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2.
Ann R Coll Surg Engl ; 103(2): e50-e52, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33559554

RESUMO

Appendix-associated hernias are extremely rare. They have been described sporadically in the literature, mostly as inguinal hernias. Appendix-associated incisional hernias are even more unusual. High clinical awareness is needed as complications can arise if misdiagnosis or delay occurs. We present an 80-year-old man with acute appendicitis in an incisional hernia. After successful surgery, the patient made a full recovery.


Assuntos
Apendicectomia , Apendicite/diagnóstico , Herniorrafia/efeitos adversos , Hérnia Incisional/diagnóstico , Doenças Raras/diagnóstico , Dor Abdominal/etiologia , Parede Abdominal/cirurgia , Idoso de 80 Anos ou mais , Apendicite/etiologia , Apendicite/cirurgia , Apêndice/diagnóstico por imagem , Apêndice/cirurgia , Hérnia Inguinal/cirurgia , Humanos , Hérnia Incisional/etiologia , Hérnia Incisional/cirurgia , Masculino , Náusea/etiologia , Doenças Raras/etiologia , Doenças Raras/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Vômito/etiologia
3.
Cir Pediatr ; 34(1): 3-8, 2021 Jan 01.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33507637

RESUMO

OBJECTIVE: To describe our experience in the diagnostic and therapeutic management of patients with acute abdomen as the main manifestation of SARS-CoV-2 infection. MATERIAL AND METHODS: A descriptive study of patients with clinical signs of acute abdomen diagnosed with COVID-19 and admitted at out healthcare facility from April 1 to May 10, 2020 was carried out. Clinical records were reviewed for data collection purposes. RESULTS: A series of 14 patients (9 male and 5 female) with a median age of 9.5 years was analyzed. All patients had abdominal pain. There were 11 patients with fever, 9 patients with vomit or diarrhea, and 9 patients with clinically suspected surgical pathology (acute appendicitis or peritonitis). Increased acute phase reactants and coagulation disorders were a common characteristic at blood tests. An abdominal ultrasonography was carried out in all patients, and a CT-scan was performed in 4 patients, which demonstrated inflammatory signs in the terminal ileum, the ileocecal valve and the ascending colon, as well as gallbladder edema. Conservative management was decided upon in all patients except one, and eight patients required intensive care admission for support treatment. CONCLUSIONS: Gastrointestinal symptoms can be the primary manifestation of the new coronavirus infection, which simulates an acute abdomen with a potentially unfavorable evolution. For an accurate diagnosis to be achieved, a good clinical record and a comprehensive physical exploration, as well as complementary tests in search of characteristic findings of COVID-19, should be carried out.


Assuntos
Abdome Agudo/diagnóstico , Dor Abdominal/etiologia , /diagnóstico , Abdome Agudo/cirurgia , Abdome Agudo/virologia , Dor Abdominal/virologia , Adolescente , Apendicite/diagnóstico , Criança , Pré-Escolar , Diarreia/epidemiologia , Diarreia/etiologia , Feminino , Febre/epidemiologia , Febre/etiologia , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Peritonite/diagnóstico , Estudos Retrospectivos , Vômito/epidemiologia , Vômito/etiologia
6.
BMJ Case Rep ; 13(12)2020 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-33318252

RESUMO

A 29-year-old man with no medical history presented to our emergency department with episodes of sudden speechlessness, hoarseness, vomiting after drinking cold water and spasms of his hands. Chvostek's and Trousseau's signs were both seen at presentation. Blood tests revealed severe hypocalcaemia (1.03 mmol/L) and rhabdomyolysis (creatine kinase (CK) of 2962 IU/L). The patient was treated immediately with calcium intravenously with an almost immediate improvement of his voice and quick normalisation of his CK. Additional investigation showed primary hypoparathyroidism in the presence of a vitamin D deficiency, requiring lifelong treatment with calcium supplements and alphacalcidol. Severe hypocalcaemia can be life threatening and prompt treatment is essential. This case reports the unusual first presentation of hypocalcaemia via speechlessness and vomiting together with rhabdomyolysis. Identifying an atypical presentation of hypocalcaemia is critical, for it can be lifesaving.


