scholarly journals Massive Spontaneous Hemothorax as a Complication of Apixaban Treatment

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
M. Abu Hishmeh ◽  
P. Srivastava ◽  
Q. Lougheide ◽  
M. Srinivasan ◽  
S. Murthy
Keyword(s):  
Pleural Effusion ◽  
Health Care Providers ◽  
Rare Complication ◽  
Pigtail Catheter ◽  
Care Providers ◽  
Nonvalvular Atrial Fibrillation ◽  
Vein Thrombosis ◽  
Spontaneous Hemothorax ◽  
First Case ◽  
Iatrogenic Trauma

Introduction. Hemothorax is usually related to chest or iatrogenic trauma from procedures such as central lines and thoracentesis. Spontaneous hemothorax is defined as pleural fluid hematocrit greater than 50% of serum hematocrit in absence of natural or iatrogenic trauma affecting the lung or pleural space. Coagulopathy secondary to anticoagulant use has been associated with spontaneous hemothorax. We present a case of spontaneous hemothorax in a patient taking apixaban for venous thromboembolism disease. To our knowledge, this is the first case report of apixaban as a cause of spontaneous hemothorax. Case Presentation. A 56-year-old woman with end-stage renal disease (ESRD) was diagnosed with upper extremity deep vein thrombosis (DVT) one month prior to presentation and was started on apixaban presented with dyspnea and left-sided pleuritic chest pain for two weeks. She was found to have left-sided large pleural effusion which was diagnosed as hemothorax. Other etiologies for spontaneous hemothorax were excluded and drainage by 12-French pigtail catheter achieved total resolution of hemothorax in three days. Discussion. Apixaban is a DOAC used to prevent stroke or thromboembolic events in patients with nonvalvular atrial fibrillation and to prevent recurrent venous thromboembolic disease. Events such as gastrointestinal, intracranial, and soft tissue bleeding have been well-documented. However, bleeding manifestation as hemothorax is seldom reported. Our patient presented with isolated left-sided large pleural effusion which was diagnosed as spontaneous hemothorax. 12-Fr pigtail catheter drainage was effective in the management of our patient and provided total resolution in three days. Conclusion. Spontaneous hemothorax is a rare complication of anticoagulant therapy and might not exhibit the usual radiological signs of traumatic hemothorax. Health care providers should have high index of suspicion for spontaneous hemothorax when evaluating new pleural effusion in patients receiving DOACs therapy. Drainage by small bore pigtail catheter might be as effective as larger chest tubes.

scholarly journals Pharmacist’s Intervention Considering the Prognosis for a Terminal Cancer Patient: A Case Report

Pharmacy ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 212
Author(s):  
Masahiro Okada ◽  
Kazuko Okazaki ◽  
Keisuke Kimura ◽  
Hiroki Sugihara ◽  
Fumiyoshi Murakami ◽  
...  
Keyword(s):  
Case Report ◽  
Health Care Providers ◽  
Prognostic Index ◽  
Oral Intake ◽  
Sigmoid Colon Cancer ◽  
Care Providers ◽  
Abdominal Wall Metastasis ◽  
First Case ◽  
Prognostic Prediction ◽  
Loss Of Appetite

Prognostic prediction has been reported to affect the decision of doctors and non-physician health care providers such as nurses, social workers, pastors, and hospice volunteers on the selection of appropriate medical interventions. This was a case of a 65-year-old woman who presented with a poor oral intake. The patient had a history of sigmoid colon cancer with abdominal wall metastasis and peritoneal dissemination. On the day of admission, nausea, anorexia, and malaise were noted, requiring immediate intervention. The patient’s prognosis was predicted using the Palliative Prognostic Index. The pharmacist suggested the use of dexamethasone tablets in order to alleviate the patient’s symptoms. Indeed, the administration of dexamethasone alleviated the symptoms of nausea, loss of appetite, and malaise. To the best of our knowledge, this is the first case report to demonstrate that prognosis prediction is important not only for other medical staff but also for pharmacists when deciding the need to initiate a treatment and continue such treatment, and when providing pharmacist interventions.

