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Massive Pulmonary Embolism Presenting as Obstructive Shock in a Nigerian Woman: A Case Report 大面积肺栓塞表现为梗阻性休克在尼日利亚妇女:一个病例报告
Pub Date : 2023-01-01 DOI: 10.26502/acmcr.96550613
Bernard B Akpu, Chidimma A. Ahaneku, Agbo J Etim, Ezoke J Epoke, D. E. Elem, B. Ekeng, Edikan B Bassey, C. Njoku, V. Ansa, C. O. Odigwe
Background: Massive pulmonary embolism is a life-threatening emergency associated with high mortality if prompt diagnosis and urgent intervention is delayed, especially in patients presenting in obstructive shock. It usually requires advanced therapies such as systemic thrombolysis, pharmaco-mechanical catheter-directed therapy, surgical embolectomy and inferior vena cava filter placement. The dearth in skilled manpower, delay in diagnosis, relative unavailability and high cost of fibrinolytics especially in resource poor environments may account for poor clinical outcomes and eventually death in such patients. Case Presentation: We present a 50-year-old Nigerian woman of Bahumono ethnicity who was admitted into our hospital with complains of sudden onset breathlessness. On presentation, she was tachypneic, tachycardic and hypotensive. D-Dimer and Troponin I levels were elevated. Computed tomography pulmonary angiography (CTPA) with intravenous contrast confirmed the diagnosis of massive pulmonary embolism. She was initially treated with low molecular weight heparin, then thrombolyzed with intravenous alteplase and later discharged on tablet dabigatran. Her symptoms had resolved at the time of discharge and she has remained stable for over 3 months. Conclusion: Pulmonary embolism, the most serious clinical presentation of venous thromboembolism can become catastrophic when it presents as the massive type. Prompt diagnosis and urgent appropriate medical intervention ensures good clinical outcomes.
背景:大面积肺栓塞是一种危及生命的紧急情况,如果及时诊断和紧急干预延迟,死亡率高,特别是在表现为阻塞性休克的患者中。它通常需要先进的治疗方法,如全身溶栓、药物机械导管指导治疗、手术栓塞切除和下腔静脉过滤器放置。熟练人力的缺乏、诊断的延误、纤溶药物的相对缺乏和高成本,特别是在资源贫乏的环境中,可能是这些患者临床结果不佳和最终死亡的原因。病例介绍:我们报告一名50岁的尼日利亚Bahumono族妇女,因突发呼吸困难而入院。在就诊时,她有呼吸急促、心动过速和低血压。d -二聚体和肌钙蛋白I水平升高。计算机断层肺血管造影(CTPA)与静脉造影剂证实诊断为大量肺栓塞。患者最初使用低分子肝素治疗,然后静脉使用阿替普酶溶栓,随后使用达比加群片出院。出院时症状已消失,病情稳定3个多月。结论:肺栓塞是静脉血栓栓塞中最严重的临床表现,当其表现为块状时可造成灾难性后果。及时诊断和紧急适当的医疗干预确保了良好的临床效果。
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引用次数: 0
Endocarditis at Prior Venous Cannulation Site after Sternal Wound Infection: Case Report 胸骨伤口感染后静脉插管部位心内膜炎1例
Pub Date : 2023-01-01 DOI: 10.26502/acmcr.96550617
Jared Cappelli, Amber Edwards
Endocarditis originating from a prior venous cannulation site is undescribed in the current literature. Infections of the heart pose significant morbidity and mortality to patients, therefore prompt recognition, diagnosis, and treatment are critical. Our patient underwent coronary artery bypass grafting (CABG) and developed a postoperative sternal wound infection with methicillin resistant staphylococcus aureus (MRSA). After failing nonoperative management, redo-sternotomy was performed with atrial wall debridement and patch repair. During this procedure, two unexpected small discrete abscess pockets of the right atrial epicardium were discovered. One of the abscess pockets fistulized into the right atrium and was noted to be at his prior venous cannulation site for cardiopulmonary bypass as evidenced by neighboring prolene suture. The patient had an uneventful recovery and was discharged home on postoperative day 7. Transthoracic echo was obtained 6 weeks after his second operation and did not show any recurrence of endocarditis. We present a unique case of persistent cardiac infection with a complicated course and management strategy.
