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1.
BMC Surg ; 20(1): 220, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33008424

RESUMO

BACKGROUND: Splenic rupture is an emergency condition and a vast number of cases are secondary to trauma. Several underlying pathologies have also been associated with splenic rupture, such as hematological diseases, malignancies, and infectious and inflammatory diseases. CASE PRESENTATION: The patient was a 52-year-old man who referred to the Poursina Hospital in Rasht while complaining of abdominal pain from the day before hospitalization. The patient reported a history of lethargy, fever, and nausea. In the examinations performed, there was a brief tenderness in the patient's epigastrium. The patient was monitored and about 12 h after hospitalization, ill appearance, respiratory (respiratory distress) symptoms, and high fever were reported for the patient. According to the examination, the patient was immediately transferred to the operating room and underwent laparotomy. During the operation, contrary to our expectations, a lot of blood (about 1000 cc) was observed in the patient's abdomen. After blood suctioning, the left upper quadrant (LUQ) was bleeding and the rupture of the spleen could also be observed. Therefore, a splenectomy was performed. In the examinations performed for the patient, the patient's rtPCR test confirmed COVID-19. CONCLUSION: The evaluation of the spontaneous splenic rupture (SSR) in our case shows that this type of risk should also be considered in patients with COVID-19 who refer to medical centers with abdominal pain, and if more cases are reported, the correctness of this process can be commented on.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Esplenectomia , Ruptura Esplênica/diagnóstico , Ruptura Esplênica/etiologia , Dor Abdominal/etiologia , Infecções por Coronavirus/terapia , Emergências , Hospitalização , Humanos , Laparotomia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/terapia , Ruptura Espontânea , Ruptura Esplênica/cirurgia
3.
Medicine (Baltimore) ; 99(40): e22583, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019474

RESUMO

INTRODUCTION: Henoch-Schönlein purpura (HSP) is an extremely rare condition in patients with pulmonary tuberculosis, with only a few reported cases. Compared to patients with typical clinical symptoms, it is difficult to make a definitive diagnosis when HSP presents as an initial manifestation in pulmonary tuberculosis patients. Herein, a case of pulmonary tuberculosis that showed HSP at first was reported, and the related literatures were reviewed. PATIENT CONCERNS: A 24-year-old man presented with palpable purpura on the extremities, accompanied by abdominal pain, bloody stools, and knee pain. DIAGNOSES: The patient was diagnosed with pulmonary tuberculosis based on the results of interferon gamma release assays, purified protein derivative test, and computed tomography. INTERVENTIONS: The patient was treated with vitamin C and chlorpheniramine for 2 weeks, and the above-mentioned symptoms were relieved. However, 3 weeks later, the purpura recurred with high-grade fever and chest pain during the inspiratory phase. The patient was then treated with anti-tuberculosis drugs, and the purpura as well as the high fever disappeared. OUTCOMES: The patient recovered well and remained free of symptoms during the follow-up examination. CONCLUSION: Pulmonary tuberculosis presenting with HSP as an initial manifestation is not common. Therefore, it is difficult to clinically diagnose and treat this disease. When an adult patient shows HSP, it is important to consider the possibility of tuberculosis to avoid misdiagnosis and delayed treatment.


Assuntos
Antituberculosos/uso terapêutico , Púrpura de Schoenlein-Henoch/etiologia , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/tratamento farmacológico , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Assistência ao Convalescente , Ácido Ascórbico/uso terapêutico , Clorfeniramina/uso terapêutico , Diagnóstico Diferencial , Febre/diagnóstico , Febre/etiologia , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Antagonistas dos Receptores Histamínicos H1/uso terapêutico , Humanos , Testes de Liberação de Interferon-gama/métodos , Masculino , Púrpura de Schoenlein-Henoch/tratamento farmacológico , Resultado do Tratamento , Tuberculina , Tuberculose Pulmonar/sangue , Tuberculose Pulmonar/diagnóstico por imagem , Vitaminas/uso terapêutico , Adulto Jovem
4.
Medicine (Baltimore) ; 99(33): e21762, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872072