A Case of Eosinophilic Pleural Effusion Complicating Multiple Myeloma

1988 ◽  
Vol 33 (3) ◽  
pp. 278-278 ◽  
Author(s):  
B.J. Lipworth ◽  
D.P. Dhillon
Keyword(s):  
Multiple Myeloma ◽  
Pleural Effusion ◽  
Light Chain ◽  
Recent Literature ◽  
Rare Complication ◽  
Light Chain Type ◽  
First Case ◽  
Eosinophilic Pleural Effusion ◽  
Chain Type

Pleural effusion is a rare complication of multiple myeloma. We report the first case of eosinophilic effusion due to light chain type disease and review the recent literature.

scholarly journals Endometrial stromal sarcoma metastasis to the lumbar spine and sphenoid bone

Rare Tumors ◽  
2011 ◽  
Vol 3 (3) ◽  
pp. 86-89 ◽  
Author(s):  
Mary I. Huang ◽  
Robert L. DeBernardo ◽  
Mark Rodgers ◽  
David J. Hart
Keyword(s):  
Health Care Providers ◽  
Pelvic Exenteration ◽  
Femoral Nerve ◽  
Endometrial Stromal Sarcoma ◽  
Sphenoid Bone ◽  
Leg Pain ◽  
Subtotal Resection ◽  
Care Providers ◽  
Stromal Sarcoma ◽  
First Case

Endometrial stromal sarcoma (ESS) is typically associated with metastasis to the abdomen, pelvis, and lung. We found three case reports of ESS metastasis to the bone (two to the thoracic spine, and one to the parietal bone). Our objective is to review the literature on ESS spinal and intracranial metastases and, report the first case of ESS metastatic to the lumbar paraspinal region and sphenoid bone. A 53-year-old female with ESS status-post radiation, chemotherapy, and pelvic exenteration surgery presented with right hip weakness, back pain, and radicular leg pain that were explained by chemotherapy-induced neuropathy, radiation-induced lumbosacral plexopathy, and femoral nerve and obturator nerve injury during pelvic exenteration surgery. During routine positron emission tomography, we found metastasis to the L3 lumbar spinal region. L3 laminectomy and subtotal resection of the mass was performed with tumor residual in the neuroforamina and pedicles. One month later, magnetic resonance imaging (MRI) performed for persistent headaches revealed a large lesion in the sphenoid bone that was biopsied transsphenoidally with the same diagnosis, but no further surgery was performed. She is intolerant of chemotherapy and currently undergoing whole brain radiation. Delay in the diagnosis and management of lumbar paraspinal and sphenoid bone metastasis of ESS likely occurred because of the uniqueness of the location and aggressiveness of ESS metastasis. Health care providers should be aware of potentially aggressive metastasis of ESS to bone, in particular the unusual locations of the lumbar paraspinal region and sphenoid bone.

scholarly journals Predicting Growth of COVID-19 Confirmed Cases in Each U.S. County with a Population of 50,000 or More Revised May 31, 2020

2020 ◽  
Author(s):  
Leon S. Robertson
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Local Governments ◽  
Motor Vehicle ◽  
Cell Phones ◽  
Care Providers ◽  
Local Spread ◽  
First Case ◽  
Local Areas ◽  
The U.S

ABSTRACTA simple model of local spread of COVID-19 is needed to assist local governments and health care providers to prepare for surges of clinical cases in their communities. National and state based models are inadequate because the virus is introduced and spreads at different rates in local areas. Models based on motor vehicle traffic measured by tracking cell phones movement in relation to daily numbers of confirmed cases are being developed but this study finds that indicator less effective in predicting future cases than time since the shutdown or the first case in a county in states that didn’t shut down. Each county has its own function of time since the shutdown or first case if there were no state shutdown that can be used to predict increases in reported cases two weeks in advance for each of 959 counties in the U.S. with populations of 50,000 or more inhabitants.

The Use of Vacuum-Assisted Closure Therapy for the Treatment of a Large Infected Facial Wound

2006 ◽  
Vol 72 (2) ◽  
pp. 129-131 ◽  
Author(s):  
Rob Schuster ◽  
Arash Moradzadeh ◽  
Kenneth Waxman
Keyword(s):  
Health Care Providers ◽  
Granulation Tissue ◽  
Chronic Wounds ◽  
Care Providers ◽  
Vacuum Assisted Closure ◽  
Vac Therapy ◽  
First Case ◽  
Facial Wound ◽  
The Face ◽  
New Treatment