起源于先前静脉插管部位的心内膜炎在当前文献中有描述。心脏感染对患者造成严重的发病率和死亡率,因此及时识别、诊断和治疗至关重要。我们的病人接受了冠状动脉旁路移植术(CABG),术后胸骨伤口感染了耐甲氧西林金黄色葡萄球菌(MRSA)。非手术治疗失败后,行胸骨切口、心房壁清创和补片修补术。在此过程中,在右心房心外膜发现了两个意想不到的小的离散脓肿袋。其中一个脓肿袋进入右心房,并在他之前进行体外循环静脉插管的位置被注意到,邻近的prolene缝合线证明了这一点。患者顺利康复,术后第7天出院回家。第二次手术后6周行经胸超声检查,未见心内膜炎复发。我们提出一个独特的病例持续心脏感染与复杂的过程和管理策略。
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引用次数: 0
Oral Lichenoid Lesions May Regress after Amalgama Removal: A Case Report Becomes a Proof of the Concept 口腔苔藓样病变可能在汞合金去除后消退:一个病例报告成为概念的证明
Pub Date : 2023-01-01 DOI: 10.26502/acmcr.96550626
Bettoni E, Bellucci G, Damiani G, Crescentini M
The aim of this report is to present a clinical case of oral lichenoid lesions (OLL) associated with amalgam and various metal restorations, including palladium, mercury, and gold. The patient presented with symptoms and lesions consistent with OLL, and the diagnosis was confirmed through a synthesis of the patient's medical history, clinical examination, histopathological analysis, and direct immunofluorescence. Oral lichenoid lesions are a group of disorders characterized by lesions that resemble oral lichen planus but are caused by a hypersensitivity reaction to certain substances, such as dental materials. In this case, the amalgam and metal restorations were suspected to be the triggering factors for the lichenoid lesions. The histopathological analysis revealed findings consistent with OLL, further supporting the diagnosis. Additionally, direct immunofluorescence testing provided additional evidence for the presence of OLL. The combination of these diagnostic approaches allowed for a comprehensive understanding of the patient's condition. As
本报告的目的是提出一个临床病例口腔苔藓样病变(OLL)与汞合金和各种金属修复,包括钯,汞和金。患者表现出与OLL相符的症状和病变,综合患者病史、临床检查、组织病理学分析和直接免疫荧光,确诊为OLL。口腔苔藓样病变是一组疾病,其特征是病变类似于口腔扁平苔藓,但由对某些物质(如牙科材料)的超敏反应引起。在这种情况下,汞合金和金属修复体被怀疑是触发因素的地衣样病变。组织病理学分析显示的结果与OLL一致,进一步支持诊断。此外,直接免疫荧光检测为OLL的存在提供了额外的证据。这些诊断方法的结合可以全面了解患者的病情。作为
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引用次数: 0
Arthroscopic Removal of Shoulder Joint Embedded Gunshot Bullet: A Case Report 关节镜下肩关节内嵌子弹取出1例
Pub Date : 2023-01-01 DOI: 10.26502/acmcr.96550586
Joseph E Nassar, Yehia Tfayli, M. Issa, Akram Al Ramlawi, A. Naja
Joint related gunshot injuries encompass significant morbidity if left untreated. Open and arthroscopic procedures are the main stay treatment for removal of foreign body. Nevertheless, there is no definitive management due to the scarcity of cases in the literature. We report the case of a white Arab 38-years-old man with a high velocity gunshot wound leading to bullet dislodgement in the left glenohumeral joint. The patient’s wound was treated with arthroscopy, extensive debridement, and decompression of subacromial space with partial acromioplasty.