Assuntos
Hipocalcemia/etiologia , Hipoparatireoidismo/diagnóstico , Mutismo/etiologia , Rabdomiólise/etiologia , Deficiência de Vitamina D/etiologia , Adulto , Cálcio/sangue , Creatina Quinase/sangue , Humanos , Hipoparatireoidismo/complicações , Masculino , Vômito/etiologia
7.
BMJ Case Rep ; 13(12)2020 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-33370983

RESUMO

One of the causes of congenital incomplete duodenal obstruction is the presence of congenital duodenal web with fenestration. This condition requires a high index of suspicion for an early and accurate diagnosis. We present an unusual presentation of duodenal web in a 6-year-old girl who presented with a 3-year history of cyclical and seasonal vomiting and abdominal pain. The diagnosis of congenital duodenal web with fenestration was made on contrast study and endoscopy and was treated surgically by incision of the web.


Assuntos
Dor Abdominal/etiologia , Obstrução Duodenal/diagnóstico , Duodeno/anormalidades , Vômito/etiologia , Dor Abdominal/cirurgia , Criança , Obstrução Duodenal/congênito , Obstrução Duodenal/cirurgia , Duodeno/cirurgia , Endoscopia , Feminino , Humanos , Fatores de Tempo , Resultado do Tratamento , Vômito/cirurgia
8.
BMJ Case Rep ; 13(12)2020 Dec 28.
Artigo em Inglês | MEDLINE | ID: mdl-33372018

RESUMO

An 85-year-old malnourished woman presented with symptoms of small bowel obstruction of uncertain aetiology. She had presented numerous times over the previous 2 years with symptoms of left groin and thigh pain, vomiting and abdominal distension. A CT of her abdomen and pelvis ultimately revealed a left-sided pelvic hernia, between the obturator internus and pectineal muscles. This was consistent with an obturator hernia. Diagnostic laparoscopy confirmed an obturator hernia of Richter type, incarcerated within the left obturator canal. Reduction revealed a hernia sac containing viable small bowel. A primary repair was performed using a double-layer suture technique to both close and plug the hernia defect. The patient rapidly recovered following hernia repair, with resolution of all previous long-standing symptoms. This case exemplifies the typical presentation of an obturator hernia and the diagnostic challenge it poses to clinicians.


Assuntos
Hérnia do Obturador/diagnóstico , Obstrução Intestinal/etiologia , Idoso de 80 Anos ou mais , Feminino , Virilha , Hérnia do Obturador/complicações , Hérnia do Obturador/diagnóstico por imagem , Hérnia do Obturador/cirurgia , Herniorrafia , Humanos , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/cirurgia , Intestino Delgado/diagnóstico por imagem , Intestino Delgado/cirurgia , Laparoscopia , Desnutrição/complicações , Dor/etiologia , Telas Cirúrgicas , Coxa da Perna , Tomografia Computadorizada por Raios X , Vômito/etiologia
9.
Medicine (Baltimore) ; 99(46): e22664, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33181647

RESUMO

INTRODUCTION: Hyperthyroidism-related anterior circulation ischemic events have been well documented; however, posterior circulation infarction is rarely reported, not to mention with superior mesenteric artery syndrome (SMAS), which has never been reported concurrently. We describe, to the best of our knowledge, the first case of hyperthyroidism-related cerebellar infarction accompanied with SMAS. PATIENT CONCERNS: A 22-year-old women presented with palpitation, postprandial vomiting, and acute body weight loss. Enlarged thyroid gland was discovered in physical examination and Graves disease was diagnosed by blood test; therefore, Propylthiouracil and ß-blocker were prescribed. Sudden onset conscious disturbance accompanied with apnea was noted during hospitalization. DIAGNOSIS: Computed tomography (CT) revealed cerebellar infarction with severe cerebellar swelling and tonsil herniation; hence, emergent suboccipital craniotomy and bilateral tonsillectomy were performed. INTERVENTIONS: Nevertheless, persisted poor passage of liquid diet during nasogastric tube feeding was noted after operation. CT of abdomen showed a sharp aorta-SMA angle (15°) and a short distance between aorta and SMA (6 mm) indicating a diagnosis of SMAS. OUTCOMES: After parental nutrition supplement and progressive rehabilitation program, she recovered to a modified Rankin Scale of 3. CONCLUSION: Although rarely reported, hyperthyroidism-related sympathetic hyperstimulation, vasculopathy could result in potentially deadly posterior circulation infarction. Furthermore, SMAS should be considered in the cases of hyperthyroidism with prolonged gastrointestinal symptoms even after treatment and should be treated simultaneously, since SMAS exacerbates depletion of intravascular volume. Further study to clarify the relation between hyperthyroidism and posterior circulation hemodynamic status is suggested.


