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Search Results: 1 - 10 of 6405 matches for " ACUTE "
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Is Outpatient Follow-Up of Epiploic Appendagitis with NSAIDs Alone and Noantibiotics Possible?  [PDF]
Mehmet ?lhan, Er?in S?nmez, Kaan G?k, Hakan Yanar, Recep Gülo?lu, Kayhan Günay, Cemalettin Ertekin
Open Journal of Gastroenterology (OJGas) , 2014, DOI: 10.4236/ojgas.2014.44025
Abstract: Purpose: To assess the clinical course of patients diagnosed as having “epiploic appendagitis” who are given only NSAIDs without antibiotic treatment. Materials and Methods: Between December 2010 and November 2013, twelve patients were presented to the Emergency Surgery Department, Istanbul Medical Faculty, Istanbul University with abdominal pain and were diagnosed having “epiploic appendagitis”. The diagnoses were made using the information gathered from patients’ complaints, physical examination, biochemical results, and radiologic images (Abdominal X-Ray, Abdominal Ultrasonography [USG], and Contrast-Enhanced Computerized Tomography [CT]). We evaluated and recorded the patients’ age distribution, sex difference, laboratory results, radiologic images, length of hospital stay, and control exams after discharge. Results: Twelve out of 35,574 (0.033%) patients who were presented to our Emergency Surgery Department with abdominal pain and were hospitalized as “epiploic appendagitis”. Of these 12 patients, 7 were male (58.3%), and 5 were female (41.7%). The mean age of the patients was 43.5 (range: 22 to 60). The mean time passed between the beginning of the symptoms and presentation to the hospital was 1 day. The length of hospital stay was 1 to 2 days with a mean of 1.3 days. All patients were followed-up non-invasively under NSAID treatment without antibiotherapy. No complications were observed throughout the hospitalization period. The follow-up period of the patients was between 2 to 31 months with a mean of 16 months. Conclusion: Epiploic appendagitis is a self-limiting, benign disease, but differential diagnosis should be done carefully. Patients who are diagnosed with epiploic appendagitis may be followed-up with NSAIDs alone without hospitalization or antibiotherapy.
Impact of rotavirus vaccine on acute gastroenteritis emergency department visits and hospitalizations in a highly-vaccinated urban cohort  [PDF]
Sheila M. Nolan, Priya Prasad, Alexander G. Fiks, Theoklis E. Zaoutis, Thomas R. TenHave, Susan E. Coffin
Open Journal of Pediatrics (OJPed) , 2011, DOI: 10.4236/ojped.2011.14012
Abstract: Background: Rotavirus vaccines (RVV) have significantly reduced rotavirus disease in children over the past 4 years in the United States. In this study, we describe the impact of RVV in preventing acute gastroenteritis (AGE) hospital encounters in a highly-vaccinated urban pediatric network during the 2007 and 2008 rotavirus seasons. Methods: We used 5 urban practices from a practice-based network to conduct a retrospective cohort study comparing the numbers of AGE emergency department (ED) visits and hospitalizations in RVV-immunized (exposed) and non-immunized (unexposed) children during the first 2 full seasons following RVV introduction. We determined incident rate ratios (IRR), using Poisson regression, and vaccine effectiveness for each outcome. Results: The 2007 and 2008 cohorts were analyzed separately. 62% of the 2007 cohort was vaccinated and 88% of the 2008 cohort. AGE hospitalizations were significantly reduced among RVV-immunized children from the 2007 cohort in the 2008 season with vaccine effectiveness of 67%. Sub-analysis of this cohort by age revealed that RVV was most protective against hospitalizations in the youngest age group (IRR = 0.21, 95% CI (0.06, 0.82). A trend toward protection against hospitalization was detected for both cohorts in the first season following immunization that did not reach a statistically significant level. For AGE ED visits, no significant difference was seen between RVV-immunized and non-immunized children in either cohort, although there was a trend toward protection (IRR’s: 0.67 - 0.7). Conclusions: RVV was highly effective in preventing AGE hospitalizations for a subset of our cohort in 2008. Given reports of RVV effectiveness, we hypothesize that herd immunity is responsible for the inability to detect a significant difference between RVV-immunized and non-immunized children in our highly- vaccinated cohort.
Nearly Total Obstruction of Ascending Aorta by Intimal Flap in Tip 1 Aortic Dissection  [PDF]
Okay Güven Karaca, Ayse Gül Kunt, Mehmet Kalender, Mehmet Ta?ar, Ata Niyazi Ecevit, Osman Tansel Dar??n
Surgical Science (SS) , 2013, DOI: 10.4236/ss.2013.41021
Abstract:

Acute Type I aortic dissections are fast progressing highly mortal vascular emergencies if management delays. In this particular paper we report a case with a Type I aortic dissection mistreated for first 2 hours as thrombotic AMI, and aortic dissection diagnosis confirmed and treated surgically immediately. 59 years old male patient admitted to emergency room with sudden onset chest pain. Patient was seen by cardiologist and with NSTMI diagnosis admitted to Coronary ICU. With the suspicion of aortic dissection patient was scanned with contrasted thoraco-abdominal CT. Exam revealed subtotal occlusion of ascending aorta by flap of De Bakey Type I aortic dissection. In conclusion aortic dissection should be considered in differential diagnosis of chest pain. Clinical suspicion aortic dissection is key point of diagnosis and immediate confirmation may be life saving.

