scholarly journals Unusual dyspnea in a hemodialysis patient: A case report

10.3823/2607 ◽  
2019 ◽  
Vol 12 ◽  
Author(s):  
Ching-Hsiang Wang ◽  
Jenq-Shyong Chan ◽  
Chung-Chi Yang ◽  
Po-Jen Hsiao
Keyword(s):  
Hemodialysis Patient ◽  
Pleural Cavity ◽  
Middle Age ◽  
Clinical Symptoms ◽  
Rapid Development ◽  
Previous History ◽  
Final Diagnosis ◽  
Spontaneous Hemothorax ◽  
Life Threatening ◽  
History Of

The typical clinical symptoms of hemothorax include a rapid development of chest pain or dyspnea, which may be life-threatening without immediate management. As we know, spontaneous hemothorax, a collection of blood within the pleural cavity without previous history of trauma or other cause, which usually onsets suddenly. The early and accurate diagnosis of spontaneous hemothorax is imperative in clinical practice. We reported a middle-age male undergoing regular hemodialysis was referred to our emergency department due to unknown cause of dyspnea and acute respiratory failure. Chest radiography revealed bilateral patchy infiltration of lung. Pleural tap analysis showed exudative pleural effusion with numerous red blood cells. Video-assisted thoracic surgery (VATS) were performed and confirmed the final diagnosis of spontaneous hemothorax. He was then successfully treated with the surgery of VATS combined chest tube thoracostomy.

The Use Of Rituximab For Preventing Delayed Haemolytic Transfusion Reaction In Highly Immunized Patients With Sickle Cell Disease

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 1162-1162
Author(s):  
France Noizat-Pirenne ◽  
Marc Michel ◽  
Armand Mekontso-Dessap ◽  
Constance Guillaud ◽  
Keyvan Razazi ◽  
...  
Keyword(s):  
Immune Response ◽  
Sickle Cell Disease ◽  
Clinical Symptoms ◽  
Previous History ◽  
Transfusion Reaction ◽  
Secondary Immune Response ◽  
Cell Disease ◽  
Off Label ◽  
Life Threatening ◽  
History Of

Abstract Introduction Transfusion plays a major role in the management of sickle cell disease (SCD). Delayed haemolytic transfusion reaction (DHTR) is frequent in SCD patients and may have a lethal outcome. DHTR is characterized by recurrence of clinical symptoms related to SCD with a marked haemoglobin (Hb) drop, rapid disappearance of HbA, within 5 to 15 days after transfusion. DHTR is mainly caused by a secondary immune response to an allo-antigen (Ag) on transfused RBCs, but some cases are described without significant antibodies (Abs) or detectable Abs. The increased rate of alloAbs in SCD patients is the result of blood groups polymorphisms between recipients (mainly of Afro-Caribbean’s origin) and donors (Caucasians). Inhibition of a primary or secondary immune response to blood group antigens is therefore a major goal for these patients. B cell depletion therapy with anti-CD20 is commonly used to treat auto-antibodies mediated diseases. Thus, one can speculate that rituximab could be helpful in preventing alloimmunization in SCD patients. Here, we report 8 cases of SCD patients previously allo-immunized, in whom a new transfusion was indicated, and treated with rituximab in order to prevent further immunization and DHTR. Patients and rituximab protocol Patients treated with rituximab were already highly immunized (high responders). All but one had a previous history of life threatening DHTR characterized by severe clinical vaso-occlusive crisis (VOC), acute chest syndrome (ACS) and/or multi organ failure (MOF) and a marked decrease of Hb compared to immediate post-transfusion level, ranging from 2 to 6 g/dl. Treatment with rituximab was given according 2 different regimens depending on the patient’s condition as follows: 1) at a fixed dose of 1,000 mg 2 weeks apart, 1 month and 2 weeks before the procedure in case of a planned surgery requiring a transfusion or 2) a single infusion of 1,000 mg in acute situations of life-threatening VOC with ACS and/or MOF. In all cases, a premedication by low dose of methyprednisolone (10 mg) was administered to limit the risk of secondary VOC. All patients were transfused with leucodepleted RBCs units with matched phenotype for the known antibodies and the most immunogenic blood groups (Rh/Kell/Duffy/Kidd/MNS). Outcome Following rituximab and after transfusion, 4 patients had a non eventful clinical course. Four patients presented a mild DHTR, with a drop of Hb ranging from 2 to 3 g/dl from baseline. Among them, 2 had mild clinical symptoms of intravascular hemolysis and/or exacerbation of VOC, but none of them had an ACS or a MOF, or needed new admission in intensive care unit. In all patients, the post transfusional immunological screening tests remained identical to the pre transfusion screening test without any newly detectable allo-Abs. None of the patients experienced a severe adverse event related to rituximab. Conclusion This retrospective analysis of 8 cases from the French referral centre for SCD suggests that rituximab may at least prevent the occurrence of newly formed antibodies in highly immunized patients and potentially minimize the risk of severe DHTR This study confirms that the mechanisms of DHTR are complex in SCD, and does not rely only on the classical conflict between red blood cell Ag and Abs. Thus, rituximab may be considered when a new transfusion seems inevitable in SCD patients with a previous history of DHTR linked to immunization. Disclosures: Off Label Use: administration of rituximab in a off-label setting.

