Heroin inhalation complicated by refractory hydrocephalus: A novel presentation.
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ABSTRACT:
SUBMITTER: Bui DH
PROVIDER: S-EPMC4442105 | biostudies-literature | 2015 May
REPOSITORIES: biostudies-literature
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Heroin inhalation complicated by refractory hydrocephalus: A novel presentation.
Bui Diep Ho DH Pace Jonathan J Manjila Sunil S Gokhale Sankalp S Shun Ming-Chieh MC Sloan Andrew A Ramos-Estebanez Ciro C
Neurology 20150422 20
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Project description:Introductionand importance: An encephalocele is a type of congenital neural tube defect defined by herniation of intracranial contents via a cranial defect. When an encephalocele is greater than the size of the head, it is referred to as a "giant encephalocele." The occurrence of encephalocele has been documented to be 1-4 instances per 10,000 live births. Surgery is challenging.Case presentationA 1-month-old baby boy sustained a huge swelling on the back of his head since birth, and it increased gradually over time. On examination, he had a huge occipital swelling measuring about 20 × 15 × 17 cm in size. A diagnosis of giant occipital encephalocele was established. Surgical excision and repair was done. After 1 month, he developed obstructive hydrocephalus and a ventriculo-periotoneal shunting was performed. On regular follow-up, he is in a good state of health.DiscussionSurgery imposes challenges for the anaesthesiologists and neurosurgeons due to its complex site, enormous size, intraoperative blood loss, and prolonged anaesthesia. A team approach is necessary for its successful treatment.ConclusionsBased on our experience, we would like to deliver following recommendations in the surgical management of giant encephalocele. Surgery should be done quickly to ensure good prognosis. Proper positioning, efficient intubation, infections and sepsis control should be emphasized. Also, fortification of food with folic acid, as well as increased education and awareness of women on the need for antenatal care may also decrease the risk of this disease.
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Project description:BACKGROUND:Acute comitant esotropia secondary to heroin withdrawal is a rarely reported phenomenon that has never been described with nystagmus. Adverse effects of heroin on eye alignment were first reported in soldiers returning from Vietnam, yet no theory is generally accepted as the cause of these abnormalities. METHOD:We present a case of a 22-year-old female who developed 40 prism diopters of alternating comitant esotropia with nystagmus 8 days after abrupt heroin cessation, review the existing literature, and propose a novel hypothesis for this phenomenon. RESULTS:After 76 days, her esotropia resolved, and she was left with 7 prism diopters of esophoria. CONCLUSION:This case demonstrates that acquired nystagmus can present in addition to acute-onset esotropia after abrupt heroin cessation. We compare and contrast the theories of this mechanism and review the literature.
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Project description:Introduction Pneumatosis Cystoides Intestinalis (PCI) is a fairly rare condition that is, however, becoming of increasing incidence. It is difficult to ascertain as many patients are asymptomatic, but, in adults, if it does present it usually presents in the fifty-to-eighty years age groups. Importance It may be primary (15% - idiopathic and benign condition) or secondary (85% - usually in neonates and due to necrotising enterocolitis) but the aetiology is unclear, with some theories that have been put forward. Many consider its pathogenesis to be due to increased intra-luminal intestinal pressure and, therefore, build-up of gas from commensal gut bacteria. Imaging and histology are important in diagnosis. Case presentation This case presentation explores the complicated presentation of a patient with PCI and his management, thereof, in order to review the appropriate investigations and the subsequent options of management. Conclusion Because it is a poorly understood condition with varying presentations, it is often misdiagnosed. The diagnosis is critical to allow the correct and most appropriate management to be carried out: non-surgical supportive care versus surgical intervention with resection and stoma or anastomosis. Highlights Pneumatosis cystoides intestinalis: presentation and management of a complicated case.● Pneumatosis Cystoides Intestinalis (PCI) is a fairly rare condition and is difficult to diagnose as many patients are asymptomatic.● Imaging and histology are key the in diagnosis and subsequent non-surgical versus surgical management.● This case presentation explores the complicated presentation of a patient with PCI and his management, along with some associated concurrent diagnoses.