Assuntos
Hiperparatireoidismo Primário/complicações , Infarto/etiologia , Síndrome da Artéria Mesentérica Superior/etiologia , Dor no Peito/etiologia , Craniotomia/métodos , Feminino , Humanos , Hiperparatireoidismo Primário/diagnóstico , Infarto/complicações , Tonsila Palatina/anormalidades , Tonsila Palatina/diagnóstico por imagem , Paralisia/etiologia , Síndrome da Artéria Mesentérica Superior/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Vômito/etiologia , Adulto Jovem
10.
Niger J Clin Pract ; 23(11): 1536-1541, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33221778

RESUMO

Objectives: The aim of this study is to evaluate the pattern of presentation, anatomic anomalies, and treatment outcomes in patients presenting with acute testicular torsion in a tertiary health institution in southeast Nigeria. Methods: This was a prospective study of all consecutive patients with acute testicular torsion seen from January 2011 to November 2019 at our institution. Their demographic and clinical data were analyzed. Results: Thirty-one acute testicular torsion cases were seen during the study period. Mean age was 22.6 (±7.3) years. Two peaks of incidence were observed. These were in the 14-19-year and 20-25-year age groups. The left testis was more commonly affected than the right; 15 cases (48.4%) versus 13 cases (41.9%). Past history of intermittent torsion was seen in 48.4% of cases. Abdominal pain was the commonest associated symptom followed by vomiting; 20 (64.5%) and 11 (35.5%). Seven cases (22.6%) of acute torsion occurred during sleep. Delay in presentation and delay in surgical intervention were observed. Only 22.6% of patients presented within 6 h of onset of symptoms and only 32.3% were operated on within 6 h of presentation. Transverse lie of the testes was the most common intraoperative finding (36%). Testicular salvage rate was 87.1%. Conclusions: Acute testicular torsion is a disease of young adults in southeast Nigeria. It is commoner on the left side with transverse lie being the most common predisposing factor. A new peak incidence in the 20-25-year age group is demonstrated. Late presentation is common but did not impact testicular loss in this study.


Assuntos
Torção do Cordão Espermático/diagnóstico , Dor Abdominal/etiologia , Adolescente , Adulto , Humanos , Masculino , Nigéria/epidemiologia , Estudos Prospectivos , Estudos Retrospectivos , Torção do Cordão Espermático/epidemiologia , Torção do Cordão Espermático/cirurgia , Testículo/patologia , Testículo/cirurgia , Fatores de Tempo , Resultado do Tratamento , Vômito/etiologia , Adulto Jovem
11.
Medicine (Baltimore) ; 99(40): e22619, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019483

RESUMO

RATIONALE: Xanthogranuloma of the sellar region is exceedingly rare, and described in only a handful of case reports. Herein, we present a case of xanthogranuloma of the sellar region to improve our knowledge for the diagnosis and management of this unusual disease. PATIENT CONCERNS: A 50-year-old female presented with the symptoms of intermittent vomiting, occasional head discomfort, and diabetes insipidus of 1 month duration. DIAGNOSES: Magnetic resonance imaging showed a large well-defined, vase-like, heterogeneous mass in the sellar region. The lesion showed mixed signal with hierarchical signal presentation. Fluid-fluid level sign can be found within the lesion. The upper part of the lesion was hyperintense, and the lower part was hypointense on both T1-weighted images and T2-weighted images. The lesion showed no enhancement following the intravenous administration of gadolinium. The normal pituitary tissue was not clearly visible. Optic chiasm was compressed and displaced by the lesion. Initial diagnosis of pituitary macroadenoma with hemorrhage in the sellar region was made before surgery. Final diagnosis of sellar xanthogranuloma was confirmed by histopathological examination after surgical resection. INTERVENTIONS: Gross total resection of the lesion was achieved using the microscope through endonasal transsphenoidal approach. OUTCOMES: The patient recovered well with improved binocular vision and no symptom of diabetes insipidus, and was discharged 5 days after operation. LESSONS: Sellar xanthogranuloma should receive diagnostic consideration for the lesion that is a heterogeneously mixed mass with a degree of T1-weighted images hyperintense in the sellar region.