RESUMO

INTRODUCTION: There have been few case reports of abdominal pain as a symptom of spontaneous intraspinal hemorrhage. We herein describe a case involving a girl with paraplegia caused by spontaneous epidural hemorrhage in the thoracic spinal canal, characterized by abdominal pain. PATIENT CONCERNS: An 8-year-old girl with sudden abdominal pain and back pain was misdiagnosed as having an abdominal disease until she had the symptom of paralysis. DIAGNOSES: The patient was diagnosed with spontaneous intraspinal hemorrhage masquerading as atypical abdominal pain. INTERVENTIONS: When the patient developed symptoms of lower extremity paralysis, thoracic magnetic resonance imaging was performed and epidural hemorrhage was found in the thoracic spinal canal. Surgical treatment was performed after the diagnosis was confirmed. OUTCOMES: The patient could almost walk normally after 3 months. One year after surgery, the Frankel grade of spinal cord function was grade D. We continued to follow-up this patient. CONCLUSION: The symptoms caused by intraspinal hemorrhage are mainly back pain with or without neurological dysfunction. However, sometimes atypical symptoms, such as abdominal and chest pain, can be identified in clinical settings. Emergency surgery is recommended as the treatment of choice for intraspinal hemorrhage with neurological dysfunction.


Assuntos
Dor Abdominal/etiologia , Hematoma Epidural Espinal/diagnóstico por imagem , Criança , Feminino , Hematoma Epidural Espinal/complicações , Hematoma Epidural Espinal/terapia , Humanos , Imagem por Ressonância Magnética , Tomografia Computadorizada por Raios X
6.
Am J Case Rep ; 21: e926785, 2020 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-32970653

RESUMO

BACKGROUND In corona virus disease 2019 (COVID-19), which emerged in December 2019 and is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), most case presentations have been related to the respiratory tract. Several recent studies reveal that angiotensin-converting enzyme 2 (ACE2), which was found in the target cells of the virus, is highly expressed in the lungs, small bowel, and vasculature. CASE REPORT A 29-year-old male construction worker from India presented with left-sided colicky abdominal pain. He tested positive for infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse transcription-polymerase chain reaction (RT-PCR). Isolated superior mesenteric vein thrombosis was diagnosed by CT (computed tomography) scan. He was managed by anti-coagulants and clinically improved. CONCLUSIONS This case report indicates that isolated venous thrombosis of the abdominal vessels without concurrent arterial thrombosis can be a complication of the hyper-coagulability state in COVID-19 patients. Hence, early evaluation of abdominal vessels in covid-19 patients who present with any abdominal symptoms should be considered, especially when found to have an elevated D-dimer level, as early treatment of thrombosis with low-molecular-weight heparin can have a significant impact on the therapeutic outcome.


Assuntos
Anticoagulantes/administração & dosagem , Infecções por Coronavirus/complicações , Oclusão Vascular Mesentérica/diagnóstico por imagem , Pneumonia Viral/complicações , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/tratamento farmacológico , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Adulto , Técnicas de Laboratório Clínico/métodos , Indústria da Construção , Infecções por Coronavirus/diagnóstico , Humanos , Índia , Masculino , Oclusão Vascular Mesentérica/tratamento farmacológico , Oclusão Vascular Mesentérica/virologia , Veias Mesentéricas , Pandemias , Pneumonia Viral/diagnóstico , Radiografia Torácica/métodos , Reação em Cadeia da Polimerase em Tempo Real/métodos , Medição de Risco , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Trombose Venosa/complicações
7.
Rev Soc Bras Med Trop ; 53: e20200494, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32876320

RESUMO

Diagnosing cases of coronavirus disease (COVID-19) with only non-respiratory symptoms has been challenging. We reported the diagnosis of a child who tested positive for COVID-19 with abdominal pain/diarrhea and tracked his family cluster. One member of the family tested positive for COVID-19 on real-time reverse-transcription polymerase chain reaction assay and three other family members had anti-SARS-CoV-2 antibodies.


Assuntos
Infecções por Coronavirus/diagnóstico , Coronavirus/isolamento & purificação , Diarreia/diagnóstico , Pandemias , Pneumonia Viral/diagnóstico , Dor Abdominal/etiologia , Betacoronavirus , Pré-Escolar , Técnicas de Laboratório Clínico , Análise por Conglomerados , Busca de Comunicante , Diarreia/etiologia , Febre/etiologia , Humanos , Masculino , Faringite/etiologia
10.
Zhonghua Zhong Liu Za Zhi ; 42(8): 670-675, 2020 Aug 23.
Artigo em Chinês | MEDLINE | ID: mdl-32867460

