Evaluation of the Preventive Effect of Chlorhexidine Acetate Gargle for Upper Gastrointestinal Tract Infection After ESD

Conditions:   Esophageal Cancer;   Gastric Cancer
Intervention:   Drug: chlorhexidine acetate gargle
Sponsor:   Peking University Third Hospital
Recruiting

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Ichthyosis: A Harbinger of Lymphoma

Description

A 60-year-old, previously healthy woman presented with patchy skin colour change and dryness for 3 months duration. She also gave a history of recurrent boils requiring local and oral antibiotics. On examination, patchy hyperpigmented skin with scaly appearance was apparent along with features of healed and active infection (figure 1). She also had multiple, firm, lymph nodes (largest 2 cm) in the bilateral axillae. On evaluation, haemoglobin was 115 g/L, white blood cells 7.8x10⁹/L, platelets 248x10⁹/L; peripheral blood smear was normal. Representative skin biopsy showed loss of granular layer characteristic of ichthyosis (figure 2). Right axillary lymph node excision biopsy and immunohistochemistry confirmed the diagnosis of T-cell non-Hodgkin's lymphoma (not otherwise specified). HIV ELISA, thyroid function tests and coeliac serology were inconclusive. She was treated with cyclophosphamide, doxorubicin, vincristine  and prednisolone chemotherapy along with moisturisers (urea-based), regular skin cleansing and salty water bath. After six cycles...

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Blind spot: blindness as initial presentation of subarachnoid haemorrhage

A 47-year-old Caucasian man with arterial hypertension was admitted after a seizure. At the emergency department, he presented with high blood pressure, bilateral vision loss (evidenced by unresponsiveness to threatening stimuli), right hemiplegia and severe agitation. The brain CT angiography showed a diffuse basal cisterns subarachnoid haemorrhage with a ruptured basilar aneurysm. He was admitted for neurovascular procedure and embolisation. The patient's neurological examination improved but blindness persisted. A funduscopic examination revealed a left eye vitreous haemorrhage and diffuse retinal haemorrhages in the posterior pole. Assuming the haemorrhages were the cause of blindness, Terson syndrome was diagnosed. The patient underwent vitrectomy surgery being discharged 5 days later maintaining left eye blindness and able to count fingers from 1 m distance with the right eye. Two months after discharge, he was re-evaluated at our clinic with left eye blurred vision and almost normal right eye visual acuity.

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Bland-White-Garland syndrome on coronary CT angiography

Description

A 2-month-old infant presented with poor weight gain, feeding intolerance and cardiomegaly on chest radiography. Transthoracic echocardiography showed severe left ventricular dilatation and dysfunction, left atrial dilatation, moderate mitral regurgitation and doubtful origin of left coronary artery (LCA). Cardiac catheterisation did not identify the origin of LCA from the aorta. Coronary CT angiography (128-multidetector CT, retrospective ECG-gated with restrictive dose modulation, 70 kVs, 1.2 mSv) revealed the origin of the LCA from the pulmonary artery trunk/root junction, immediately above the sinus of Valsalva and was consistent with remaining echocardiography findings (figure 1). The right coronary artery had normal origin. After surgical reimplantation of the LCA in the ascending aorta there was good clinical evolution, with significant weight gain and gradual left ventricular function improvement.

Figure 1

Anomalous left coronary artery from the pulmonary artery (PA) trunk/root junction on multidetector coronary CT angiography. (A) Origin of the...

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Rocuronium for control of muscle spasms in a tetanus patient with chronic methamphetamine use disorder

This is a case of a 31-year-old Filipino man with chronic methamphetamine use disorder who developed tetanus from a necrotic skin graft over his left calcaneus, which was fractured after a motor vehicular accident. During the course of his illness, the patient's muscle spasms were unusually refractory to benzodiazepine, which is the first-line drug used in the management of muscle spasms. The muscle spasms were successfully controlled on the seventh day of illness with rocuronium at a dose of 10 μg/kg/min and midazolam at 0.30 mg/kg/hour. Both infusions were tapered off until the 23rd day of illness. The patient was discharged on the 30th day of illness, improved and stable.

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Wellens syndrome: a pattern to remember

Description

Electrocardiographic changes in asymptomatic individuals may be a diagnostic challenge. The knowledge and early identification of these patterns and their correct association with clinical picture shall have an urgent and specific management.

A 75-year-old Caucasian man with medical history of hypertension and peripheral arterial disease presented at the emergency department, transported by the prehospital emergency team, complaining of an intense chest pain, which woke him up, with irradiation to the left upper limb and diaphoresis. The patient denied nausea, vomiting, palpitations and previous complaints of angina as well. It was administered, during transport, sublingual nitroglycerine, with resolution of the pain.

The patient was vigil, oriented and haemodynamically stable. Physical examination was unremarkable.

The admission ECG, without pain, showed sinus rhythm, heart rate of 60 bpm, right bundle branch block pattern and deep negative symmetrical T waves in the precordial derivations (V2 to V6) suggestive of type 2 Wellens'...

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An unusual cause of thunderclap headache after eating the hottest pepper in the world - "The Carolina Reaper"

Description

A 34-year-old man with no significant medical history presented to the emergency room (ER) after an episode of thunderclap headache. His symptoms began with dry heaves but no vomiting immediately after participation in a hot pepper contest where he ate one 'Carolina Reaper,' the hottest chili pepper in the world. He then developed intense neck and occipital head pain that became holocephalic. During the next few days, on at least two occasions and in retrospect he thought probably more often, he experienced brief intense thunderclap headaches lasting seconds. The pain was excruciating and thus he came to the ER. He denied any focal tingling sensation or weakness, slurred speech, or transient loss of vision. Physical examination revealed blood pressure of 134/69 mm Hg and no neurological deficits. Urine drug screen and non-contrast CT head and neck were unremarkable. CT angiography revealed no aneurysm but demonstrated unexpected multifocal luminal...

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