain and severe hypertension. Computed tomography of the abdomen revealed bilateral renal infarction and a renal angiography confirmed the bilateral and irregular stenosis due to FMD, in the absence of systemic vasculitis and other risk factors for thromboembolic events. Therefore, angioplasty with balloon was performed in order to obtain a good vessel patency and to improve patency in the long term follow-up. After the endovascular treatment the blood pressure improved markedly, maintaining this result at 3-months follow-up. Our case highlight the importance of recognizing renal infarction as an initial presentation of FMD


Assuntos
Humanos , Masculino , Adulto , Infarto/etiologia , Displasia Fibromuscular/complicações , Hipertensão Renovascular/etiologia , Obstrução da Artéria Renal/etiologia , Infarto/diagnóstico , Artéria Renal/diagnóstico por imagem , Infarto/diagnóstico por imagem , Dor Abdominal/diagnóstico por imagem , Dor Abdominal/etiologia , Radiografia Torácica , Anti-Hipertensivos/uso terapêutico , Valsartana/uso terapêutico , Angiografia
16.
Pediatrics ; 145(6)2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32385133

RESUMO

OBJECTIVES: To characterize the clinical manifestations, outcomes, and complications of hijab pin ingestion in adolescents and to identify risk factors for a need for intervention. METHODS: A retrospective review of patients <25 years of age who presented to our emergency department because of hijab pin ingestion between 2007 and 2018. Comparison was performed between impaled and nonimpaled pins. RESULTS: We reviewed 1558 foreign-body ingestion cases. Of these, 208 (13.3%) patients presented because of hijab pin ingestion, with a total of 225 ingested pins. The mean patient age was 14.7 ± 4.1 years, and 88% of patients were girls. Time from ingestion to presentation was 24 ± 49.5 hours. Most pins were located in the stomach (46.6%), and 18.6% of all pins were impaled. Location in the stomach (odds ratio = 4.3 [95% confidence interval: 1.9-9.2]; P < .001) and abdominal tenderness on examination (odds ratio = 2.7 [95% confidence interval: 1.3-5.6]; P = .007) were strong independent risk factors for an impaled pin. Time to intervention was 22.9 hours, and 41 endoscopies were performed. One patient required laparoscopic surgery. No complications were observed. CONCLUSIONS: The hijab pin is an increasingly encountered foreign body in pediatric practice. Its specific clinical features distinguish it from other sharp objects. A delayed interventional approach in selected patients does not carry a higher risk of complications and results in significantly fewer interventions compared to existing guidelines. These findings will help guide pediatric specialists in this prevalent clinical scenario. Management recommendations are proposed.


Assuntos
Tratamento Conservador/tendências , Ingestão de Alimentos/fisiologia , Serviço Hospitalar de Emergência/tendências , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/terapia , Dor Abdominal/diagnóstico por imagem , Dor Abdominal/etiologia , Dor Abdominal/terapia , Adolescente , Adulto , Criança , Pré-Escolar , Tratamento Conservador/métodos , Feminino , Corpos Estranhos/complicações , Humanos , Lactente , Recém-Nascido , Masculino , Adulto Jovem
17.
Intern Med ; 59(10): 1257-1265, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32418953