scholarly journals Orbital Schwannoma: Case Report and Review

2019 ◽  
Vol 38 (03) ◽  
pp. 199-202 ◽  
Author(s):  
Ricardo Lourenço Caramanti ◽  
Mário José Goes ◽  
Feres Chaddad ◽  
Lucas Crociati Meguins ◽  
Dionei Freitas de Moraes ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Previous History ◽  
Mass Effect ◽  
Complete Resection ◽  
High Signal ◽  
Resonance Imaging ◽  
History Of Disease ◽  
Orbital Pain ◽  
History Of ◽  
Magnetic Resonance Imaging Mri

AbstractOrbital schwannomas are rare, presenting a rate of incidence between 1 and 5% of all orbital lesions. Their most common clinical symptoms are promoted by mass effect, such as orbital pain and proptosis. The best complementary exam is the magnetic resonance imaging (MRI), which shows low signal in T1, high signal in T2, and heterogeneous contrast enhancement. The treatment of choice is surgical, with adjuvant radiotherapy if complete resection is not possible. We report the case of a 24-year-old male patient with orbital pain and proptosis, without previous history of disease. The MRI showed a superior orbital lesion compatible with schwannoma, which was confirmed by biopsy after complete resection using a fronto-orbital approach.

scholarly journals Acute respiratory distress secondary to a huge chronic left ventricular pseudo-aneurysm

2019 ◽  
Vol 6 (4) ◽  
pp. K19-K22
Author(s):  
Jonathan Hinton ◽  
George Hunter ◽  
Madhava Dissanayake ◽  
Rob Hatrick
Keyword(s):  
Myocardial Infarction ◽  
Pulmonary Edema ◽  
Previous History ◽  
Late Presentation ◽  
Left Ventricular ◽  
Inferior Wall ◽  
Life Threatening ◽  
History Of ◽  
Pseudo Aneurysm ◽  
Chest X Ray

Summary Pseudo-aneurysms are a rare, potentially life-threatening complication of a myocardial infarction. We present the case of a 45-year-old male who was brought to the emergency department in extremis and had a previous history of a late presentation inferior ST-elevation myocardial infarction treated percutaneously. Clinical examination revealed evidence of cardiogenic shock, pulmonary edema and a pulsatile epigastric mass. Chest X-ray demonstrated marked cardiomegaly and pulmonary edema. Urgent echocardiography confirmed the presence of a huge basal inferior wall pseudo-aneurysm with bi-directional flow. This was also associated with severe mitral regurgitation, due to posterior mitral annular involvement. The patient was transferred to the local cardiothoracic surgical unit where he underwent emergency repair of the pseudo-aneurysm and mitral valve replacement. Despite the surgery being complex he made a full recovery.

scholarly journals Measles outbreak in Gothenburg urban area, Sweden, 2017 to 2018: low viral load in breakthrough infections

2019 ◽  
Vol 24 (17) ◽  
Author(s):  
Nicklas Sundell ◽  
Leif Dotevall ◽  
Martina Sansone ◽  
Maria Andersson ◽  
Magnus Lindh ◽  
...  
Keyword(s):  
Viral Load ◽  
High Risk ◽  
Medical Records ◽  
Clinical Symptoms ◽  
Previous History ◽  
Contact Tracing ◽  
Measles Outbreak ◽  
History Of ◽  
Measles Vaccination