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Project description:BackgroundPin inhalation is an accidental entry of a pin into the respiratory passages. This study aims to shed the light on pin inhalation as a hazard and show the magnitude of such preventable thoracic problem and determine the safest method of management.Patients and methodsThis is a retrospective single center case series, conducted during 18 month period from January 2016 to April 2017, All patients with pin inhalation had been collected and analyzed according to the age, gender, time between aspiration to presentation and symptoms and signs, number of attempts, bronchoscopic or open removal of the pins with complications.ResultsThe total number of patients in this study was 162. The mean age was 11years. Pin inhalation accident was more common in patients less than 10 years in males and less than 20 years in females. The most common gender was female (73%). The most common presenting symptom was cough (54%). The left tracheobronchial tree was the most common site for pin lodgment 107 (67.3%) followed by the right side 23 (14.4%). The majority of the pins were extracted in one piece (94%). Thoracotomy was done in one patient, no death reported.ConclusionSharp pin inhalation is a serious hazard and can have lethal outcome. History is the major parameter to start the diagnosis of pin inhalation and radiography is the gold standard to confirm the diagnosis.
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Project description:Complicated Meckel's diverticulum represents a common etiology of acute abdomen in children. However, this condition is less frequent in adults. We reviewed the records of adult patients who underwent the surgical removal of complicated Meckel's diverticulum between 2001 and 2017 at 2 tertiary French medical centers. We then analyzed the clinical characteristics, mode of presentation, and management for all patients.The Meckel's diverticulum was resected in 37 patients (24 males and 13 females). The mean patient age was 46.1?±?21.4 years. The most common clinical presentations of complicated Meckel's diverticulum were diverticulitis (35.1%, n?=?13), small-bowel obstruction (35.1%, n?=?13), and gastrointestinal bleeding (29.8%, n?=?11) (anemia, n?=?1; hematochezia, n?=?10). Age distribution was significantly different (P?=?.02) according to the 3 Meckel's diverticulum complications: patients with diverticulitis (P?=?.02) were statistically more frequently over 40 (P?=?.05), significantly older than patients with gastrointestinal bleeding who were more frequently <40 (P?=?.05). There was a preoperative diagnosis available for 15 of the 37 patients (40%). An exploratory laparoscopy was necessary to determine the cause of disease for the other 22 patients (60%). An intestinal resection was performed in 33 patients (89%) and diverticulectomy was performed in 4 patients (11%). There was heterotopic tissue found in only 6 patients (16%). Postoperative complications were as follows: 1 death by cardiac failure in a 92-year-old patient and 2 patients with postoperative wound infections. The follow-up time was 3 to 12 months.The correct diagnosis of complicated Meckel's diverticulum in adults is difficult due to the lack of specific clinical presentation. As a result, exploratory laparoscopy appears to play a central role in cases of acute abdomen with uncertain diagnosis.
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Project description:Acute esophageal necrosis (AEN) is a rare presentation of severe esophageal injury. The optimal long-term management of complications related to AEN, particularly stricture formation, are not well defined. We report a case of AEN in a patient who presented with diabetic ketoacidosis (DKA) and had dysphagia due to refractory stricture formation after mucosal healing occurred. A 62-year-old male with diabetes mellitus presented with altered mental status. He was admitted for hypovolemic shock secondary to DKA and treated with vasopressors, fluid resuscitation, and insulin. After resolution of DKA, he reported persistent dysphagia. Upper endoscopy showed circumferential black mucosal discoloration throughout the entire esophagus that spared the gastroesophageal junction. He was diagnosed with AEN and was continued on a proton pump inhibitor and sucralfate with improvement in symptoms. Repeat endoscopy 4 weeks later showed a 10-cm benign-appearing stricture in the mid esophagus. He underwent dilation with temporary symptomatic relief; however, recurrence in symptoms has thus far necessitated a total of 10 repeat upper endoscopies, including repeat dilations along with local steroid injection therapy. AEN is a rare presentation of severe esophageal injury and is typically associated with severe hemodynamic compromise. Although most cases resolve with supportive care and mucosal healing, there is little information regarding prognosis and optimal management of complications, such as refractory esophageal strictures. We describe a case of AEN complicated by refractory symptomatic esophageal stricture despite several dilations and intralesional steroid injections and discuss our approach to treatment.
