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Diagnostic and Therapeutic Implications of Cholelithiasis in Children  [PDF]
Nexhmi Hyseni, Sadik Llullaku, Sejdi Statovci, Murat Berisha, Hysni Jashari, Gani Ceku, Sali Grajqevci, Fjolla Hyseni
Surgical Science (SS) , 2016, DOI: 10.4236/ss.2016.73019
Abstract: Introduction: Cholecystitis, for a long time considered as a disease of adults, has had an increased documented incidence of non-haemolitic cholelithiasis in the Pediatric Surgery practice in the last 20 years. Even though diseases of the gall bladder are rare in children, pediatric patients account for 4% of all cases with cholecystectomy. Cholecystitis and other diseases of the gall bladder should be considered in differential diagnosis in every patient with abdominal pain in the right upper quadrant, followed by jaundice, especially in children with history of hemolysis. Aim: The aim is to discuss the diagnostic and therapeutic modalities in 6 children with acute cholecystitis and cholelithiasis diagnosed and treated at the clinic of the authors. Patients and Methods: In the last 5 years, at UCCK, 6 patients under 12 years of age were operated, cholecystectomy was performed. The disease was more prevalent in female patients (66.66%—4 patients) than in male patients (33.33%—2 patients). Mean age was 8.6. Clinical manifestations presented: increased body temperature, abdominal pain and abdominal tenderness during examination. Other clinical manifestations included: vomiting in 4 patients (66.66%), jaundice in 2 patients (33.33%). Lab results showed leucosytosis in 3 patients (50%), disorders of the liver in 2 patients (33%). 2 patients were diagnosed with spherocytosis and splenomegaly, 1 patient had empyema of gall bladder (wall thickness of the gall bladder > 3.7 mm). Clinical diagnosis was confirmed with ultrasound. Ultrasound criteria are: gall bladder thickness (3.5 mm), stones ose sludge with acoustic shadow, and collection of liquid around gall bladder (pericholecystitis). Results: All patients were initially treated with naso-gastric tube (suction), fluids and antibiotics. Cholecystectomy was performed in 4 patients and cholecys-tectomy with splenectomy in 2 patients due to spherocytosis. Discussion and conclusion: Choleli-thiasis in children is most commonly associated with haemolitic and haemoglobin diseases (Hereditary Spherocytosis, Sideropenic Anaemia, Thalasemia etc.). The incidence of cholesterol stones is higher than pigment stones. Cholecystitis and cholelithiasis in children are more common than previously thought. Ultrasound confirms with great accuracy the presence of stones and acalculous cholesytitis. Treatment is usually surgical, laparoscopic or open surgery, depending on the stage of the disease and the experience of the surgeon.
Diagnostic and therapeutic-restorative procedures for masticatory dysfunctions
Freesmeyer, Wolfgang B.,Fussnegger, M. R.,Ahlers, M. O.
GMS Current Topics in Otorhinolaryngology, Head and Neck Surgery , 2005,
Abstract: Temporomandibular disorders (TMD) or craniomandibular disorders, respectively, involve diseases of the teeth and periodontia as well as the masticatory muscles, temporomandibular joints and associated structures. It has been shown in recent years that psychological, social and general medical influences are of enormous importance in the etiology of TMD in addition to anatomical, physiological, parafunctional and other biological causes. This signifies that therapists confronted with TMD should already include at an early stage other specialists such as pain therapists, neurologists, ENT physicians, psychotherapists and physiotherapists. Patients need to be referred to dentists specializing in TMD when ENT examinations yield no pathological findings. The treatment of TMD is subdivided into the following steps that are always related to underlying diagnoses: informing patients, self-observation, relaxation therapy, behavioral therapy, physiotherapy, drug therapy, therapeutic local anesthesia, splint therapy, and, if necessary, prosthetic and/or orthodontic therapy to restore a stable occlusion.