Oral ulcerations as the first manifestations of acute leukemia: A case report  [PDF]
Somayeh Alirezaei, Mahin Bakhshi, Jamileh-Bigom Taheri, Ahmad R. Mafi, Omid Moghaddas
Open Journal of Stomatology (OJST) , 2013, DOI: 10.4236/ojst.2013.39083
Abstract:

Acute myeloblastic leukemia (AML) is a highly fatal malignant bone marrow disease. Physicians, dentists and all other healthcare professionals should be aware of sinister oral signs and symptoms in order to early diagnosis and referral of patients. Here we report a case of AML who presented with oral ulcers. Ulcers developed after a parrot bite, which initially misled the physicians. Unfortunately our patient did not survive, but early diagnosis and prompt investigation and treatment can be life-saving in many other similar cases.

Acute pancreatitis revealing ulcerative colitis—A case report  [PDF]
Nora Bousfiha, Iliass Iliass Charif, Mohamed el Abkari, Adil Ibrahimi, Ihsane Mellouki
Open Journal of Gastroenterology (OJGas) , 2014, DOI: 10.4236/ojgas.2014.41003
Abstract: The association of acute pancreatitis with ulcerative colitis [UC] has been described in the literature. It is usually induced by drugs, but sometimes it may be idiopathic. This association remains rare. We report the case of a patient who was treated in our department. Medical observation: Mr. KA, a 60-year-old man, was admitted in our unit for management of acute epigastric. The clinical examination at the admission was normal. After eliminating a cardiac or surgical cause, the diagnosis of acute pancreatitis was made on the basis of the presence of a serum lipase up to 5 times the normal level and pain intensity. An abdominal scanner tomography was performed for the assessment of the pancreatitis. It has shown a pancreatitis stage C associated with a thick rectosigmoidien that was discovered incidentally. Symptomatology was enriched 10 days after by the occurrence of rectal bleeding. A lower endoscopy was performed after the improvement of the pancreatitis and had shown an ulcerative colitis on pancolitis which was confirmed by biopsy. In order to search other causes of this pancreatitis, other tests were made [a biliary IRM, endoscopic ultrasonography, autoimmune tests] and the results were negative. We concluded an idiopathic pancreatitis. The ulcerative colitis was classified as moderate and the patient was put on oral corticosteroids with degression. The evolution was marked by a clinical and biological improvement of pancreatitis and colitis. Conclusion: The association of idiopathic pancreatitis with ulcerative colitis is rare. The case of our patient is the first case reported in our series with 400 cases of ulcerative colitis diagnosed in our service.
Diagnosis of Acute Appendicitis in Adults: Role of a Simple Clinical Diagnostic Triad  [PDF]
Kassem Alubaidi, Malik Aikoye, P. S. Basnyat
Surgical Science (SS) , 2016, DOI: 10.4236/ss.2016.74026
Abstract: Objectives: Acute appendicitis remains the commonest intra-abdominal surgical emergency. This study sought to identify the clinical factors that are most reliable in the diagnosis of acute appendicitis. Methods: This was a retrospective review of consecutive adult appendicectomies over a 6 months period. The frequency of different clinical parameters was assessed to determine the most reliable predictors of acute appendicitis. A simple triad of 3 of the most frequent clinical parameters was examined for diagnostic potential by calculating its sensitivity, specificity, positive predictive value and negative predictive value. Results: There were a total of 124 patients. The median age was 33 years while the gender distribution was 54 males to 70 females. The most common clinical parameters in the patients with appendicitis were right iliac fossa tenderness or peritonism (100.0%), anorexia (78.8%), nausea (75.9%), migratory abdominal pain i.e. pain migrating to right lower quadrant (55.7%), tachycardia (41.3%) and pyrexia i.e. body temperature of 37.8 degrees Celsius and above (22.1%). The simple triad of anorexia, right iliac fossa tenderness and migratory abdominal pain showed specificity for the diagnosis of acute appendicitis of 84.2% and sensitivity of 45.7%. The positive predictive value of this triad was 94.1% while the negative predictive value was 21.9%. Conclusion: Our study reveals that the positivity for this simple clinical triad strongly rules in the diagnosis of acute appendicitis. Its specificity and positive predictive value compares with the most reliable scoring systems for acute appendicitis in literature. Further approaches to diagnosis such as imaging and diagnostic laparoscopy should be considered when this triad is negative and appendicitis is suspected. This simple diagnostic approach allows for prompt diagnosis and treatment which expectedly would improve the morbidity associated with acute appendicitis.