Assuntos
Diabetes Insípido/etiologia , Granuloma/cirurgia , Sela Túrcica/patologia , Xantomatose/patologia , Xantomatose/cirurgia , Diagnóstico Diferencial , Feminino , Gadolínio/administração & dosagem , Granuloma/patologia , Cefaleia/etiologia , Humanos , Imagem por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Neoplasias Hipofisárias/diagnóstico , Sela Túrcica/diagnóstico por imagem , Resultado do Tratamento , Vômito/etiologia
12.
Medicine (Baltimore) ; 99(40): e22641, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019489

RESUMO

RATIONALE: Rotavirus is routinely diagnosed by the detection of antigens or the viral genome. However, these tests have limitations, in that they do not detect all rotavirus strains. PATIENT CONCERNS: We present a case of a 27-month-old girl who was hospitalized for 4 days with severe gastroenteritis, including high fever, vomiting, diarrhea, mild dehydration, and periumbilical pain. Notably, the patient previously received the Rotarix vaccine. DIAGNOSES: The laboratory tests were negative for rotavirus, astrovirus, adenovirus, and norovirus as well as common diarrhea-causing bacteria. Human-bovine recombinant rotavirus was detected by MinION sequencing. INTERVENTIONS: To investigate the cause agents from the unexplained severe gastroenteritis infant, the stool sample was prepared by random amplification for Nanopore MinION sequencing. OUTCOMES: Treatment through the administration of ORS solution and galtase powder with probiotics was successful after the diagnosis of unusual rotavirus infection. LESSONS: This case report is the first detection of an unusual human-bovine recombinant rotavirus in an idiopathic gastroenteritis using Nanopore MinION sequencing.


Assuntos
Gastroenterite/virologia , Sequenciamento por Nanoporos/métodos , Infecções por Rotavirus/diagnóstico , Vacinas contra Rotavirus/efeitos adversos , Rotavirus/genética , Dor Abdominal , Doença Aguda , Pré-Escolar , Desidratação/etiologia , Diarreia/etiologia , Fezes/virologia , Feminino , Febre/etiologia , Hidratação/métodos , Gastroenterite/patologia , Gastroenterite/terapia , Humanos , Probióticos/uso terapêutico , Rotavirus/isolamento & purificação , Infecções por Rotavirus/complicações , Infecções por Rotavirus/virologia , Índice de Gravidade de Doença , Resultado do Tratamento , Vacinação/efeitos adversos , Vacinas Atenuadas/efeitos adversos , Vômito/etiologia
13.
J Pregnancy ; 2020: 6153146, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33062334

RESUMO

Introduction: Obstetric danger signs are those signs that a pregnant woman will see or those symptoms that she will feel which indicate that something is going wrong with her or with the pregnancy. Evidence on the prevalence of obstetric danger signs and contributing factors were crucial in designing programs in the global target of reducing maternal morbidity and mortality. Objective: To assess the prevalence of obstetric danger signs during pregnancy and associated factors among mothers in a Shashemene rural district, South Ethiopia. Methods: A community-based cross-sectional study design was conducted among 395 randomly selected women who gave birth in the last six months. A pretested interviewer-administered questionnaire was utilized. Data were cleaned, coded, and entered into Epi data manager version 4.1 and then exported to SPSS version 20. Bivariable and multivariable logistic regression analyses were employed to assess the association between independent variables with the outcome variable. Statistical significance was declared at p < 0.05. Result: One hundred sixty-three (41.3%) of women had a history of obstetric danger signs during pregnancy. The most prevalent obstetric danger signs were vaginal bleeding (15.4%) followed by swelling of the body 12.7% and severe vomiting 5.3%. Women who have less than four times antenatal care visits were 6.7 times more likely to experience obstetric danger signs (AOR 6.7 (95% CI 3.05, 14.85)) compared to those who had antenatal care visit four times and above. Women who have inadequate knowledge of obstetric danger signs were 2.5 times more likely to experience obstetric danger signs during pregnancy (AOR 2.5 (95% CI 1.34, 4.71)), and primigravida women were 6.3 times more likely to have obstetric danger signs during pregnancy (AOR 6.3 (95% CI 2.61, 15.09)) compared to multiparous women. Conclusion: About half of the pregnant mothers have experienced at least one obstetric danger signs. Public health interventions on maternal health should give priority to the prevalent causes of obstetric danger signs, strengthening completion of four antenatal care visits and health education on obstetric danger signs for pregnant mothers at community level especially for primgravid women.