In an outbreak of measles in Gothenburg, Sweden, breakthrough infections (i.e. infections in individuals with a history of vaccination) were common. The objective of this study was to compare measles RNA levels between naïve (i.e. primary) and breakthrough infections. We also propose a fast provisional classification of breakthrough infections. Medical records were reviewed and real-time PCR-positive samples genotyped. Cases were classified as naïve, breakthrough or vaccine infections. We compared clinical symptoms and measles RNA cycle threshold (Ct) values between breakthrough and naïve infections. Sixteen of 28 confirmed cases of measles in this outbreak were breakthrough infections. A fast provisional classification, based on previous history of measles vaccination and detectable levels of measles IgG in acute serum, correctly identified 14 of the 16 breakthrough infections, confirmed by IgG avidity testing. Measles viral load was significantly lower in nasopharyngeal samples from individuals with breakthrough compared with naïve infections (median Ct-values: 32 and 19, respectively, p < 0.0001). No onward transmission from breakthrough infections was identified. Our results indicate that a high risk of onward transmission is limited to naïve infections. We propose a fast provisional classification of breakthrough measles that can guide contact tracing in outbreak settings.

scholarly journals IgG Anti-Toxoplasma pada Cairan Otak Pasien Terinfeksi HIV dan AIDS dengan Meningitis

2018 ◽  
Vol 1 (1) ◽  
Author(s):  
Yunilda Andriyani ◽  
Agnes Kurniawan ◽  
Ika Puspa Sari ◽  
Retno Wahyuningsih
Keyword(s):  
Clinical Diagnosis ◽  
Predictive Value ◽  
Medical Records ◽  
Clinical Symptoms ◽  
Aids Patients ◽  
Significant Difference ◽  
Life Threatening ◽  
History Of ◽  
Weak Negative Correlation ◽  
End Stage

Toksoplasmosis diperkirakan telah menginfeksi sepertiga populasi dunia dan dapat mengancam jiwa pasien dengan imunokompromi. Ensefalitis toksoplasma (ET) terjadi akibat reaktivasi infeksi laten T. gondii yang sering terjadi pada pasien AIDS, terutama stadium akhir. Untuk menegakkan diagnosis pasti pada pasien AIDS dengan kelainan SSP sangatlah sulit. Diagnosis ET ditegakkan hanya berdasarkan asumsi dari gejala klinis, gambaran radiologi, dan respon terhadap terapi yang diberikan. Pemeriksaan kadar IgG dari cairan organ masih jarang dilakukan. Sampel cairan otak diperoleh dari 50 pasien HIV dan AIDS yang dikumpulkan sejak Januari 2013 hingga 2014 di Laboratorium Parasitologi FKUI. Kadar CD4+, gejala klinis, hasil radiologi, diagnosis klinis, riwayat terapi profilaksis ko-trimoksazol, dan analisis cairan otak, diperoleh dari rekam medik.Dari 50 sampel, diperoleh hasil 24 (48%) positif dan 26 (52%) negatif IgG anti-Toxoplasma. Dari IgG positif, terdapat 5 (20,83%) dengan kadar tinggi, dan 19 (79,17%) dengan kadar IgG rendah. Tidak ada perbedaan bermakna antara kadar IgG antiToxoplasma dengan hasil radiologi, diagnosis klinis, maupun riwayat terapi profilaksis ko-trimoksazol. Diperoleh korelasi negatif antara kadar CD4+ dan IgG anti-Toxoplasma, walaupun kekuatannya sangat lemah. Berdasarkan hasil radiologi, diperoleh sensitivitas 56%, spesifisitas 57%, nilai duga positif 41%, dan nilai duga negatif 71%. Toxoplasmosis is estimated to infect a third of the world's population and can be life-threatening to human immunocompromised system . Toxoplasma Encephalitis (TE) is caused by reactivation of latent T. gondii infection that often occurs in AIDS patients especially those with end-stage . To establish a definite diagnosis in AIDS patients with Central Nervous System (CNS)disorders is very difficult. The diagnosis of TE is only based on the assumptions of clinical symptoms, radiological features, and responses to the therapy given. Examination of IgG levels from organ fluids is still rare. CSF samples were taken from 50 HIV/AIDS patients collected from January 2013 to 2014 at the Parasitology Laboratory at FKUI (Medical Departement of University of Indonesia). CD4 levels, clinical symptoms, radiological results, clinical diagnosis, history of co-trimoxazole prophylaxis, and SCF analysis were obtained from medical records. The results showed that IgG-anti Toxoplasma was positive in 24 patients (48%) and negative in 26 patients (52%). From the positive IgG, there were 5 patients(20.83%) with high IgG levels, and 19 patients(79.17%) with low IgG levels. There was no significant difference between the levels of IgG anti-toxoplasma and the results of radiology, clinical diagnosis, and a history of co-trimoxazole prophylactic therapy. There was a weak negative correlation between CD4 + and IgG anti-Toxoplasma levels, The results of radiology showed values of sensitivity 56%, specificity 57%, positive predictive value 41%, and negative predictive value 71%.