Therapeutic effect of Epley maneuver on patients with posterior semicircular canal in benign paroxysmal positional vertigo  [cached]
Gholamali Dashti-Khadivaki,Aghil Absalan,Peyman Boroumand
Zahedan Journal of Research in Medical Sciences , 2010,
Abstract: Background: Benign paroxysmal positional vertigo (BPPV) is characterized by brief attacks of vertigo, nausea and/or positional nystagmus during head movements. Epley maneuver is one of the therapeutic processes for these patients and had various results in different studies. The objective of this study was to determine the efficacy of this procedure on treatment of patients with BPPV.Material and Methods: This study was performed from January 2008 till September 2009 in otolaryngology clinic of Khatam teaching hospital in Zahedan. The study was conducted among 67 patients (38 female, 29 male) with p-BPPV between the ages of 27 and 68 years old. Epley maneuver with restriction was performed for treatment after diagnosis of BPPV and one week later, results evaluated using the Dix-Hallpike test.Result: 92.5% of patients had positive response to this type of treatment. Conclusions: The study revealed good efficacy of Epley maneuver on patients with BPPV
Hyperparathyroidism: molecular, diagnostic and therapeutic aspec
Miko?aj Pietkiewicz,Ewa Nienartowicz,D?brówka Soko?owska-D?bek,Urszula Zaleska-Dorobisz
Post?py Higieny i Medycyny Do?wiadczalnej , 2010,
Abstract: The sensitivity of parathyroid glands to a low calcium level in plasma results in parathyroid hormone (PTH) release in order to restore the normal Ca2 concentration. Hyperparathyroidism is a common endocrinopathy, caused by uncontrolled growth of parathyroid cells. In primary hyperparathyroidism, hypercalcemia develops due to extensive autonomous secretion of PTH. Secondary hyperparathyroidism is a well-established complication of chronic renal insufficiency, where marked parathyroid hyperplasia occurs, especially in patients with long dialysis vintage. The elevated PTH level in the circulation is a direct result of renal function disturbances, vitamin D deficiency, and impaired calcium/phosphate metabolism. After successful kidney transplantation, the normalization of kidney function fails to normalize the secretion of PTH by parathyroid glands, which have become relatively autonomous and unresponsive to hypercalcemic conditions in the plasma. The development of tertiary hyperparathyroidism occurs in these conditions.The aim of our report is to present current views on the clinical, pathological and biochemical features of primary, secondary and tertiary hyperparathyroidism. The diagnostics of calcium/phosphate abnormalities in parathyroid gland disorders, as well as some aspects of hyperparathyroidism treatment, are briefly summarized.
Perinatal tuberculosis: Diagnostic and therapeutic approach  [PDF]
Petrovi? Slobodanka,Lju?tina-Pribi? Radmila,Bjelica-Rodi? Branislavka,Vilotijevi?-Dautovi? Gordana
Medicinski Pregled , 2012, DOI: 10.2298/mpns1212496p
Abstract: Introduction. The number of people suffering from tuberculosis has increased rapidly in the whole world over the past three decades. The classical age distribution of disease has also changed. According to the epidemiological data the number of pregnant women having tuberculosis has also risen with the resulting increase in the incidence of perinatal tuberculosis. Pregnancy and Tuberculosis. The presentation of tuberculosis in pregnancy varies. The effects of tuberculosis on pregnancy depend upon various factors: site and extent of the disease, nutritional status and immune status of mother, concomitant diseases, stage of pregnancy when the treatment started and others. A delay between the onset and diagnosis occurs regularly. Treatment response, time to clearance of bacilli from sputum, and prognosis are similar to non pregnant women. Prinatal tuberculosis. Perinatal tuberculosis is extremely rare if the mother is effectively treated in pregnancy, but disease is usually fatal if untreated. Diagnosis of perinatal tuberculosis is very often problematic and difficult. The reason of this is the fact that the initial manifestations of disease are nonspecific and may be delayed. In practice, congenital and early neonatal infections have almost the same mode of presentations, treatment and prognosis. Epidemiological data on the active tuberculosis in mother or some other family member are of the utmost importance in diagnoing tuberculosis. Differences in immune responses in the fetus and neonate add to the diagnostic difficulties already recognised in young children. Tuberculin tests are negative in at least 75% of cases. Conclusion. If the condition is recognized and treated according to existing tuberculosis protocols, the outcome is favourable.