关节相关的枪伤如果不及时治疗,会导致严重的发病率。开放和关节镜手术是取出异物的主要住院治疗方法。然而,由于文献中病例的缺乏,没有明确的管理方法。我们报告的情况下,白人阿拉伯人38岁的男子与高速枪伤导致子弹脱臼在左肩关节。患者的伤口经关节镜、广泛清创和部分肩峰成形术肩峰下间隙减压治疗。
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引用次数: 0
Tapia syndrome: an Unusual Complication to Recognize at the Time of the COVID-19 Pandemic Tapia综合征:在COVID-19大流行时期要识别的不寻常并发症
Pub Date : 2023-01-01 DOI: 10.26502/acmcr.96550589
M. Piagnerelli, Delphine Ranwez, Perrine Arnould, Chloe d’Adesky, P. Biston, Myriam Houa
Guidelines for acute respiratory distress syndrome (ARDS) management include sedation, neuromuscular blockade for protective ventilation and the need for the prone position. This technique can lead to neurologic sequelae like the Tapia syndrome following the patient position. We reported two ARDS COVD-19 patients with Tapia syndrome due to prone position. Both patients, a white European 57 year-old female and a Black African 50 year-old male, were intensive care unit (ICU) admitted for ARDS due to COVID-19. They were orotracheal intubated and mechanical ventilated for respectively 23 and 68 days with 7 and 4 sessions of prone position. Both were tracheotomized during their ICU stay. We observed during the respiratory weaning, swallowing difficulties associated with a tongue deviation during protusion and paralysis of the ipsilateral vocal cord suggesting a Tapia syndrome. Prone position for the treatment of hypoxic ARDS COVID-19 patients with lateral flexion of the head could induce a compression on the lower cranial nerves and their collateral branches and lead to the Tapia syndrome with long neurologic sequelae: swallowing disorder, dysarthria and dysphagia due to difficulty to move the tongue with paralysis of the vocal cord. Because mechanical ventilation on prone position is a cornerstone of the treatment of hypoxic COVID-19 patients, the number of patients with Tapia syndrome may increase in the future.
急性呼吸窘迫综合征(ARDS)的治疗指南包括镇静、保护性通气的神经肌肉阻滞和俯卧位的必要性。这种技术可能导致神经系统后遗症,如患者体位后的Tapia综合征。我们报道了2例因俯卧位而出现Tapia综合征的ARDS covid -19患者。这两名患者,一名57岁的欧洲白人女性和一名50岁的非洲黑人男性,因COVID-19引起的ARDS入住重症监护病房。经气管插管和机械通气分别为23天和68天,7天和4个俯卧位。两人在ICU住院期间均行气管切开术。我们观察到,在呼吸脱机期间,吞咽困难与舌头偏移和同侧声带麻痹有关,提示Tapia综合征。俯卧位治疗低氧性ARDS COVID-19伴头部侧屈的患者可压迫下颅神经及其侧支,导致Tapia综合征伴长期神经系统后遗症:吞咽障碍、发音障碍和吞咽困难,因舌动困难伴声带麻痹。由于俯卧位机械通气是低氧COVID-19患者治疗的基石,未来Tapia综合征患者数量可能会增加。
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引用次数: 0
Femur Neck Fracture in a Patient with Klippel-Trenaunay Syndrome- Case Report Klippel-Trenaunay综合征患者股骨颈骨折1例报告
Pub Date : 2023-01-01 DOI: 10.26502/acmcr.96550584
Fabio Seiji Mazzi Yamaguchi, Leandro Ejnisman, Julio Parente, D. Bussius, B. A. Rudelli, Helder de Souza Miyhara, Henrique Melo de Campos Gurgel
Klippel-Trenaunay Syndrome (KTS) is a rare congenital disorder characterized by a triad of capillary malformation with port-wine stain, varicose veins, or venous malformation of the lower limbs, and bony and soft tissue hypertrophy. In this case report, we present the case of a 47-year-old woman who was diagnosed with KTS in her left lower limb at the age of 22. She was admitted to the Hip Group Ambulatory at the Hospital das Clinicas of Sao Paulo, Brazil, due to osteoarthritis in her left hip joint caused by KTS. The patient suffered a Garden 4 left femoral neck fracture after falling from a standing position. Based on imaging, physical examination, and vascular evaluation, our initial surgical plan was Total Hip Arthroplasty (THA) with bone graft and acetabular cage via the posterior approach. However, due to significant blood loss, hemodynamic instability, and the presence of large vessels close to the acetabulum, we decided to abort the initial plan of THA and instead opted for Resection Arthroplasty of Girdlestone. KTS is a challenge for orthopedic surgeons and requires a multidisciplinary evaluation. Patients with KTS who undergo THA require a radiologic study of malformations to choose an appropriate surgical approach, despite the high risk of bleeding.
