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Imperforate anus with a rectovestibular fistula and pseudotail: a case report
Miranda D Raines, Marcia L Wills, Gretchen P Jackson
Journal of Medical Case Reports , 2010, DOI: 10.1186/1752-1947-4-317
Abstract: A Caucasian girl was born at term after an uncomplicated pregnancy and was noted at birth to have a skin-covered posterior midline mass and imperforate anus with a fistula to the vaginal vestibule. Ultrasound and magnetic resonance imaging revealed a predominately fatty lesion without presacral extension and ruled out associated spinal and cord abnormalities. The patient underwent diversion with colostomy and a mucous fistula in the newborn period as a fistulogram demonstrated a long fistulous tract to normal rectum and it was anticipated that anoplasty and resection of the mass would require extensive posterior dissection. The sacrococcygeal mass was removed during posterior sagittal anorectoplasty at the age of six weeks which was determined to be a pseudotail because of the composition of brown fat and cartilage. The patient is now 14 months old with normal bowel function after a colostomy takedown.A comprehensive preoperative assessment and thoughtful operative plan were necessary in this unusual case because of the extensive differential diagnosis for sacrococcygeal masses in the newborn and the frequency of anomalies and syndromes associated with tail variants and imperforate anus. The pediatricians and neonatologists who initially evaluate such patients and the surgeons who correct these disorders must be aware of the potential pitfalls in their management.Human tails and pseudotails are rare congenital lesions that have been reported since the late 19th century. These entities typically present as skin-covered lumbosacral masses seen in the newborn period. The possible diagnoses for this presentation are broad, ranging from benign hamartomas to aggressive malignancies and meningoceles. As one series illustrates, the management can be complicated not only by the spectrum of disorders and associations but also by parental resistance to crucial preoperative imaging [1].Human tails may occur alone or associated with other anomalies. The most common abnormality a
Treatment of hepatic encephalopathy by on-line hemodiafiltration: a case series study
Shinju Arata, Katsuaki Tanaka, Kazuhisa Takayama, Yoshihiro Moriwaki, Noriyuki Suzuki, Mitsugi Sugiyama, Kazuo Aoyagi
BMC Emergency Medicine , 2010, DOI: 10.1186/1471-227x-10-10
Abstract: This case series study was conducted from May 2001 to October 2008 at the medical intensive care unit of a tertiary care academic medical center. Seventeen consecutive patients who admitted to our hospital presenting with acute liver failure were treated with artificial liver support including daily on-line hemodiafiltration and plasma exchange.After 4.9 ± 0.7 (mean ± SD) on-line hemodiafiltration sessions, 16 of 17 (94.1%) patients completely recovered from hepatic encephalopathy and maintained consciousness for 16.4 ± 3.4 (7-55) days until discontinuation of artificial liver support (a total of 14.4 ± 2.6 [6-47] on-line hemodiafiltration sessions). Significant correlation was observed between the degree of encephalopathy and number of sessions of on-line HDF required for recovery of consciousness. Of the 16 patients who recovered consciousness, 7 fully recovered and returned to society with no cognitive sequelae, 3 died of complications of acute liver failure except brain edema, and the remaining 6 were candidates for liver transplantation; 2 of them received living-related liver transplantation but 4 died without transplantation after discontinuation of therapy.On-line hemodiafiltration was effective in patients with acute liver failure, and consciousness was maintained for the duration of artificial liver support, even in those in whom it was considered that hepatic function was completely abolished.Acute liver failure is usually fatal, and in the US, the mortality rate remains as high as 30% in adult patients [1]. Although liver transplantation for acute liver failure has increased the survival rate markedly, the limited supply of suitable livers implies that transplantation is not available to all patients; 22.7% of patients who were listed for transplantation die awaiting transplantation 3 days after being listed (range 1-6 days). On the other hand, 45% of patients with acute liver failure survive with medical therapy alone without liver transplantation [1].