Chronic wounds in difficult locations pose constant challenges to health care providers. Negative-pressure wound therapy is a relatively new treatment to promote wound healing. Laboratory and clinical studies have shown that the vacuum-assisted closure (VAC) therapy increases wound blood flow, granulation tissue formation, and decreases accumulation of fluid and bacteria. VAC therapy has been shown to hasten wound closure and formation of granulation tissue in a variety of settings. Accepted indications for VAC therapy include the infected sternum, open abdomen, chronic, nonhealing extremity wounds and decubitus ulcers. We report the first case of VAC therapy successfully used on a large infected wound to the face to promote healing.

scholarly journals Acute Myopericarditis after COVID-19 Vaccine in Teenagers

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Shashikanth Ambati ◽  
Michael Colon ◽  
Maya Mihic ◽  
Javier Sanchez ◽  
Adnan Bakar
Keyword(s):  
Chest Pain ◽  
Health Care Providers ◽  
Systolic Function ◽  
Correct Diagnosis ◽  
Care Providers ◽  
First Case ◽  
Ct Angiogram ◽  
St Segment ◽  
Coronary Syndromes ◽  
Taking Care

Background. There have been an increasing number of reports of myocarditis and pericarditis in adolescents and young adults after coronavirus disease 19 vaccinations. The pathophysiology of myocarditis after this vaccination is indeterminate currently. The problem is a relatively new phenomenon, and so there are no current guidelines on how to manage these cases of myopericarditis. We intend to describe our management in these two cases so that it can help guide pediatricians, intensivists, and cardiologists taking care of similar cases. Case Summaries. The first case is a young adolescent who presented with chest pain after receiving his second dose of coronavirus disease 19 vaccination with no other symptoms. His troponin was found to be 40 ng/mL. He had a normal echocardiogram and chest CT angiogram. His troponins trended down with symptomatic pain management after 3 days. The second case is another adolescent who presented with fever, fatigue, headache, and chest pain 3 days after receiving his second dose of coronavirus vaccine. His troponin was elevated to 5 ng/mL, electrocardiogram with ST segment elevations, and mildly decreased systolic function on echocardiogram. His troponins and electrocardiogram were normalized in 3 days at the time of his discharge. Conclusion. The clinical course of vaccine-associated myocarditis appears favorable as both our patients have responded well to medications and rest with prompt improvement in symptoms with full recovery. The experience remains limited at this time regarding the investigations, management, and follow-up of this novel clinical entity. It is vital for all the health care providers taking care of adolescents to have knowledge about this phenomenon and make correct diagnosis in those presenting with chest pain after COVID-19 vaccine and in preventing unnecessary invasive procedures such as coronary angiogram to rule out acute coronary syndromes.

Recurrent Venous Thromboembolism in Two Patients With Cancer Taking Rivaroxaban

2016 ◽  
Vol 30 (3) ◽  
pp. 381-384 ◽  
Author(s):  
Jacqueline M. Theodorou ◽  
Yogini Patel ◽  
Patricia Ford
Keyword(s):  
Venous Thromboembolism ◽  
Cancer Patient ◽  
Health Care Providers ◽  
Patient Population ◽  
Fixed Dose ◽  
Care Providers ◽  
Patients With Cancer ◽  
Treatment And Prevention ◽  
First Case ◽  
Recurrent Venous Thromboembolism

Pharmacologic agents for the treatment and prevention of venous thromboembolism in the cancer patient population are limited. Currently, low-molecular-weight heparin is recommended by national consensus guidelines for this indication. Rivaroxaban, an oral factor Xa inhibitor, is Food and Drug Administration (FDA) approved for the treatment and prevention of venous thromboembolism and offers the convenience of oral fixed-dose regimens, no routine laboratory monitoring, and has few drug and dietary interactions; however, its use in patients with cancer has not been largely studied. We report 2 cases of recurrent venous thromboembolism in patients with active cancer on rivaroxaban therapy. The first case is a 64-year-old female admitted for recurrent pulmonary embolism, and the second case is a 70-year-old female admitted for recurrent deep vein thrombosis. Both patients were receiving rivaroxaban at the time of thromboembolic recurrence. These cases serve as a reminder to health-care providers that more safety and efficacy data in the cancer patient population are needed prior to using rivaroxaban for venous thromboembolism treatment.

scholarly journals Interesting series of extra abdominal complications in two patients with chronic pancreatitis secondary to chronic alcoholism and pancreatic divisum