RESUMO

Objective: The study aimed to analyze the clinicopathological features, treatment, and prognosis factors of primary esophageal small-cell carcinoma (PESC). Methods: The clinical records and follow-up data of 100 patients with PESC were collected, and the clinicopathological features and treatments were examined. Log-rank test and Cox regression model were performed to identify the independent prognostic factors. Results: Progressive dysphagia, weight loss, and abdominal pain were the most common initial symptoms in the 100 patients with PESC. The primary tumor site mainly occurred in the middle of the chest (51%, 51/100), and the ulcer type was the most common under gastroscope (31%, 31/100). One or more positive markers of epithelial origin were present in all of the enrolled patients. At the time of diagnosis, 80 cases had limited disease (LD) and 20 cases had extensive disease (ED). The 1-, 3-, and 5-year survival rates of PESC patients were 57.0%, 18.0%, and 11.0%, respectively, with a median survival time (MST) of 13.8 months. In all PESC patients, multivariate Cox regression analysis indicated that the significant prognostic factors included the lesion length (OR=2.661, P<0.001), TNM staging (OR=1.464, P=0.016), and treatment methods (OR=0.333, P<0.001). Besides, in patients with LD, the lesion length (OR=2.638, P=0.001) and treatment methods (OR=0.285, P<0.001) were independent prognostic factors. The MST of patients in surgery + chemotherapy group (21.6 months) was longer than that of the surgery only group (8.3 months, P=0.021), while patients in surgery+ chemotherapy+ radiotherapy group were also associated with a longer MST than the chemotherapy + radiotherapy group (31.0 months, 9.8 months, respectively; P<0.001). Conclusions: PESC is a rare esophageal malignant tumor with poor prognosis. Our findings reveal that the lesion length, TNM staging, and treatment method are independent prognostic factors for PESC patients. Moreover, surgery-based comprehensive treatments may prolong the survival of patients with LD.


Assuntos
Carcinoma de Células Pequenas/cirurgia , Neoplasias Esofágicas/cirurgia , Dor Abdominal/etiologia , Carcinoma de Células Pequenas/mortalidade , Carcinoma de Células Pequenas/patologia , Transtornos de Deglutição/etiologia , Neoplasias Esofágicas/mortalidade , Neoplasias Esofágicas/patologia , Esofagectomia , Humanos , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Perda de Peso
11.
Medicine (Baltimore) ; 99(31): e21471, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756169

RESUMO

RATIONALE: Although rare, pancreatic neoplasms can occur during pregnancy, both in benign and malignant forms. Mucinous cystic neoplasms (MCNs) of the pancreas, a type of these neoplasms, are precursor lesions to invasive pancreatic cancer. The presence of the ovarian-type stroma is a defining feature. PATIENT CONCERNS: The first case was a 38-year-old woman in her 18th week of pregnancy with abdominal pain that worsens a few weeks later. The second case was a 30-year-old woman in her 17th week of pregnancy with abdominal pain in the left hypochondrium. DIAGNOSIS: The patients were under clinical examination and laboratory test including carbohydrate antigen 19-9 (CA 19-9) and carcinoembryonic antigen (CEA). Both patients had magnetic resonance imaging (MRI). The diagnosis of a MCNs of the pancreas was done preoperatively in the 2 cases. INTERVENTIONS: Both patients underwent distal pancreatectomy during pregnancy. One of them was an emergency laparotomy because of a ruptured MCN. OUTCOMES: Both patients were completely recovered from distal pancreatectomy and continued to full term, delivering a healthy baby by Caesarean section. After 6 years of follow-up, the first patient underwent a total gastrectomy, because of a gastric cancer with carcinomatosis. Currently the 2 patients are still alive after 8 years and 5 years of follow-up, respectively. LESSONS: Surgical resection of MCNs during pregnancy should be considered during the second trimester given common distal pancreas location, rapid growth, risk of spontaneous rupture, and malignant potential.