scholarly journals Performance of COVID-19 associated symptoms and temperature checking as a screening tool for SARS-CoV-2 infection

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257450
Author(s):  
Benjamin Demah Nuertey ◽  
Kwame Ekremet ◽  
Abdul-Rashid Haidallah ◽  
Kareem Mumuni ◽  
Joyce Addai ◽  
...  
Keyword(s):  
Public Space ◽  
Roc Analysis ◽  
Screening Tool ◽  
Clinical Symptoms ◽  
Effective Means ◽  
Final Diagnosis ◽  
P Value ◽  
Social Distancing ◽  
Chi Squared ◽  
History Of

Introduction Coronavirus disease-19 (COVID-19), which started in late December, 2019, has spread to affect 216 countries and territories around the world. Globally, the number of cases of SARS-CoV-2 infection has been growing exponentially. There is pressure on countries to flatten the curves and break transmission. Most countries are practicing partial or total lockdown, vaccination, massive education on hygiene, social distancing, isolation of cases, quarantine of exposed and various screening approaches such as temperature and symptom-based screening to break the transmission. Some studies outside Africa have found the screening for fever using non-contact thermometers to lack good sensitivity for detecting SARS-CoV-2 infection. The aim of this study was to determine the usefulness of clinical symptoms in accurately predicting a final diagnosis of COVID-19 disease in the Ghanaian setting. Method The study analysed screening and test data of COVID-19 suspected, probable and contacts for the months of March to August 2020. A total of 1,986 participants presenting to Tamale Teaching hospital were included in the study. Logistic regression and receiver operator characteristics (ROC) analysis were carried out. Results Overall SARS-CoV-2 positivity rate was 16.8%. Those with symptoms had significantly higher positivity rate (21.6%) compared with asymptomatic (17.0%) [chi-squared 15.5, p-value, <0.001]. Patients that were positive for SARS-CoV-2 were 5.9 [3.9–8.8] times more likely to have loss of sense of smell and 5.9 [3.8–9.3] times more likely to having loss of sense of taste. Using history of fever as a screening tool correctly picked up only 14.8% of all true positives of SARS-CoV-2 infection and failed to pick up 86.2% of positive cases. Using cough alone would detect 22.4% and miss 87.6%. Non-contact thermometer used alone, as a screening tool for COVID-19 at a cut-off of 37.8 would only pick 4.8% of positive SARS-CoV-2 infected patients. Conclusion The use of fever alone or other symptoms individually [or in combination] as a screening tool for SARS-CoV-2 infection is not worthwhile based on ROC analysis. Use of temperature check as a COVID-19 screening tool to allow people into public space irrespective of the temperature cut-off is of little benefit in diagnosing infected persons. We recommend the use of facemask, hand hygiene, social distancing as effective means of preventing infection.

Pedophilic Episodes in Middle Age and Senescence: An Intergenerational Encounter

1995 ◽  
Vol 40 (3) ◽  
pp. 125-129 ◽  
Author(s):  
M. Cormier Bruno ◽  
Renée Fugère ◽  
Ingrid Thompson-Cooper
Keyword(s):  
Forensic Psychiatry ◽  
Middle Age ◽  
Previous History ◽  
Later Life ◽  
Careful Analysis ◽  
Acting Out ◽  
Emotional Context ◽  
History Of ◽  
The Relationship