Assuntos
Complicações na Gravidez/epidemiologia , Adolescente , Adulto , Estudos Transversais , Edema/epidemiologia , Edema/etiologia , Edema/prevenção & controle , Etiópia/epidemiologia , Feminino , Número de Gestações , Educação em Saúde , Humanos , Conhecimento , Mortalidade Materna , Gravidez , Complicações na Gravidez/etiologia , Complicações na Gravidez/prevenção & controle , Cuidado Pré-Natal/estatística & dados numéricos , Prevalência , Inquéritos e Questionários , Hemorragia Uterina/epidemiologia , Hemorragia Uterina/etiologia , Hemorragia Uterina/prevenção & controle , Vômito/epidemiologia , Vômito/etiologia , Vômito/prevenção & controle , Adulto Jovem
14.
Medicine (Baltimore) ; 99(36): e21961, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899032

RESUMO

This retrospective study was aimed to determine the factors suggesting the need for computed tomography (CT) scanning when ultrasound (US) imaging results are negative or non-diagnostic in children suspicious for acute appendicitis in the emergency department.Patients less than 18 years old who underwent abdominal ultrasound and CT to rule out acute appendicitis were enrolled. Patients were classified into 2 groups: the false-negative group, in which patients had negative or non-diagnostic results on the initial US and a final diagnosis of acute appendicitis on the following abdominal CT, and the true-negative group, in which patients had negative or non-diagnostic US results and were negative on abdominal CT. Logistic regression and propensity score matching with the predicting factors were performed.The presence of vomiting (odds ratio (OR), 7.78; 95% confidence interval (CI), 1.92-41.04) and poor oral intake (OR, 4.67; 95% CI, 1.21-21.15) with a high white blood cell (WBC) count (OR 1.26; 95% CI, 1.09-2.37), segmented neutrophil ratio (OR, 1.09; 95% CI, 1.03-1.16), and C-reactive protein (CRP) (OR, 1.49; 95% CI, 1.09-2.37) were suggestive of the false-negative group. The propensity-matched population also showed significant associations with vomiting (OR, 7.86; 95% CI, 1.65-37.40) and poor oral intake (OR, 5.50; 95% CI, 1.28-23.69) with an elevated WBC count (OR, 1.27; 95% CI, 1.08-1.50), segmented neutrophil ratio (OR, 1.09; 95% CI, 1.03-1.16), and CRP (OR, 1.51; 95% CI, 1.03-2.22).A CT scan should be considered in children with suspected acute appendicitis if they have vomiting, high CRP, and high WBC count, despite negative or non-diagnostic US results.


Assuntos
Apendicite/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Apendicite/fisiopatologia , Proteína C-Reativa/análise , Estudos de Casos e Controles , Criança , Diagnóstico Tardio , Erros de Diagnóstico , Feminino , Humanos , Masculino , Pontuação de Propensão , Curva ROC , Estudos Retrospectivos , Ultrassonografia , Vômito/etiologia
15.
Bull Cancer ; 107(10): 1019-1023, 2020 Oct.
Artigo em Francês | MEDLINE | ID: mdl-32972763

RESUMO

In this review, we report a case of a bone's metastatic breast cancer in Malian patient treated by chemotherapy in whom SRAS-COV-2's diagnosis was made 9days after the onset gastrointestinal symptoms. Patient quickly died before any COVID-19's treatment. According to the poor outcomes of cancer patients with COVID-19, authors emphasize to an intensive attention to such patients in order to find the best therapeutic balance between the two pathologies during this pandemic.


Assuntos
Betacoronavirus , Neoplasias da Mama/complicações , Carcinoma Ductal de Mama/secundário , Infecções por Coronavirus/complicações , Diarreia/etiologia , Pandemias , Pneumonia Viral/complicações , Neoplasias da Coluna Vertebral/secundário , Vômito/etiologia , Adulto , Antineoplásicos Fitogênicos/uso terapêutico , Conservadores da Densidade Óssea/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Carcinoma Ductal de Mama/complicações , Carcinoma Ductal de Mama/tratamento farmacológico , Docetaxel/uso terapêutico , Evolução Fatal , Feminino , Infecções por HIV/complicações , Humanos , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/secundário , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/tratamento farmacológico , Tomografia Computadorizada por Raios X , Ácido Zoledrônico/uso terapêutico
16.
Medicine (Baltimore) ; 99(37): e22063, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925740