Assuntos
Dor Abdominal/etiologia , Cistadenoma Mucinoso/cirurgia , Neoplasias Pancreáticas/patologia , Adulto , Assistência ao Convalescente , Antígeno CA-19-9/metabolismo , Antígeno Carcinoembrionário/metabolismo , Cesárea/métodos , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Pancreatectomia/métodos , Neoplasias Pancreáticas/diagnóstico por imagem , Gravidez , Complicações Neoplásicas na Gravidez/epidemiologia , Período Pré-Operatório , Resultado do Tratamento
14.
Clinics (Sao Paulo) ; 75: e2209, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32844958

RESUMO

OBJECTIVES: To assess the outcomes of pediatric patients with laboratory-confirmed coronavirus disease (COVID-19) with or without multisystem inflammatory syndrome in children (MIS-C). METHODS: This cross-sectional study included 471 samples collected from 371 patients (age<18 years) suspected of having severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The study group comprised 66/371 (18%) laboratory-confirmed pediatric COVID-19 patients: 61 (92.5%) patients tested positive on real-time reverse transcription-polymerase chain reaction tests for SARS-CoV-2, and 5 (7.5%) patients tested positive on serological tests. MIS-C was diagnosed according to the criteria of the Center for Disease Control. RESULTS: MIS-C was diagnosed in 6/66 (9%) patients. The frequencies of diarrhea, vomiting, and/or abdominal pain (67% vs. 22%, p=0.034); pediatric SARS (67% vs. 13%, p=0.008); hypoxemia (83% vs. 23%, p=0.006); and arterial hypotension (50% vs. 3%, p=0.004) were significantly higher in patients with MIS-C than in those without MIS-C. The frequencies of C-reactive protein levels >50 mg/L (83% vs. 25%, p=0.008) and D-dimer levels >1000 ng/mL (100% vs. 40%, p=0.007) and the median D-dimer, troponin T, and ferritin levels (p<0.05) were significantly higher in patients with MIS-C. The frequencies of pediatric intensive care unit admission (100% vs. 60%, p=0.003), mechanical ventilation (83% vs. 7%, p<0.001), vasoactive agent use (83% vs. 3%, p<0.001), shock (83% vs. 5%, p<0.001), cardiac abnormalities (100% vs. 2%, p<0.001), and death (67% vs. 3%, p<0.001) were also significantly higher in patients with MIS-C. Similarly, the frequencies of oxygen therapy (100% vs. 33%, p=0.003), intravenous immunoglobulin therapy (67% vs. 2%, p<0.001), aspirin therapy (50% vs. 0%, p<0.001), and current acute renal replacement therapy (50% vs. 2%, p=0.002) were also significantly higher in patients with MIS-C. Logistic regression analysis showed that the presence of MIS-C was significantly associated with gastrointestinal manifestations [odds ratio (OR)=10.98; 95%CI (95% confidence interval)=1.20-100.86; p=0.034] and hypoxemia [OR=16.85; 95%CI=1.34-211.80; p=0.029]. Further univariate analysis showed a positive association between MIS-C and death [OR=58.00; 95%CI=6.39-526.79; p<0.0001]. CONCLUSIONS: Pediatric patients with laboratory-confirmed COVID-19 with MIS-C had a severe clinical spectrum with a high mortality rate. Our study emphasizes the importance of investigating MIS-C in pediatric patients with COVID-19 presenting with gastrointestinal involvement and hypoxemia.


Assuntos
Infecções por Coronavirus/complicações , Infecções por Coronavirus/mortalidade , Coronavirus , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/mortalidade , Síndrome de Resposta Inflamatória Sistêmica/epidemiologia , Síndrome de Resposta Inflamatória Sistêmica/virologia , Dor Abdominal/etiologia , Betacoronavirus , Criança , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Estudos Transversais , Diarreia/etiologia , Febre/etiologia , Glucocorticoides/uso terapêutico , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Masculino , Síndrome de Linfonodos Mucocutâneos/epidemiologia , Síndrome de Linfonodos Mucocutâneos/terapia , Síndrome de Linfonodos Mucocutâneos/virologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Respiração Artificial , Índice de Gravidade de Doença , Síndrome de Resposta Inflamatória Sistêmica/terapia , Vômito/etiologia
15.
Intern Med ; 59(15): 1795-1801, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32741889