Spreading tentacles of solvent abuse AND#8211; a case series study  [cached]
Mona Srivastava,Ashish Nair
National Journal of Medical Research , 2012,
Abstract: Introduction:-Solvent abuse is fast spreading among various sections of the society, with increasing urbanization and industrialization this problem is assuming significance. Materials and methods:-This case series discusses solvent abuse in five cases, Discussion:-The discussion will help in emphasizing the need for a holistic approach and stringent measures along with legal steps to deal with this menace. Conclusion:-The increasing availability and graduation to other drugs of abuse is also highlighted. [National J of Med Res 2012; 2(3.000): 395-398]
Prolapsed sigmoid intussusception per anus in an elderly man: a case report
Penn S Teyha, Alphonce Chandika, Vihar R Kotecha
Journal of Medical Case Reports , 2011, DOI: 10.1186/1752-1947-5-389
Abstract: We present a case of a 66-year-old African man who presented to our emergency department with a mass protruding per anus with obstipation. During laparotomy, we found that the sigmoid colon had intussuscepted into the rectum and out from the anus. Other abdominal viscera were normal and without any obvious mesenteric lymphadenopathy. Sigmoid colectomy and spectacle colostomy were performed. Grossly, the excised bowel looked normal, but the histologic results showed features of necrosis and chronic inflammation.While 70% to 90% of cases of adult intussusception have an identifiable cause or lesion, most pediatric intussusceptions are idiopathic. The presentation in an adult described herein was of an uncommon idiopathic type with no identifiable cause found on the basis of the history, physical examination, or histological findings."Intussusception" refers to the telescoping of the proximal bowel into the distal bowel or vice versa (retrograde intussusception). The telescoped part is referred to as the "intussusceptum," and the receiving part is called the "intussuscipiens." This condition is commonly described in infants and rarely in adults. Adult intussusception represents 5% of all cases of intussusception and accounts for only 1% to 5% of intestinal obstructions in adults [1,2]. Almost 90% of cases of intussusception in adults have an underlying bowel pathology such as carcinoma, polyps, Meckel's diverticulum, colonic diverticulum, strictures, or benign neoplasms, which are usually discovered intra-operatively [3]. In this report, we present a case of an elderly man with a prolapsed intussusception.A 66-year-old African man from a rural area presented to our emergency department complaining of persistent, dull lower-back pain of three months' duration and a mass protruding per anus for the previous four days. His lower-back pain was radiating to both thighs and was aggravated by farming activities. His pain was relieved by resting, and the pain was not accompani
A case study of Gr?bner bases and Hilbert series  [PDF]
Soutrik Roy Chowdhury
Mathematics , 2015,
Abstract: In this expository style of writing I will give an introduction of Gr\"{o}bner bases and compute it for some algebras and then show how to use it to compute Hilbert series for algebras from chains.