2017 ◽  
Vol 8 (1) ◽  
Author(s):  
Dhaval Choksi ◽  
Vikas Pandey ◽  
Prateik Poddar ◽  
Alisha Chaubal ◽  
Meghraj Ingle ◽  
...  
Keyword(s):  
Case Report ◽  
Chronic Pancreatitis ◽  
Pleural Effusion ◽  
Rare Complication ◽  
Chronic Alcoholism ◽  
High Index ◽  
Abdominal Complications ◽  
First Case ◽  
Per Se ◽  
High Index Of Suspicion

Pancreaticopleural fistula is an extremely rare complication of chronic pancreatitis. Interestingly it may present without any symptoms of pancreatitis per se. The diagnosis requires a high index of suspicion due to the predominant thoracic symptoms. Cases with massive, rapidly refilling, refractory pleural effusion in the setting of pancreatitis (symptomatic or asymptomatic) should be suspected of having a pancreaticopleural fistula. We report two cases of pancreaticopleural fistula. One of the patient also had pancreatic divisum and to the best of our knowledge this is the first case report of pancreatic divisum with pancreaticopleural fistula in the literature.

scholarly journals Transitional Cell Carcinoma and Pseudocirrhosis— A Case Report and Review of the Literature

2020 ◽  
Vol 3 (S 01) ◽  
pp. S73-S76
Author(s):  
Gilad Borisovsky ◽  
Daniel A. Goldstein ◽  
Noa Eliakim-Raz ◽  
Shlomit R. Tamir
Keyword(s):  
Case Report ◽  
Liver Disease ◽  
Transitional Cell Carcinoma ◽  
Cell Carcinoma ◽  
Rare Complication ◽  
Transitional Cell ◽  
Review Of The Literature ◽  
Vein Thrombosis ◽  
First Case ◽  
Metastatic Liver

AbstractPseudocirrhosis is the occurrence of capsular retraction in patients with metastatic liver disease, usually of breast origin. It usually appears in these patients following chemotherapy and may result from shrinkage of the tumor, with scarring and nodular regeneration. In this article, we describe the first case of pseudocirrhosis, following treatment of transitional cell carcinoma metastatic to the liver. Portal vein thrombosis, a rare complication in pseudocirrhosis, was also detected in this patient.

scholarly journals An Unusual Combination of Three Rare Complications: Pleuro-Pancreatic Fistula, Chylous Ascites, and Renal Vein Thrombosis, in a Case of Acute Severe Pancreatitis

2019 ◽  
Vol 05 (04) ◽  
pp. e188-e191
Author(s):  
Tanweerul Huda ◽  
Anjaly Mohan ◽  
Mohammad Masoom Parwez ◽  
Bharati Pandya
Keyword(s):  
Pleural Effusion ◽  
Pancreatic Fistula ◽  
Renal Vein ◽  
Rare Complication ◽  
Chylous Ascites ◽  
Renal Vein Thrombosis ◽  
Chest Drain ◽  
Acute Severe Pancreatitis ◽  
Vein Thrombosis ◽  
Severe Pancreatitis

Abstract Background Acute pancreatitis is fraught with a variety of complications, which account for the mortality associated. Our case had a fulminant course, with three rare, near-fatal complications and was successfully managed conservatively. Pleural effusion due to pleuro-pancreatic fistula is uncommon, seen in only 1% cases, of which right-sided effusions are rarer still. Management modalities include conservative, endoscopic, and surgical options. Chylous ascites is an extremely rare complication of pancreatitis and is managed with high protein, low lipid diet, restricted to medium-chain triglycerides (MCTs). Extra-splanchnic venous thrombosis is uncommon in pancreatitis, and isolated renal vein thrombosis is very rare. Case Presentation A 34-year-old, chronic alcoholic male, presented to the outpatient department (OPD) in a state of shock and respiratory distress. Chest radiograph showed massive right-sided pleural effusion. The pleural fluid was hemorrhagic with markedly elevated amylase levels, and contrast-enhanced computed tomography (CECT) confirmed the presence of a right-sided pleuro-pancreatic fistula. Left renal vein thrombosis was also noted. The patient improved with chest drain, intravenous (IV) octreotide, and anticoagulants. Subsequently, he developed hemorrhagic pancreatic ascites, which later turned chylous. This was managed with dietary modifications. The patient had a prolonged recovery but was finally discharged after 45 days. Conclusion It is a challenge managing the various complications of acute severe pancreatitis. We describe this case to emphasize maintaining a high sensitivity for timely diagnosis and appropriate addressal of all the complications for better patient outcomes.

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