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Gallstone Ileus after Bariatric Gastric Bypass
No full textRACHEL YOO READING PA1, Aaron Hechtman Wyomissing PA1, Sigrid Williamson West Reading PA1, Charles Wen Reading PA2Reading Hospital1 Drexel University College of Medicine2 Small bowel obstruction due to gallstone ileus is a rare complication of bariatric surgery. A 51-year-old female with a history of gastric bypass 18 years prior presented to the emergency department with three days of persistent nausea, vomiting, and distension. CT imaging on admission found a high grade, small bowel obstruction with transition point likely in the right lower quadrant and with pneumobilia. The patient was taken to the operating room for an exploratory laparotomy. A 5.0 x 3.2 x 2.9 cm gallstone was extracted via enterolithotomy with stone extraction. The patient’s post-operative course was complicated by a perihepatic abscess. After rapid weight loss status post bariatric surgery, patients have an increased risk of biliary disease – most commonly being symptomatic cholelithiasis and acute cholecystitis. However, gallstone ileus is a rare complication and can be difficult to diagnose, which delays prompt surgical management. Therefore, there must be continued vigilance in recognizing biliary disease including gallstone ileus in the gastric bypass patients and preventing complications of biliary disease within the bariatric surgery population
Methamphetamine Use and Suicide: A Case Report and Brief Review of Literature.
No full textRecreational use of methamphetamines has greatly increased in frequency across the world. Like other stimulants, methamphetamines can cause several health consequences, and their addictive nature can lead to psychiatric disorders. Suicidal ideation and attempts are common in methamphetamine users and have become a leading cause of death next to incidental overdoses. In the current report, we review a case of a methamphetamine user who attempted suicide by jumping off a bridge. Further, we contextualize this case by reviewing recent literature on the relationship between methamphetamine use and suicide
Characterization of Naloxone Administration in Pediatric Patients Presenting with Altered Mental Status at an Urban, Tertiary Care Children’s Hospital
Get PDFCorrespondence on \u27Technique and impact on first pass effect primary results of the ASSIST global registry\u27 by Gupta
No full textMyocardial Infarction and Complete Heart Block in a Patient With Anomalous Origin of the Left Coronary Artery From the Pulmonary Artery (ALCAPA).
No full textAnomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital malformation. We present a case of an elderly patient with ALCAPA presenting with complete heart block and non-ST-elevation myocardial infarction years after diagnosis and surgical correction. An 81-year-old female with a history of ALCAPA presented to the emergency department with chest pain and progressive mental deterioration. She was bradycardic and hypotensive. An electrocardiogram revealed a complete heart block. Troponin was 4.04 ng/mL. She received atropine and underwent transcutaneous pacing. Left heart catheterization revealed complete occlusion of the mid-left circumflex artery, which was intervened with balloon angioplasty and chronic total occlusion of the right coronary artery. She was supported with temporary transvenous pacing, did not require further pacing support, and was discharged home. Previous records unearthed that in 1988 she had presented with syncope and was diagnosed with ALCAPA, filling from right-to-left collaterals with large and ectatic coronaries. At the time, she underwent surgical correction with excision of the left coronary from the pulmonary artery and reimplantation in the left coronary cusp along the posterior aorta. She had remained asymptomatic after her surgery until this presentation. ALCAPA is extremely rare in adults. Insufficient collaterals to the left ventricle cause inadequate blood supply, leading to ischemia in adults, predisposing them to arrhythmias and risk of sudden death. Adults with ALCAPA remain at increased risk of adverse cardiac events later in life, requiring long-term monitoring
Alien hand syndrome: An atypical presentation of acute left parietal stroke in a community emergency department.
No full textA case of Alien hand syndrome as a presentation of an acute left parietal stroke to improve emergency providers recognition of the condition as a manifestation of acute stroke. We report a case of an 81-year-old female who presented with a complaint of inability to control her right arm accompanied with a subjective sense of right upper extremity numbness and weakness. It was later identified that the patient had an acute left parietal stroke and was describing alien hand syndrome, described as involuntary movements of the right hand and upper extremity. This presentation of stroke is important for emergency providers to recognize as it is uncommon, greater awareness by emergency providers may improve stroke outcomes by early detection and activation of routine acute stroke interventions. SUMMARY: In this case report a patient presented with alien hand syndrome, with inability to control her right hand along with a subjective complaint of numbness and reduction in strength in the right upper extremity, found to be due to an acute left parietal stroke that was confirmed by MRI imaging
Efficacy and Safety of Colchicine in Pediatric Pericarditis: A Systematic Review and Future Directions.
No full textPediatric pericarditis presents challenges in its management, necessitating effective therapeutic interventions. Colchicine, known for its efficacy in adults, requires further investigation for its application and safety in pediatric cohorts. A systematic search across renowned databases identified relevant literature on colchicine use in pediatric pericarditis. Twenty-nine articles underwent rigorous screening, with 18 studies meeting inclusion criteria. Data extraction, quality assessment, and synthesis were conducted meticulously. Included studies comprised case reports, case series, and retrospective cohort studies. Colchicine demonstrated efficacy in reducing recurrence rates and symptom burden, with doses ranging from 0.25 mg/day to 2 mg/day. Adverse events were minimal, predominantly gastrointestinal. Notably, nausea was the most common side effect reported. The safety profile of colchicine was favorable, with rare instances of hepatic and hematologic toxicity. Colchicine emerges as a promising therapeutic option for pediatric pericarditis, demonstrating efficacy in reducing recurrence rates and alleviating symptoms. Its favorable safety profile suggests potential as a preferred long-term therapy. However, further research, including randomized controlled trials, is warranted to confirm its efficacy and safety and explore potential combination therapies
Small Hemothoraces Not Drained on Admission: Initial Volume Predicts Need for Intervention.
No full textBACKGROUND: Unlike large hemothoraces (HTX), small HTX after blunt trauma may be observed without drainage. We aimed to study if there were risk factors that would predict the need for intervention in initially observed small HTX.
METHODS: A retrospective review of patients with blunt traumatic HTX from 2016 to 2022 was performed. Patients with small HTX (pleural fluid volume[CT]) were included. Patients were considered as being initially observed if there was no intervention for the HTX within 48 hours after admission. Primary outcome was any HTX-related intervention (open, thoracoscopic or percutaneous procedures) occurring after 48 hours and up to 6 months after injury. Univariable and multivariable statistical analyses were employed. A
RESULTS: Of 335 patients with HTX, 188 (59.6%) met inclusion criteria. Median (interquartile range) HTX volume was 90 (36-134) ml. One hundred and twenty-seven (68%) were initially observed. Of these, 31 (24%) had the primary outcome. These patients had a larger HTX volume (median, 129 vs 68 mL,
CONCLUSION: For small HTX initially observed, number of rib fractures and initial volume predicted delayed HTX-related intervention
