Gallbladder volvulus—acute cholecystitis ‘with a twist’

Abstract

A Caucasian 92-year-old female was admitted to hospital with acute epigastric pain associated with vomiting. Initial investigations revealed mildly raised inflammatory markers, normal liver function tests but a markedly distended gallbladder with prominent wall thickening. The patient was managed with intravenous antibiotics for acute cholecystitis but deteriorated significantly on Day 2 of admission. An emergency laparoscopic cholecystectomy was performed and we found a gangrenous gallbladder secondary to gallbladder volvulus. The patient recovered well in the postoperative period and was discharged home 7 days later.

https://ift.tt/2QT8KHy

Paradoxical embolism through PFO leading to stroke in a gunshot victim with IVC injury

Abstract

A 23-year-old man presented to the emergency department with multiple gunshot wounds to the chest and abdomen, and was taken to the operating room emergently for exploratory laparotomy due to hemodynamic instability. The patient underwent inferior vena cava (IVC), bowel and ureter repair during the procedure, requiring massive amounts of blood products. The patient transferred to the surgical intensive care unit with a routine post-operative course for approximately the next 7 days before presenting with signs of stroke. The patient was diagnosed with deep vein thrombosis in IVC at the repair site on a follow-up venogram. Upon further work-up with echocardiography, the patient was determined to have a patent foramen ovale (PFO), with paradoxical embolism as the most likely cause of the stroke. We present this unusual case of a GSW leading to stroke due to embolism from a venous source through a PFO.

https://ift.tt/2PFy1bG

Solitary fibrous tumor of the stomach with high-grade sarcomatous dedifferentiation

Abstract

Solitary fibrous tumors (SFT) are uncommon fibroblastic mesenchymal neoplasms that display a wide range of histologic behaviors. These tumors, which are estimated to account for 2% of all soft tissue neoplasms, typically follow a benign clinical course. However, it is estimated that 10–30% of SFTs are malignant and demonstrate aggressive behavior with local recurrence and metastasis up to several years after surgical resection. We report a case of SFT arising from the stomach, which is an exceptionally rare finding and has been reported only six times in the literature. Our case was complicated by diagnostic dilemma with GIST, highlighting the challenges of diagnosing and characterizing SFTs. Additionally, this tumor was associated with dedifferentiation into undifferentiated pleomorphic sarcoma. To our knowledge, there are no documented cases of a malignant SFT arising from the stomach to demonstrate dedifferentiation into an undifferentiated pleomorphic sarcoma.

https://ift.tt/2DMDp6i

Burden of Herpes Zoster in the Japanese Population with Immunocompromised/Chronic Disease Conditions: Results from a Cohort Study Claims Database from 2005–2014

Abstract

Introduction

The aim of this study is to describe the disease burden and costs of herpes zoster (HZ) in the general adult Japanese population or patients with immunocompromised (IC) conditions or chronic disorders.

Methods

A retrospective cohort study of individuals aged 18–74 years was conducted using January 2005 to December 2014 records from the Japan Medical Data Center claims database. Twenty-eight IC conditions and chronic disorders were defined by diagnosis codes and/or procedures/treatments. HZ and its related complications were identified. Incidence rates (IR), frequency of HZ-related complications, healthcare resource utilization (HRU), and direct medical costs were estimated. HRU and costs were estimated on a subcohort of HZ cases occurring April 2012–January 2014.

Results

The overall IR of HZ in the total cohort of 2,778,476 adults was 4.92/1000 person-years (PY) [95% confidence interval (CI): 4.86–4.98] and increased with age. The IR in the IC cohort (51,818 subjects) was 8.87/1000 PY (95% CI: 8.29–9.48), ranging from 5.55/1000 PY (95% CI: 4.26–7.09) in psoriasis to 151.68/1000 PY (95% CI: 111.45–201.71) in hematopoietic stem cell transplant recipients; most IRs were in the range 6–10/1000 PY. The IRs in individuals with chronic disorders were also relatively high, in the range 5.40–12.90/1000 PY. The frequency of postherpetic neuralgia was 4.01% (95% CI: 3.72–4.33) in the total cohort and 11.73% (95% CI: 9.01–14.93) in the IC cohort. The mean [standard deviation (SD)] number of outpatient visits was 3.4 (4.9) and 5.0 (5.7), respectively, and the proportion of HZ patients hospitalized was 2.20% and 6.70%, respectively. The mean (SD) direct medical cost per HZ episode was ¥34,664 (¥54,433) and ¥55,201 (¥92,642) in the total and IC cohort, respectively.

Conclusions

The elevated burden of HZ in Japanese individuals harboring IC conditions and chronic disorders documented in our study underlines the need for prevention of HZ in people with these conditions.

Funding

GlaxoSmithKline Biologicals SA.

https://ift.tt/2DLgVmb

Nichtkleinzelliges Lungenkarzinom – Staging nach TNM und Therapieprinzipien

https://ift.tt/2A3nj46

Familienorientierte Kunsttherapie für Kinder und Jugendliche mit Krebs sowie deren Eltern im Akutkrankenhaus

Zusammenfassung

Hintergrund und Fragestellung

Wenn ein Kind an Krebs erkrankt, stellt dies dessen Familie meist vor große Herausforderungen. Kunsttherapie kann dabei helfen, die Krankheit psychisch zu verarbeiten. Die Autoren haben in dem hier vorgestellten Projekt ein Angebot entwickelt, mit dem Kinder und ihre Eltern kunsttherapeutisch begleitet werden. Dabei wurde geprüft, ob sich diese familienorientierte kunsttherapeutische Intervention während der onkologischen Behandlung im Krankenhaus durchführen lässt und dazu beiträgt, offene Kommunikation innerhalb der Familie zu fördern und psychische Belastungen zu verringern.

Methoden

Die Intervention umfasst bis zu 11 Sitzungen. Innovativ ist das gleichzeitige kunsttherapeutische Arbeiten von Kind und Eltern mit jeweils einer kunsttherapeutisch ausgebildeten Person. An der Machbarkeitsprüfung haben insgesamt 8 Eltern-Kind-Paare teilgenommen. Die Zufriedenheit mit dem Angebot und die psychische Belastung erfassten die Autoren durch Stundenprotokolle und standardisierte Fragebögen.

Ergebnisse

Das Angebot erwies sich als machbar und im klinischen Alltag prinzipiell umsetzbar. Es zeigten sich jedoch organisatorische Widrigkeiten bei der Umsetzung bezüglich des veranschlagten Umfangs der kunsttherapeutischen Einheiten sowie bei der Gewinnung von Teilnehmern. Die Teilnehmenden gaben an, dass die Intervention dazu beitrug, sich emotional zu entlasten, die Wahrnehmung eigener Bedürfnisse und Ängste zu verbessern und einen Austausch in der Familie zu ermöglichen.

Schlussfolgerung

Mit dem Angebot kann ein niedrigschwelliges Verfahren in der psychosozialen stationären Begleitung von krebskranken Kindern und ihren Familien bereitgestellt werden. Es unterstützt eine differenziertere Wahrnehmung und Spiegelung des Persönlichen innerhalb der Familie.

https://ift.tt/2TnJlY4

Posterior interosseous nerve palsy caused by synovial osteochondromatosis of the elbow analyzed by three-dimensional reconstruction: a case report

Synovial osteochondromatosis, a benign tumor consisting of cartilage and bone, generally presents as multiple osteochondral or chondral nodules. Peripheral nerve palsy caused by synovial osteochondromatosis is...

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