Is Microsporidial keratitis an emerging cause of stromal keratitis? – a case series study
Geeta K Vemuganti, Prashant Garg, Savitri Sharma, Joveeta Joseph, Usha Gopinathan, Shashi Singh
BMC Ophthalmology , 2005, DOI: 10.1186/1471-2415-5-19
Abstract: Patient charts of five cases of microsporidial stromal keratitis diagnosed between January 2002 and June 2004 were reviewed retrospectively for clinical data, microbiologic and histopathologic data. The presence of microsporidia was confirmed by special stains on corneal scrapings and/or corneal tissues, and electron microscopy. All patients were immunocompetent with a preceding history of trauma in three. Four patients presented with unilateral, small, persisting deep stromal infiltrates, of uncertain etiology, in the cornea, which were not responding to conventional antimicrobial treatment and required penetrating keratoplasty in three. Fifth case was unsuspected and underwent keratoplasty for post-traumatic scar. Three of five cases were diagnosed on corneal scrapings, prior to keratoplasty, while two were diagnosed only on histology. The microsporidia appeared as oval well defined bodies with dense staining at one pole. None of the patients showed recurrence following keratoplasty.Microsporidia, though rare, should be suspected in chronic culture-negative stromal keratitis. Organisms could lie dormant without associated inflammation.Microsporidia are small, oval, obligate intracellular eukaryotic protozoan parasites, widely distributed in vertebrates and invertebrates, but mostly cause infections in immunocompromised individuals [1-3]. The ocular manifestations include superficial punctate keratoconjunctivitis [4-6], and corneal stromal keratitis [7-14] and these two manifestations are directed by the genus involved as well as the immune status of the patient. Keratoconjunctivitis is usually seen in immunocompromised individuals or in contact lens wearers; mostly by genus Encephalitozoon while the stromal keratitis is caused by Nosema and Microsporidium. However, recent reports suggest that keratoconjunctivitis can also occur in immunocompetent individuals [15,16]. A review of the literature in English using PubMed revealed eight cases of corneal stromal involve
Paediatric referrals in rural Tanzania: the Kilombero District Study – a case series
Fidel Font, Llorens Quinto, Honoraty Masanja, Rose Nathan, Carlos Ascaso, Clara Menendez, Marcel Tanner, Joanna Schellenberg, Pedro Alonso
BMC International Health and Human Rights , 2002, DOI: 10.1186/1472-698x-2-4
Abstract: A sample of patient records from primary level government health facilities throughout 1993 were summarised by age, diagnosis, whether a new case or a reattendance, and whether or not they were referred. From August 1994 to July 1995, mothers or carers of all sick children less than five years old attending the Maternal and Child Health (MCH) clinic or outpatient department (OPD) of SFDDH were interviewed using a standard questionnaire recording age, sex, diagnosis, place of residence, whether the child was admitted to the paediatric ward, and whether the child was referred.From record review, only 0.6% of children from primary level government facilities were referred to a higher level of care. At the referral hospital, 7.8 cases per thousand under five catchment population had been referred annually. The hospital MCH clinic and OPD were generally used by children who lived nearby: 91% (n = 7,166) of sick children and 75% (n = 607) of admissions came from within 10 km. Of 235 referred children, the majority (62%) had come from dispensaries. Almost half of the referrals (48%) took 2 or more days to arrive at the hospital. Severe malaria and anaemia were the leading diagnoses in referred children, together accounting for a total of 70% of all the referrals. Most referred children (167/235, 71%) were admitted to the hospital paediatric ward.The high admission rate among referrals suggests that the decision to refer is generally appropriate, but the low referral rate suggests that too few children are referred. Our findings suggest that the IMCI strategy may need to be adapted in sparsely-populated areas with limited transport, so that more children may be managed at peripheral level and fewer children need referral.A functioning referral system is a critical part of an appropriate health care delivery system [1,2]. Referral systems have been given particular emphasis in the context of the health sector reform movement [2] and through the WHO/ UNICEF Integrated Managem
Ovulation induction with minimal dose of follitropin alfa: a case series study
Isidoro Bruna-Catalán, Marco Menabrito, the Spanish Collaborative Group
Reproductive Biology and Endocrinology , 2011, DOI: 10.1186/1477-7827-9-142