RESUMO

RATIONALE: Wandering spleen (WS) is a rare clinical entity characterized by splenic hypermobility caused by absent or abnormal laxity of the suspensory ligaments, which fix the spleen in its normal position. Due to abnormal attachment, the spleen is predisposed to torsion and a series of complications. Pediatric WS is mostly reported in children aged <10 years, especially among infants aged <1 year; it is uncommon among toddlers between 1 and 3 years. To the authors' knowledge, only seven cases of WS have been described previously. Herein, we present the case of a 3-year-old toddler with WS and splenic torsion. PATIENT CONCERNS: A 3-year-old boy was presented to the pediatric emergency room with a 2-day history of abdominal pain and vomiting. The ultrasonographic examination revealed a mass in the left upper abdomen cavity and absence of spleen in its normal position. Computed tomography showed an enlarged displaced spleen occupying the left abdomen cavity with an elongated splenic vascular pedicle (whirl sign), suggesting splenic torsion. DIAGNOSES: The patient was diagnosed that had WS and splenomegaly, with or without complications due to splenic torsion. INTERVENTIONS: The patient underwent emergency laparotomy and splenectomy due to nonviability after detorsion. OUTCOMES: The postoperative course was uneventful, and the patient was discharged on the 7th day postoperatively without complications. The patient had favorable outcome over a 1-year follow-up. LESSONS: Herein, we reported the case of a toddler with WS with splenic torsion. Moreover, after reviewing relevant studies in literature, we presented our findings on the diagnosis and treatment of toddlers with WS. Toddlers with WS are characterized by acute abdominal pain, unclear history description, examination restrictions, and high rates of life-threatening complications. High level of suspicion, careful physical examination, detailed history collection, and objective investigation are crucial in the management of toddlers with WS.


Assuntos
Esplenopatias/diagnóstico por imagem , Esplenopatias/etiologia , Anormalidade Torcional/diagnóstico por imagem , Anormalidade Torcional/etiologia , Baço Flutuante/complicações , Baço Flutuante/diagnóstico por imagem , Abdome Agudo/etiologia , Pré-Escolar , Humanos , Masculino , Esplenectomia , Esplenopatias/cirurgia , Tomografia Computadorizada por Raios X , Anormalidade Torcional/cirurgia , Ultrassonografia , Vômito/etiologia
17.
Ideggyogy Sz ; 73(7-08): 286-288, 2020 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-32750246

RESUMO

Intracranial localization of Ewing's sarcoma is considerably very rare. Herein, we present clinical and neuroimaging findings regarding a 4-year-old boy with intracranial Ewing's sarcoma. He was born prematurely, suffered intraventricular haemorrhage, posthaemorrhagic hydrocephalus developed, and a ventriculoperitoneal shunt was inserted in the newborn period. The patient endured re-gular follow ups, no signs of shunt malfunction nor increased intracranial pressure were observed. The last neuroima-ging examination was performed at 8 months of age. Upon reaching the age of 4 years, repeated vomiting and focal seizures began, and symptoms of increased intracranial pressure were detected. A brain MRI depicted a left frontoparietal space-occupying lesion infiltrating the superior sagittal sinus. The patient underwent a craniotomy resulting in the total excision of the tumour. The histological examination of the tissue revealed a small round blue cell tumour. The diagnosis was confirmed by the detection of EWSR1 gene translocation with FISH (fluorescent in situ hybridization). No additional metastases were detected during the staging examinations. The patient was treated in accordance to the EuroEwing 99 protocol. Today, ten years onward, the patient is tumour and seizure free and has a reasonably high quality of life.


Assuntos
Encéfalo/diagnóstico por imagem , Sarcoma de Ewing/diagnóstico , Convulsões/etiologia , Vômito/etiologia , Neoplasias Ósseas/genética , Pré-Escolar , Craniotomia , Humanos , Hibridização in Situ Fluorescente , Pressão Intracraniana , Imagem por Ressonância Magnética , Masculino , Neuroimagem , Qualidade de Vida , Proteína EWS de Ligação a RNA , Sarcoma de Ewing/complicações , Sarcoma de Ewing/genética , Sarcoma de Ewing/cirurgia , Translocação Genética , Resultado do Tratamento
18.
Pediatrics ; 146(2)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32732262