The Role of Dutasteride in Acute Prostatic Haematuria  [PDF]
Vitalis Obisike Ofuru, Christopher Chinedu Obiorah
International Journal of Clinical Medicine (IJCM) , 2017, DOI: 10.4236/ijcm.2017.811056
Abstract: Background: Dutasteride has been found to reduce chronic prostatic bleeding and when taken 2 - 6 weeks preoperatively reduces bleeding during transurethral prostate resection. The aim of this study is to determine if the drug will be effective in the control of acute gross prostatic haematuria. Patients and Method: 87 Consecutive patients with gross haematuria were enrolled. Clotting Profile, Cystoscopy and Intravenous Urography were done to exclude haematuria from medical, renal and bladder causes. Patients suspected to have prostatic haematuria were further evaluated using serum Prostate specific antigen (PSA) and Prostate scan. Those with elevated PSA ≥ 10 ng/ml and abnormal digital rectal examination (DRE) finding had prostate biopsy. The patients were randomly divided into 2 treatment groups. The control group had Normal saline irrigation and broad spectrum antibiotics while the second group received 0.5 mg oral dutasteride in addition. The time taken and volume of irrigation fluid used before haematuria stopped were noted. Statistical analysis was done using SPSS version 20.0. Result: 75 patients had haematuria of prostatic origin. 49 (65.3%) of these had benign prostatic hyperplasia (BPH) and 26 (34.7%) had cancer of prostate. 25(51%) of the 49 patients with BPH had Normal saline irrigation and antibiotics while 24 (49%) had oral dutasteride in addition. 14 (53.8%) of the prostate cancer patients had Normal saline irrigation and antibiotics while 12 (46.2%) had dutasteride in addition. Haematuria resolved in significantly shorter length of time using lesser volume of irrigation fluid in those treated with dutasteride than in those on control arm. Conclusion: Addition of 0.5 mg oral dutasteride daily leads to early resolution of acute prostatic haematuria.
Helical Computed Tomography in Evaluation of Selected Cases of Acute Abdomen  [PDF]
Saddig D. Jastaniah, Alamin M. Salih
Advances in Computed Tomography (ACT) , 2014, DOI: 10.4236/act.2014.33006
Abstract: Acute abdomen is a common presentation in emergency medicine. It represents 5% to 10% of all Emergency Department (ED) visits. Diagnosis by imaging includes digital X-ray unit, sonography (US) unit and computed tomography (CT) equipment. During the last years, a trend towards increased use of computed tomography in patients with acute abdomen can be seen. Additionally, patient with severe claustrophobic often cannot tolerate MR scanner. The aim of the present study was to investigate the possibility of optimizing Helical CT parameters in the protocol and emphasize the CT features of selected cases of disorders related acute abdominal complain at the Emergency Department both in general and in a number of selected conditions (Urolithiasis, Aortic Aneurysm Rupture and acute cholecystitis). According to this work findings, non-contrast CT after ultrasound is diagnostic modality for patients with urinary stones in the Emergency Department. Contrast-enhanced CT was highly sensitive for acute aortic syndrome and therefore the CT imaging protocols must be adjusted in order to minimize dose from radiation.
Toxicolological Test of Saponins from Sapindus mukorossi Gaerth  [PDF]
Menghao Du, Sumei Huang, Jinping Zhang, Jingwen Wang, Lisong Hu, Jingmin Jiang
Open Journal of Forestry (OJF) , 2015, DOI: 10.4236/ojf.2015.57067
Abstract: The study has been carried out to investigate acute oral toxicity, acute dermal toxicity in SPF rats and dermal irritation in rabbits. The result shows: 1) acute oral toxicity test shows that LD50 of saponins from Sapindus mukorossi is 9260 mg/kg (95% confidence interval is 6360 - 13,500 mg/kg) and 7940 mg/kg (95% confidence interval is 4890 - 12,900 mg/kg); 2) acute dermal toxicity test shows that LD50 of saponins from Sapindus mukorossi is more than 5000 mg/kg in both female and male Wistar rats; 3) dermal irritation test in rabbits shows that the average score of dermal irritation per day of each rabbit is zero after 14 days of continuous dermal irritation. According to the classification standard of toxicity in “Hygienic Standard for Cosmetics” (2002 version), the sample is classified as “practical nontoxic” and “non dermal irritation”. Thus, we can conclude that the saponin extraction from S. mukorossi Gaerth is safe for cosmetics.
Giant Appendicolith in Acute Exacerbation of Chronic Appendicitis: Case Report and Literature Review  [PDF]
Alberto Manuel González Chávez, Ricardo Ray Huacuja Blanco, Mario Andrés González Chávez, Silviano Ríos Pascual, Diego Abelardo álvarez Hernández, José de Jesús Curiel Valdés
Surgical Science (SS) , 2017, DOI: 10.4236/ss.2017.811051
Abstract: Right iliac fossa pain remains a challenge for clinicians, since it requires considering several differential diagnoses. Acute appendicitis continues to be one of the most important diagnoses to confirm or to rule out in acute abdominal pain, due to the associated morbidity and mortality. Currently, imaging studies contribute to increase diagnostic certainty, but sometimes reveal unexpected findings, which may further complicate the diagnosis and therapeutic decisions. We present the case of an unusual image finding in the right iliac fossa, a calcification suggestive of gallstone ileus, in the context of an acute abdomen with an unusual transoperative finding, whose definitive diagnosis by pathology, was also rare.
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