klipppel - trenaunay综合征(KTS)是一种罕见的先天性疾病,其特征是具有葡萄酒色斑的毛细血管畸形,下肢静脉曲张或静脉畸形,以及骨和软组织肥大。在这个病例报告中,我们提出了一名47岁的女性,她在22岁时被诊断为左下肢KTS。她因KTS引起的左髋关节骨关节炎,住进了巴西圣保罗医院髋关节组门诊。患者从站立位置坠落后发生左股骨颈Garden 4骨折。基于影像学、体格检查和血管评估,我们最初的手术计划是全髋关节置换术(THA),通过后路骨移植物和髋臼笼。然而,由于大量失血,血流动力学不稳定,以及髋臼附近存在大血管,我们决定放弃最初的THA计划,转而选择切除关节成形术。对于骨科医生来说,KTS是一个挑战,需要多学科的评估。接受THA的KTS患者需要对畸形进行放射学研究,以选择合适的手术方法,尽管出血的风险很高。
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引用次数: 0
Physical Effects of Hippotherapy on Balance and Gross Motor Function of a Child with Cerebral Palsy 海马疗法对脑瘫儿童平衡和大运动功能的物理影响
Pub Date : 2023-01-01 DOI: 10.26502/acmcr.96550597
Faruq Ahmed, Md Abdullah Al Zubayer, Suria Akter, Mst. Hosneara Yeasmin, Mohammad Nazmul Hasan, Z. Mawa, A. Islam
Introduction: Hippotherapy is a therapeutic approach using the movement of the horse, administered by trained health professionals. The purpose of this study was to evaluate the effects of hippotherapy on balance and gross motor function of children with CP. Case Description: A subject for this case study that was recruited from an inclusive school was 10 years old boy, with an athetoid type of cerebral palsy. He has a history of bilateral fluctuating muscle tone and tightness in both the upper limb and lower limb. The most common symptoms of the child were involuntary movement, tremors, poor posture, unsteadiness, twisting of the trunk, slow, writhing movements, abrupt movements
介绍:海马疗法是一种治疗方法,利用马的运动,由训练有素的卫生专业人员管理。本研究的目的是评估海马疗法对CP儿童的平衡和大运动功能的影响。病例描述:本病例研究的受试者来自一所包容性学校,是一名患有动脉样型脑瘫的10岁男孩。他有上下双侧肌肉张力波动和紧绷的病史。孩子最常见的症状是不自主运动、颤抖、姿势不良、不稳、躯干扭曲、动作缓慢、扭动、动作突然
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引用次数: 0
Changes in Blood Thallium Concentration during and after Prussian Blue Administration 普鲁士蓝给药前后血铊浓度的变化
Pub Date : 2023-01-01 DOI: 10.26502/acmcr.96550606
M. Onodera, Y. Fujita, Y. Fujino, Y. Inoue
,
,
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引用次数: 0
Visceral leishmaniasis in a 10-month-old Austrian girl Epidemiological Aspects and Treatment Strategies with review of the Iiterature 10个月奥地利女孩内脏利什曼病流行病学方面和治疗策略与文献回顾
Pub Date : 2023-01-01 DOI: 10.26502/acmcr.96550627
H. Dornbusch, T. Perwein, Petra Ritter-Sovinz, C. Urban
,
,
{"title":"Visceral leishmaniasis in a 10-month-old Austrian girl Epidemiological Aspects and Treatment Strategies with review of the Iiterature","authors":"H. Dornbusch, T. Perwein, Petra Ritter-Sovinz, C. Urban","doi":"10.26502/acmcr.96550627","DOIUrl":"https://doi.org/10.26502/acmcr.96550627","url":null,"abstract":",","PeriodicalId":72280,"journal":{"name":"Archives of clinical and medical case reports","volume":"199 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69344486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Promoting Health Students’ Well-Being: The Study Protocol of a Quasi-Experimental Intervention Study 促进健康学生幸福感:一项准实验干预研究的研究方案