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Project description:A 2-year-old boy with highly pathogenic avian influenza A(H5N1) virus infection with minimal respiratory symptoms developed encephalitis complicated by obstructive hydrocephalus. Viral RNA was detectable in cerebrospinal fluid. The virus belonged to H5N1 clade 2.3.2.1b and had acquired the mammalian adaptation mutation PB2 Q591K.
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Project description:New onset refractory status epilepticus (NORSE) is a neurological emergency and difficult to treat condition. We report a case of involuntary movements resulting from thiopentone sodium infusion during the management of refractory status epilepticus. A young woman was admitted with fever and NORSE in the neurology intensive care unit. In addition to supportive measures, she was treated with intravenous lorazepam, phenytoin sodium, sodium valproate, midazolam and thiopentone sodium. While on thiopentone sodium, she developed involuntary twitches involving her upper limbs and face with EEG showing no evidence of ongoing status epilepticus. Because of the temporal relationship with thiopentone infusion, we tapered the dose of thiopentone sodium, which resulted in the disappearance of the movements. The patient recovered well with no recurrence of the seizures during the hospital stay.
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Project description:Migraine is a leading cause of disability worldwide. A minority of individuals with migraine develop resistant or refractory conditions characterised by ≥ 8 monthly days of debilitating headaches and inadequate response, intolerance, or contraindication to ≥3 or all preventive drug classes, respectively. Resistant and refractory migraine are emerging clinical definitions stemming from better knowledge of the pathophysiology of migraine and from the advent of migraine-specific preventive treatments. Resistant migraine mostly results from drug failures, while refractory migraine has complex and still unknown mechanisms that impair the efficacy of preventive treatments. Individuals with resistant migraine can be treated with migraine-specific preventive drugs. The management of refractory migraine is challenging and often unsuccessful, being based on combinations of different drugs and non-pharmacological treatment. Future research should aim to identify individuals at risk of developing treatment failures, prevent the condition, investigate the mechanisms of refractoriness to treatments, and find effective treatment strategies.
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Project description:BackgroundPeptic ulcer disease (PUD), once primary a surgical problem, is now medically managed in the majority of patients. The surgical treatment of PUD is now strictly reserved for life-threatening complications. Free perforation, refractory bleeding and gastric outlet obstruction, although rare in the age of medical management of PUD, are several of the indications for surgical intervention. The acute care surgeon caring for patients with PUD should be facile in techniques required for bleeding control, bypass of peptic strictures, and vagotomy with resection and reconstruction. This video procedures and techniques article demonstrates these infrequently encountered, but critical operations.Content video descriptionA combination of anatomic representations and videos of step-by-step instructions on perfused cadavers will demonstrate the key steps in the following critical operations. Graham patch repair of perforated peptic ulcer is demonstrated in both open and laparoscopic fashion. The choice to perform open versus laparoscopic repair is based on individual surgeon comfort. Oversewing of a bleeding duodenal ulcer via duodenotomy and ligation of the gastroduodenal artery is infrequent in the age of advanced endoscopy and interventional radiology techniques, yet this once familiar procedure can be lifesaving. Repair of giant duodenal or gastric ulcers can present a challenging operative dilemma on how to best repair or exclude the defect. Vagotomy and antrectomy, perhaps the least common of all the aforementioned surgical interventions, may require more complex reconstruction than other techniques making it challenging for inexperienced surgeons. A brief demonstration on reconstruction options will be shown, and it includes Roux-en-Y gastrojejunostomy.ConclusionSurgical management of PUD is reserved today for life-threatening complications for which the acute care surgeon must be prepared. This presentation provides demonstration of key surgical principles in management of bleeding and free perforation, as well as gastric resection, vagotomy and reconstruction.Level of evidenceVideo procedure and technique, not applicable.
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