RESUMO

OBJECTIVES: Acute nystagmus (AN) is an uncommon neurologic sign in children presenting to pediatric emergency departments. We described the epidemiology, clinical features, and underlying causes of AN in a large cohort of children, aiming at identifying features associated with higher risk of severe underlying urgent conditions (UCs). METHODS: Clinical records of all patients aged 0 to 18 years presenting for AN to the pediatric emergency departments of 9 Italian hospitals in an 8-year period were retrospectively reviewed. Clinical and demographic features and the underlying causes were analyzed. A logistic regression model was applied to detect predictive variables associated with a higher risk of UCs. RESULTS: A total of 206 patients with AN were included (male-to-female ratio: 1.01; mean age: 8 years 11 months). The most frequently associated symptoms were headache (43.2%) and vertigo (42.2%). Ataxia (17.5%) and strabismus (13.1%) were the most common neurologic signs. Migraine (25.7%) and vestibular disorders (14.1%) were the most common causes of AN. Idiopathic infantile nystagmus was the most common cause in infants <1 year of age. UCs accounted for 18.9% of all cases, mostly represented by brain tumors (8.3%). Accordant with the logistic model, cranial nerve deficits, ataxia, or strabismus were strongly associated with an underlying UC. Presence of vertigo or attribution of a nonurgent triage code was associated with a reduced risk of UCs. CONCLUSIONS: AN should be considered an alarming finding in children given the risk of severe UCs. Cranial nerve palsy, ataxia, and strabismus should be considered red flags during the assessment of a child with AN.


Assuntos
Nistagmo Patológico/etiologia , Ataxia/complicações , Ataxia/diagnóstico , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/diagnóstico , Infecções do Sistema Nervoso Central/complicações , Infecções do Sistema Nervoso Central/diagnóstico , Criança , Pré-Escolar , Estudos de Coortes , Doenças dos Nervos Cranianos/complicações , Doenças dos Nervos Cranianos/diagnóstico , Doenças Desmielinizantes/complicações , Doenças Desmielinizantes/diagnóstico , Tontura/etiologia , Serviço Hospitalar de Emergência , Feminino , Cefaleia/etiologia , Humanos , Hipertensão Intracraniana/complicações , Hipertensão Intracraniana/diagnóstico , Itália , Masculino , Transtornos de Enxaqueca/complicações , Transtornos de Enxaqueca/diagnóstico , Náusea/etiologia , Envenenamento/complicações , Envenenamento/diagnóstico , Estudos Retrospectivos , Estrabismo/etiologia , Vertigem/etiologia , Doenças Vestibulares/complicações , Doenças Vestibulares/diagnóstico , Vômito/etiologia
19.
Medicine (Baltimore) ; 99(31): e21434, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756153

RESUMO

RATIONALE: Intracranial aneurysm with the first manifestation of acute subdural hematoma (aSDH) is rare in the field of neurosurgery. Usually subarachnoid hemorrhage or intracranial hematoma happens after the rupture of an intracranial aneurysm, whereas trauma is the primary cause of aSDH. PATIENT CONCERNS: Here, we present the case of a 71-year-old woman who presented with spontaneous aSDH with progressive headache and vomiting. DIAGNOSIS: Urgent head computed tomography (CT) identified an aSHD, but the patient had no history of trauma. CT angiography (CTA) identified the cause of the aSDH as rupture of an intracranial aneurysm in the left middle cerebral artery. INTERVENTIONS: Emergent craniotomy with hematoma evacuation was performed. OUTCOMES: Due to prompt diagnosis and appropriate intervention, the patient recovered fully with no disability. LESSONS: This unique case demonstrates that aSDH caused by intracranial aneurysm rupture requires timely identification and appropriate action to prevent adverse outcomes. We performed a comprehensive systematic literature review to examine the etiology and pathogenesis of non-traumatic aSDH. Furthermore, digital subtraction angiography should be considered in patients diagnosed with an aSDH with no known cause.


Assuntos
Angiografia Digital/métodos , Hematoma Subdural Agudo/etiologia , Aneurisma Intracraniano/patologia , Artéria Cerebral Média/diagnóstico por imagem , Ruptura/complicações , Adulto , Idoso , Angiografia Digital/normas , Angiografia por Tomografia Computadorizada/métodos , Craniotomia/métodos , Feminino , Cefaleia/etiologia , Hematoma Subdural Agudo/diagnóstico por imagem , Hematoma Subdural Agudo/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média/patologia , Resultado do Tratamento , Vômito/etiologia
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