RESUMO

Objective With the advent of endoscopic treatment, the detailed diagnosis of colorectal neoplasms made using magnifying colonoscopy has become increasingly important. However, insertion difficulty causes pain in unsedated colonoscopy. The aim of this prospective observational study was to clarify the factors associated with a patient's pain in unsedated colonoscopy using a magnifying endoscope. Methods Patient pain was assessed using a numerical rating scale (0-10) immediately after the procedure. We defined 5 as mild enough pain that patients would not be reluctant to undergo another colonoscopy. Acceptable pain was defined as 5 or less and severe pain was defined as 8 to 10. Univariate and multivariate linear regression analyses were performed using the pain scale score as a dependent variable. Results A total of consecutive 600 patients undergoing unsedated colonoscopies were evaluated to assess their abdominal pain. The completion rate was 99.5% (597/600). The mean pain scale score was 3.88±2.38. The rate of acceptable pain was 80.5% (483/600). The rate of severe pain was 6.7% (40/600) including the incomplete cases. A comparison of polyp-positive and polyp-negative cases revealed no marked difference in patient pain (3.82±2.24 vs. 3.94±2.49, respectively; p=0.590) or insertion time (6.62±3.98 vs. 6.29±4.21, p=0.090), while more observation time was needed in polyp-positive cases than in polyp-negative ones (16.30±4.95 vs. 13.08±4.69, p<0.01). Univariate and multivariate linear regression analyses revealed that an older age, colectomy, antispasmodic agent use, and a small-diameter endoscope were significant factors associated with less patient pain. In particular, a small-diameter endoscope induces significantly more acceptable pain than a non-small diameter endoscope [85.63% (274/320) vs. 73.93% (207/280), p=0.00003]. Conclusion Unsedated colonoscopy using a magnifying endoscope by an expert may result in acceptable pain levels. The use of an antispasmodic agent, particularly hyoscine N-butyl bromide, and a small-diameter endoscope are recommended for reducing abdominal pain during unsedated colonoscopy.


Assuntos
Dor Abdominal/etiologia , Colonoscopia/efeitos adversos , Colonoscopia/métodos , Idoso , Colonoscopia/instrumentação , Neoplasias Colorretais/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Medição da Dor/métodos , Estudos Prospectivos , Fatores de Risco , Índice de Gravidade de Doença
20.
Am J Case Rep ; 21: e925753, 2020 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-32724028

RESUMO

BACKGROUND The novel COVID-19 disease caused by the SARS-CoV-2 virus is a highly infectious disease that originated in Wuhan, China, and has rapidly spread throughout the world. In addition to respiratory complications, the virus has also been implicated in damage to other organ systems as well as coagulopathy. The present report describes the first presumptive case of COVID-19-associated acute superior mesenteric artery thrombosis and acute intestinal ischemia. CASE REPORT A 55-year old man presented to the emergency department with nausea, generalized abdominal pain and diarrhea; he denied having a fever or any respiratory symptoms. Computed tomography (CT) of the abdomen and pelvis revealed bilateral pulmonary ground-glass opacities. He tested positive for SARS-CoV-2, and was treated with hydroxychloroquine, azithromycin and ceftriaxone, and was discharged home after five days of inpatient treatment. One week later, the patient returned with recurrent nausea, vomiting and worsening diffuse abdominal pain. A CT scan of the abdomen showed a 1.6-cm clot, causing high grade narrowing of the proximal superior mesenteric artery and bowel ischemia. The patient emergently underwent exploratory laparotomy, thromboembolectomy and resection of the ischemic small bowel. A post-operative complete hypercoagulable workup was unrevealing. CONCLUSIONS Despite the absence of respiratory symptoms, patients infected with SARS-CoV-2 may show atypical presentations, such as gastrointestinal symptoms. Clinicians managing patients with suspected or confirmed SARS-CoV-2 infection during the COVID-19 pandemic should monitor these patients for potential complications that may arise from this disease.


Assuntos
Infecções por Coronavirus/complicações , Intestinos/irrigação sanguínea , Isquemia/virologia , Oclusão Vascular Mesentérica/virologia , Pneumonia Viral/complicações , Trombose/virologia , Dor Abdominal/etiologia , Betacoronavirus , Diarreia/etiologia , Embolectomia , Humanos , Infarto/diagnóstico , Infarto/cirurgia , Infarto/virologia , Intestinos/diagnóstico por imagem , Intestinos/cirurgia , Isquemia/diagnóstico por imagem , Isquemia/cirurgia , Masculino , Artéria Mesentérica Superior/diagnóstico por imagem , Artéria Mesentérica Superior/cirurgia , Oclusão Vascular Mesentérica/diagnóstico por imagem , Oclusão Vascular Mesentérica/cirurgia , Pessoa de Meia-Idade , Pandemias , Trombectomia , Trombose/diagnóstico por imagem , Trombose/cirurgia , Tomografia Computadorizada por Raios X
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