Oesophageal Perforation: A diagnostic and therapeutic challenge in a resource limited setting. A report of three cases
Deo D Balumuka, Phillipo L Chalya, William Mahalu
Journal of Cardiothoracic Surgery , 2011, DOI: 10.1186/1749-8090-6-116
Abstract: We report three cases of oesophageal perforation which were all treated conservatively with tube thoracostomy, nil by mouth with feeding gastrostomy, intravenous antibiotics and chest physiotherapy. Two patients achieved oesophageal healing but one died due to severe septicaemia.In a resource restricted setting, conservative management which includes enteral nutrition by feeding gastrostomy, tube thoracostomy to drain inter pleural contaminants, intravenous antibiotics and chest physiotherapy is a safe and effective treatment for oesophageal perforations.Oesophageal perforation is an uncommon but potentially fatal injury that can quickly progress to mediastinitis, sepsis and multiorgan failure, if early recognition and proper treatment is not instituted [1]. The commonest cause of oesophageal perforation is instrumentation. The frequent use of upper gastrointestinal fiberoptic endoscopy has led to an increase in the actual number of perforations [2]. The most common area of perforation is in the region of the cricopharyngeus muscle. The oesophageal inlet is the narrowest area of the oesophagus and the cricopharyngeus muscle contributes to the decrease in diameter of the lumen [2]. The next commonest site is the lower oesophagus as it narrows to pass through the hiatus[3]. Dilations of the oesophagus carry a risk of perforation, because most are performed for stricture and perforations occur in the diseased thoracic or abdominal portion of the oesophagus [2]. Sever perforations can be caused by; attempted foreign body removal either by a poorly trained endoscopist, or by one who tries to push the foreign body ahead of the endoscope in to the stomach too vigorously[2] or by using the wrong equipment in a resource restricted area.However, most literature comes from western institutions with little coming from Sub-Saharan Africa. We present three cases of oesophageal perforations in a limited diagnostic and therapeutic facility with the aim of showing the feasibility of
Polycystic Ovarian Syndrome: A Diagnostic and Therapeutic Challenge
Manmohan K Kamboj,Dilip R Patel
Journal of Pediatric Sciences , 2010,
Abstract: Polycystic ovarian syndrome (PCOS) is the commonest endocrinopathy in women with a multi-factorial etiology, and presents not just a diagnostic dilemma but also a therapeutic challenge as well. The clinical features of the syndrome in adolescents result from hyperandrogenemia and oligo/anovulation. Most women presenting with non-pregnancy related secondary amenorrhea, oligomenorrhoea, acne, hirsutism, and infertility have PCOS. Consensus diagnostic criteria have been developed by the United States National Institutes of Health (NIH), and the European Society of Human Reproduction and Embryology and American Society of Reproduction (Rotterdam criteria). PCOS needs to be suspected, recognized, and treated to prevent some long term complications. Treatment modalities need to be individualized to address the specific concerns of each female presenting with this entity. This article reviews the diagnosis and principles of management of PCOS.
Acute schistosomiasis: clinical, diagnostic and therapeutic features
Lambertucci, J. R.;
Revista do Instituto de Medicina Tropical de S?o Paulo , 1993, DOI: 10.1590/S0036-46651993000500003
Abstract: three distinct syndromes caused by schistosomiasis have been described: cercarial dermatitis or swimmer's itch, acute schistosomiasis or katayama fever, and chronic schistosomiasis. complications of acute schistosomiasis have also been reported. the absence of a serological marker for the acute stage has hindered early diagnosis and treatment. recently, an elisa test using klh (keyhole limpet haemocyanin) as antigen, has proved useful in differentiating acute from chronic schistosomiasis mansoni. clinical and experimental evidence indicate that steroids act synergistically with schistosomicides in the treatment of katayama syndrome. in this paper, clinical, diagnostic and therapeutic features of acute schistosomiasis are updated.
