A Sneaky Symptom

​BY JEFFREY LOMBARDO, MD, &MARK SUPINO, MDThe progressive suprapubic pain was a cunning symptom.The 38-year-old man had had five days of that pain and dysuria. By the time he presented to our ED, his pain had spread to the right lower quadrant as well. He had a history of diverticulitis after a laparoscopic left hemicolectomy four years earlier.He reported no fevers, but complained of nausea and diarrhea. He was afebrile at 36.8°C with a pulse of 76 bpm. All other vital signs were normal. Physical exam was significant for suprapubic pain and right lower quadrant tenderness to palpation without rebound, guarding, or distention.His workup revealed a normal white blood cell count of 4.2, as well as a normal basic chemistry and urinalysis. A CT of the abdomen and pelvis with intravenous contrast showed a dilated appendix tip measuring 12 mm with mucosal enhancement and fat stranding. The appendix was elongated and overlying the bladder.Computed tomography of the abdomen and pelvis with intravenous contrast. The yellow arrows show the appendix coursing through the lower abdomen and overlying the bladder.Our patient was diagnosed with acute appendicitis. He was given antibiotics, intravenous fluids, kept NPO, and admitted to the surgical team. He underwent uncomplicated laparoscopic appendectomy and was discharged the next day.Suprapubic pain and right lower quadrant pain are typical chief complaints in the emergency department, but it is important to keep a broad differe...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research

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Authors: Hosokawa T, Suzuki S, Tanami Y, Sato Y, Ko Y, Nomura K, Oguma E, Yamada Y Abstract In contrast to computed tomography, ultrasound can be performed without radiation exposure, repeatedly performed by the patients' bedside. Hence, in this case series, we describe the evaluation of complications including hematoma, superficialsurgical site infection, mediastinitis, and pseudoaneurysm associated mediastinitis using ultrasound in pediatric patients after cardiovascular surgery. To our knowledge, no previous reports have evaluated such complications using ultrasound. Ultrasound may be useful for the early diagno...
Source: Medical Ultrasonography - Category: Radiology Tags: Med Ultrason Source Type: research
Authors: Gavrila IL, Badea RI, Jude C, Socaciu MA, Comsa M, Badea AF Abstract Abdominal ultrasound (US) performed as a "primary imaging procedure" is an important diagnostic tool in gastroenterol-ogy. Expanding the routine investigation to the lower thoracic region might sometimes accelerate the diagnosis in inconclusive manifestations such as pulmonary pathology.US is a valuable tool in evaluating patients with breathing difficulties, chest pain, hypoxia, or chest trauma. This paper presents the particular situation of a patient hospitalized in the gastroenterology depart-ment, where the US identified si...
Source: Medical Ultrasonography - Category: Radiology Tags: Med Ultrason Source Type: research
Authors: Maconi G, Sousa M Abstract Gastrointestinal ultrasound (GIUS) has been increasingly used for the management of gastrointestinal disorders due to its potentialities as a cheap, widely available and safe examination with comparable accuracy to other techniques such as Computed Tomography or Magnetic Resonance Imaging. However, some limitations have been stated to justify its underuse such as its dependency on the operator, small field of view and penetration and need of expertise. However, most of these limitations are inherent to any technique. The main problems with GIUS are lack of standardized definition...
Source: Medical Ultrasonography - Category: Radiology Tags: Med Ultrason Source Type: research
Authors: Roman A, Palego F, Achimas-Cadariu P, Vlad C, Andries A, Tomuleasa CI, Gata VA, Pintican R, Rada MP, Feier D Abstract AimsThe present study aims to investigate the pain, anxiety and other factors that are associated with percutaneous computed tomography (CT)- and ultrasound (US)-guided biopsies of tumors.Material and MethodsThe study prospectively included 60 consecutive patients, of which 24 underwent CT-guided biopsies and 36 US-guided biopsies. The location of targeted tumors was within the thorax, abdomen, pelvis, and limbs. A questionnaire containing numerical rate scales (0-10) regarding procedural a...
Source: Medical Ultrasonography - Category: Radiology Tags: Med Ultrason Source Type: research
CONCLUSIONS: EUS guided fine needle aspiration/biopsy of focal liver lesions is safe, provides a very high diagnostic accuracy and should not be considered only as a rescue method after failure of percutaneous guided biopsies. PMID: 32096783 [PubMed - as supplied by publisher]
Source: Medical Ultrasonography - Category: Radiology Tags: Med Ultrason Source Type: research
Publication date: Available online 25 February 2020Source: Neuroscience LettersAuthor(s): Jie Li, Binke Yuan, Guoxiong Li, Xingqi Lu, Yun Guo, Ying Yang, Minjie Liang, Jianping Ding, Quan Zhou
Source: Neuroscience Letters - Category: Neuroscience Source Type: research
Conclusion: Most cases of RPH had an excellent outcome with conservative management alone. PMID: 32089021 [PubMed - as supplied by publisher]
Source: Expert Review of Hematology - Category: Hematology Tags: Expert Rev Hematol Source Type: research
George SelginThis morning, upon logging in to my Twitter account, I found it brimming with reports that the Hong Kong government was about to embark upon an unprecedented experiment with helicopter money. " Helicopter Money is Here, " blurtsanFT Alphavilleheadline. " Hong Kong Embraces Helicopter Money, "saysZero Hedge. The foreign press has also chimed in: " Helicopter Money Comincia a Hong Kong, " writesItalian financial journalist Maurizio Blondet.In typically understated fashion,Zero Hedge' s report concludes thus:So Hong Kong is about to unleash the mother of all stagflations on its peopl...
Source: Cato-at-liberty - Category: American Health Authors: Source Type: blogs
Conclusions: Certain groups were more likely to underestimate risks of mixing opioid pain-relievers with alcohol or benzodiazepines. Results underscore the importance of targeted public awareness campaigns, prevention programing, and communication between physicians and patients about the risks of mixing substances, particularly among high-risk groups. PMID: 32091310 [PubMed - as supplied by publisher]
Source: Substance Use and Misuse - Category: Addiction Tags: Subst Use Misuse Source Type: research
Authors: Osei-Owusu J, Yang J, Del Carmen Vitery M, Tian M, Qiu Z Abstract Severe local acidosis causes tissue damage and pain, and is associated with many diseases, including cerebral and cardiac ischemia, cancer, infection, and inflammation. However, the molecular mechanisms of the cellular response to extracellular acidic environment are not fully understood. We recently identified a novel and evolutionarily conserved membrane protein, PAC (also known as PACC1 or TMEM206), encoding the proton-activated chloride (Cl-) channel, whose activity is widely observed in human cell lines. We demonstrated that genetic del...
Source: Channels - Category: Molecular Biology Tags: Channels (Austin) Source Type: research
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