The study of pedophilic episodes in later life shows how acting out in a particular emotional context can help the offender to reorganize his life. After reviewing 36 cases referred to the McGill Clinic in Forensic Psychiatry between 1980–1989, a previous history of offender victimization was found in 12 cases. Careful analysis of all the cases showed reactivation of conflict in their family of procreation in 34 cases. Various psychodynamic hypotheses are suggested through the longitudinal history of the perpetrator and the nature of the relationship between victim and perpetrator. Analysis of a longitudinal follow-up in 26 cases suggests that through various mechanisms of organization, disorganization and reorganization, the pedophilic episode represented an opportunity for these middle-aged and senescent pedophiles to resolve some issues underlying their pedophilic interests, leading to a higher level of maturity, thereby preventing relapse of pedophilic episodes.

scholarly journals Diagnosis of bone metastasis from thyroid carcinoma: a multidisciplinary approach

2015 ◽  
Vol 4 (11) ◽  
pp. 205846011560324
Author(s):  
Thor Bechsgaard ◽  
Giedrius Lelkaitis ◽  
Karl E Jensen ◽  
Caroline Ewertsen
Keyword(s):  
Thyroid Carcinoma ◽  
Multidisciplinary Approach ◽  
Previous History ◽  
Final Diagnosis ◽  
Resonance Imaging ◽  
Patient History ◽  
Cortical Destruction ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
Diagnosis Of Bone Metastasis

Sarcomas are rare tumors originating from soft tissue or bone. Diagnosis and treatment of sarcomas should be performed at specialized sarcoma centers, where patients are evaluated at a multidisciplinary tumor conference. We present a case where sarcoma was suspected from magnetic resonance imaging (MRI), but histology revealed a metastasis from thyroid carcinoma, although the patient had no previous history of thyroid malignancy and resection of the thyroid gland was without malignancy. Ultrasound-guided biopsy was possible due to cortical destruction and the multidisciplinary approach with re-evaluation of previous pathology and a thorough patient history enabled a final diagnosis.

scholarly journals Acute Hepatitis due to Garcinia Cambogia Extract, an Herbal Weight Loss Supplement

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Akshay Sharma ◽  
Elisa Akagi ◽  
Aji Njie ◽  
Sachin Goyal ◽  
Camelia Arsene ◽  
...  
Keyword(s):  
Weight Loss ◽  
Acute Hepatitis ◽  
Previous History ◽  
Herbal Supplement ◽  
Drug Induced ◽  
Garcinia Cambogia ◽  
Drug Induced Liver Injury ◽  
Supplement Use ◽  
Life Threatening ◽  
History Of

The Drug Induced Liver Injury Network reports dietary supplements as one of the most important causes of drug induced hepatotoxicity, yet millions of people use these supplements without being aware of their potential life-threatening side effects. Garcinia cambogia (GC) extract is an herbal weight loss supplement, reported to cause fulminant hepatic failure. We present a case of a 57-year-old female with no previous history of liver disease, who presented with acute hepatitis due to GC extract taken for weight loss, which resolved after stopping it and got reaggravated on retaking it. Obtaining a history of herbal supplement use is critical in the evaluation of acute hepatitis.

scholarly journals Pulmonary Arteriovenous Malformation (AVM) Causing Tension Hemothorax in a Pregnant Woman Requiring Emergent Cesarean Delivery

2011 ◽  
Vol 2011 ◽  
pp. 1-3 ◽  
Author(s):  
Nidhi Sood ◽  
Nikhil Sood ◽  
Vibhu Dhawan
Keyword(s):  
Pregnant Woman ◽  
Arteriovenous Malformations ◽  
Previous History ◽  
Tube Placement ◽  
Pulmonary Arteriovenous Malformations ◽  
Pleuritic Chest Pain ◽  
Chest Tube Placement ◽  
Bleeding Vessel ◽  
Life Threatening ◽  
History Of

Pulmonary arteriovenous malformations (PAVMs), although most commonly congenital, are usually detected later in life. We present a case of a 25-year-old woman with no previous history of AVM or telangiectasia, who presented with life-threatening hypoxia, hypotension, and pleuritic chest pain in 36th week of gestation. Chest tube placement revealed 4 liters of blood. Patient was subsequently found to have bleeding pulmonary AVM as the source of hemothorax. Successful embolisation of the bleeding vessel followed by thoracoscopic evacuation of the organized clot relieved the hypoxia. Further screening for AVM revealed large splenic AVM for which patient underwent splenectomy in the coming months.

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