Abstract: Spanish centers that had performed at least five OI cycles during 2008 using 37.5 IU/day follitropin alfa as a starting dose were invited to participate. Data could be provided from any cycle performed in 2008 (up to a maximum of 12 consecutive cycles per site). Case report forms were collected during April-November 2009 and reviewed centrally. Descriptive statistics were obtained from all cases, and follicular development and clinical pregnancy rates assessed. Potential associations of age and body mass index with follicular development and clinical pregnancy were assessed using univariate correlation analyses.Thirty centers provided data on 316 cycles of OI using a starting dose of 37.5 IU/day follitropin alfa. Polycystic ovary syndrome was the cause of anovulatory infertility in 217 (68.7%) cases. Follitropin alfa at 37.5 IU/day was sufficient to achieve ovarian stimulation in 230 (72.8%) cycles. A single follicle ≥16 mm in diameter developed in 193 cycles (61.1%; 95% confidence interval [CI] 55.7-66.4%). Seventy-eight women (24.7%; 95% CI 19.9-29.5%) became pregnant: 94.9% singleton and 5.1% twin pregnancies. Fourteen started cycles (4.4%) were cancelled, mainly due to poor response. Univariate correlation analyses detected weak associations.Monofollicular growth rate was comparable with optimal rates reported elsewhere and the pregnancy rate exceeded that in other studies of OI using gonadotropins. A starting dose of 37.5 IU/day follitropin alfa is an effective option in selected cases to prevent ovarian hyper-response without loss of efficacy. The analysis could not identify a single selection criterion for individuals who would benefit from this treatment approach; this merits further investigation in prospective studies.Exogenous follicle-stimulating hormone (FSH) is the most common treatment for chronic anovulatory infertility. Pharmacologic ovulation induction (OI) results in a pregnancy rate of 10-20% per cycle [1]. However, treatment with exogenous gonad
Wolfram Syndrome: Endocrinological Features in a Case Series Study and Review of the Literature
Ali Rabbani,Abdolmajid Kajbafzadeh,Reza Shabanian,Aria Setoodeh
Iranian Journal of Pediatrics , 2007,
Abstract: Objective: Wolfram syndrome (WFS) is a rare and complex genetic disorder referred to as DIDMOAD (diabetes insipidus, diabetes mellitus, optic atrophy and deafness). Material & Methods: All insulin dependent diabetic patients presented over a period of 10 years, who had optic atrophy or a positive family history of WFS, were enrolled in the study. Criteria for the diagnosis of WFS were the presence of insulin dependent diabetes mellitus (IDDM) along with optic atrophy unexplained by any other disease and/or some other abnormalities associated with WFS. Findings: WFS has been diagnosed in sixteen patients, 9 males and 7 females aged 5.5 to 22yr (median age of 13.4 yr). Nine patients (more than half) came from consanguineous marriages. The earliest manifestation of WFS was IDDM (at a median age of 5.4yrs). All patients developed non-autoimmune IDDM before the age of 8 years old. Only two cases were ketoacidotic. Common diabetic complications of proliferative retinopathy, glomerulosclerosis and neuropathy were remarkably absent in our patients even with long-lasting diabetes mellitus. Antidiuretic hormone (ADH)-responsive diabetes insipidus was confirmed by water deprivation test in 8 patients (50%). The incidence of diabetes insipidus in our patients was lower compared to other studies. Growth retardation, as short stature and a weight below the 5th percentile for age and gender, was found in 13 (81%) and 5 (31%) patients respectively. Conclusion: Early diagnosis and proper treatment aimed at relieving the symptoms and preventing the future complications are of paramount value and importance.
High Type Imperforate Anus Without Associated Anomalies in a Nigerian Child: A Case Report
CO Maduforo, OC Okpala, US Etawo
Afrimedic Journal , 2011,
Abstract: Background: The High type imperforate anus is usually associated with congenital anomaly in the other systems or organs. It is rare to have the above type without accompanying anomalies. Aim: To report a case of high imperforate anus without associated anomalies of the other systems or organs in a Nigerian child who was presented at the University of Port Harcourt Teaching Hospital, Port Harcourt. Methods: A case report of a 4-day old Nigerian male +1 delivered to a 34-year old para 2 woman by spontaneous vertex delivery, presented with failure to pass meconium after 4 days. Clinical and imaging examinations revealed a high type imperforate anus without associated anomalies of the other systems. Relevant review of literature was also done. Conclusion: This is a rare clinical entity. The role of radiological imaging in the management of this condition is highlighted. Key Words: Imperforate anus, High type, Associated anomaly. Afrimedic Journal 2011;2(1):24-27
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