RESUMO

Objective Acute abdominal pain (AAP) of diverse etiology is a common chief complaint of patients who present to the emergency department (ED). AAP may pose a diagnostic challenge to physicians in training. We aimed to evaluate whether or not resident trainee doctors examine patients presenting with AAP in a Japanese acute-care hospital following Kendall's diagnostic algorithm. Methods We conducted a retrospective medical chart review from January 2015 to December 2016. Patients Patients ≥50 years old who presented to the ED within 7 days of the onset of AAP who were evaluated by residents at the ED of an acute care hospital were enrolled in this study. Patients transported by ambulance and referred from other hospitals and classified as level 1 or 2 according to the Japanese version of the Canadian Triage and Acuity Scale were excluded. Data, including the clinical history, location and character of pain, and age and gender of patients as well as the level of experience of residents, were abstracted from charts. We evaluated the concordance rate between the actual diagnostic process followed by residents and Kendall's diagnostic algorithm for AAP. Results We analyzed 466 patients (mean age 67.6 years) in the study who were evaluated and diagnosed by 123 residents. The concordance rate between the diagnostic procedures performed by residents and those suggested by Kendall's diagnostic algorithm was 61.2%. A low concordance rate was observed among patients with peritoneal signs, shock or toxic appearance (25.0%), suggested acute coronary syndromes (ACS) (55.1%), epigastric or right upper-quadrant pain (52.8%), and left upper-quadrant pain (55.6%). Abdominal ultrasonography is one of the recommended examinations for patients with signs of peritoneal irritation, shock or toxic appearance, right lower-quadrant pain, and left upper- or lower-quadrant pain, but the rates were relatively low at 25.0%, 34.4%, 31.8%, and 26.7%, respectively. Conclusion Abdominal ultrasonography required by Kendall's diagnostic algorithm was not performed appropriately in patients with symptoms and signs of peritonitis, shock or toxic appearance, right lower-quadrant pain, and left upper- or lower-quadrant pain or in female patients by resident trainees. Our findings underscore the importance of providing resident doctors with focused training concerning ultrasonography by attending physicians.


Assuntos
Dor Abdominal/etiologia , Internato e Residência , Dor Abdominal/diagnóstico , Dor Abdominal/diagnóstico por imagem , Síndrome Coronariana Aguda/diagnóstico , Idoso , Algoritmos , Estudos Transversais , Serviço Hospitalar de Emergência , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Peritonite/diagnóstico , Peritonite/diagnóstico por imagem , Exame Físico , Estudos Retrospectivos , Choque Séptico/diagnóstico por imagem , Ultrassonografia
19.
Am Surg ; 86(4): 324-333, 2020 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-32391756

RESUMO

Overutilization of healthcare resources is a threat to long-term healthcare sustainability and patient outcomes. CT is a costly but efficient means of assessing abdominal pain; however, 97 per cent of ED physicians acknowledge its overutilization. This study sought to understand factors that influence ED providers' decision regarding CT use in the evaluation of abdominal pain. After evaluating a patient for acute abdominal pain, ED providers filled in a form in which the primary diagnosis and index of suspicion were recorded. Bivariate and multivariate analyses were used to identify predictors of outcomes. The CT scan utilization rate was 54.82 per cent. Whereas 34.11 per cent of CT scans were normal, 30 per cent yielded an acute abdominal pathology. Tenderness and rebound tenderness were positive predictors of high index of suspicion [odds ratio (OR) 2.09 and 2.54, respectively]. These variables were also predictive of obtaining a CT scan [OR 2.64 and 3.41, respectively]. Compared with whites, the index of suspicion was 26 per cent and 56 per cent less likely to be high when patients were black [OR 0.73] or Hispanic [OR 0.44] respectively. Blacks and Hispanics were less likely to have CT scans performed than whites [OR 0.58 and 0.48, respectively]. Leukocytosis significantly affected the index of suspicion for acute abdominal pathology, obtaining a CT scan and the acuity of CT scan diagnosis on multivariate analysis. Patients aged ≥60 years had 2.03 odds of acute CT finding compared with those aged <60 years. There is a need for committed efforts to optimize CT scan utilization and eliminate socioeconomic disparities in health care.


Assuntos
Dor Abdominal/diagnóstico por imagem , Sobremedicalização/estatística & dados numéricos , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Dor Abdominal/etnologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Peso Corporal , Serviço Hospitalar de Emergência , Feminino , Disparidades em Assistência à Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Fatores de Risco , Fatores Socioeconômicos , Adulto Jovem
20.
AJR Am J Roentgenol ; 215(3): 607-609, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32301631

RESUMO

OBJECTIVE. This series of patients presented to the emergency department (ED) with abdominal pain, without the respiratory symptoms typical of coronavirus disease (COVID-19), and the abdominal radiologist was the first to suggest COVID-19 infection because of findings in the lung bases on CT of the abdomen. CONCLUSION. COVID-19 infection can present primarily with abdominal symptoms, and the abdominal radiologist must suggest the diagnosis when evaluating the lung bases for typical findings.


Assuntos
Dor Abdominal/diagnóstico por imagem , Dor Abdominal/virologia , Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico por imagem , Adulto , Humanos , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Pandemias , Tomografia Computadorizada por Raios X
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