Pub Date : 2023-01-01 DOI: 10.26502/acmcr.96550629
El Ouazzani, Houria,, Bourdaire Christiane, Picard Angélique, Gazaix Lena
Introduction: Several studies identified high prevalence of anxiety, stress, and depression for health students, including paramedic students. For this reason, the health students’ well-being represents a public health issue. To improve this situation, we need to develop interventions at the beginning of health studies. The implementation of occasional and/or regular well-being promotion interventions meets a real need for many of health students. Objectives of this study: We aim to assess a well-being promotion intervention among paramedic students in Le Havre (France). Methods and analysis: This is a protocol of monocentric quasi-experimental study designed to assess the impact of the intervention on well-being, resilience, self-esteem, and stress among paramedic students throw validated scales distributed before the intervention and 8 months after. Students’ satisfaction will be assessed through a questionnaire. A first analysis will describe the study population. The comparison of average scores will be performed. The results of satisfaction questionnaire will allow evolving the intervention to best meet the needs of students next year. Discussion: The scientific publications on this theme will enrich the literature and contribute to the integration of this approach of well-being promotion nationally and internationally. The expected benefits from this study are the adoption of a healthy lifestyle, the improvement of students’ well-being and their awareness of the importance of health promotion in patients’ care. Ethics and dissemination: The project received ethical approval from the Research Ethics Board of Le Havre Hospital. The results will be disseminated via scientific publications and conference presentations.
几项研究发现,焦虑、压力和抑郁在健康专业的学生中普遍存在,包括护理专业的学生。因此,健康学生的健康是一个公共健康问题。为了改善这种情况,我们需要在健康研究开始时制定干预措施。实施偶尔和(或)定期的福祉促进干预措施满足了许多卫生专业学生的实际需要。本研究的目的:我们旨在评估勒阿弗尔(法国)护理学生的福祉促进干预。方法与分析:本研究采用单中心准实验研究方案,通过干预前和干预后8个月发放的有效量表,评估干预对护理专业学生幸福感、恢复力、自尊和压力的影响。学生的满意度将通过问卷进行评估。第一次分析将描述研究人群。将进行平均分数的比较。满意度调查问卷的结果将有助于改进明年的干预措施,以最好地满足学生的需求。讨论:关于这一主题的科学出版物将丰富文献,并有助于在国内和国际上整合这种促进福祉的方法。本研究的预期效益是采用健康的生活方式,改善学生的幸福感,并提高他们对患者护理中健康促进重要性的认识。伦理和传播:该项目获得了勒阿弗尔医院研究伦理委员会的伦理批准。研究结果将通过科学出版物和会议报告进行传播。
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引用次数: 0
期刊
Archives of clinical and medical case reports
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