Infraorbital cutaneous angiosarcoma: a diagnostic and therapeutic dilemma
Tobias Ettl, Johannes Kleinheinz, Ravi Mehrotra, Stephan Schwarz, Torsten E Reichert, Oliver Driemel
Head & Face Medicine , 2008, DOI: 10.1186/1746-160x-4-18
Abstract: This case presents a 64-year-old man with a six-month-history of a recurrent diffuse and erythematous painless swelling below the left eye. Several resections with intraoperatively negative resection margins followed, but positive margins were repeatedly detected later on permanent sections. Histopathologic examination of the specimen diagnosed a cutaneous angiosarcoma. Neither, finally achieved negative margins on permanent sections, nor a following chemotherapy could prevent the recurrence of the disease after five months and the patient's dead 21 months after the first diagnosis.The case elucidates the current diagnostic and therapeutic dilemma of this entity, which shows an unfavourable clinical course in spite of multimodal therapy.A cutaneous angiosarcoma (synonyms: lymphangiosarcoma and haemangiosarcoma) is a rare malignant tumour of vascular endothelial cells. It occurs predominantly in the elderly and is confined to the face and the scalp region in more than 50% of cases [1]. Despite the aggressive behaviour and poor prognosis, the diagnosis is often delayed due to its variable and often benign clinical appearance. This case documents a facial cutaneous angiosarcoma in an elderly male patient, revealing the diagnostic and therapeutic dilemma of this entity, which shows an unfavourable clinical course in spite of multimodal therapy.A 64-year-old man presented with a six month history of a recurrent diffuse and erythematous painless swelling (3 × 2 cm2) below the left eye to the Department of Dermatology, Regensburg University, Germany. Cervical lymphadenopathy was clinically not detectable. Routine laboratory results showed no abnormality. Presuming an allergic dermatitis, topical treatment with steroids was initiated. Because of the persistence of the lesion, an incisional biopsy was performed three weeks later (Figure 1). Histopathology of the specimen showed an invasively growing tumour of the dermis, composed of atypical vascular endothelia in a disorder
Current diagnostic and therapeutic approaches to invasive bladder cancer
?ozi? Jasenko,Bogdanovi? Jovo
Medicinski Pregled , 2005, DOI: 10.2298/mpns0510465d
Abstract: Introduction Bladder cancer is the second most common urological cancer (after prostate cancer, and before kidney and testicular tumors). After setting a diagnosis for bladder cancer, transitional cell carcinoma (TCC), 25% of pts have extravehicular spread of the disease, and almost 50% dies in the follow-up period and after radical surgical procedures. About 30-40% pts develop a recurrence, even after radical cystectomy is preformed, and with negative lymph nodes. T2 stage is underestimated in 40-50% of cases, whereas lymph nodes are positive in 10% of cases in T1 stage of the disease. The aim of this study was to present modern diagnostic-therapeutic procedures, which are being used in multimodal treatment of invasive bladder tumors (surgery, chemotherapy, radiotherapy), indications for their use, and treatment outcome in regard to the stage of the disease. Pathological diagnosis Pathological diagnosis is a key factor for correct and on-time treatment. Pathological diagnosis is made by the biopsy of the tumor. Clinical diagnosis is made by using modern diagnostic procedures (ECHO, CT, MRI, PET scan), and tumor markers (DNA content, p-53, E-Calherine, pRb -retinoblastoma, BCL-2. PCNA. lelomerase. NMP-22, BTA-test. etc.). Treatment of bladder cancer Treatment of bladder tumors is multimodal, multidisciplinary and includes surgery, chemotherapy and radiotherapy. In regard to indications and established protocols, surgery is partial, simple or radical cystectomy, followed by different types oj urine derivation (wet storna-Bricker's Heal conduit, dry stoma-Kock pouch, ureterosigmoidostomy-Main- pouch 11, or orthotopic Heal bladder substitution). The use of new operative procedures can be done only during the early stage of the disease. Orthotopic substitution of bladder with ileum, significantly improves the quality of life in these patients. Also, the use of new chemotherapeutics (Methotrexate, Vinblastine, Cisplatine, Gemcitabine, Taxol, alone or in combination) or radiotherapy together with surgery increases the survival rate, even in patients with invasive form of disease. Conclusion Using new diagnostic equipment, up-to date therapeutic procedures, bladder cancer becomes a curable disease (depending on the stage of the disease) with high survival rate and better quality of life.
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