Acquired angioedema in a patient with chronic lymphocytic leukaemia

Acquired angioedema [AAE] is defined by acquired deficiency of C1 esterase inhibitor. It is a rare disorder characterized by recurrent angioedema without urticiaria, which may be associated with lymphoproliferative disorders [LPD]. We are reporting a case of 71 years old female, known case of Chronic Lymphocytic Leukaemia [CLL] who presented to the emergency room [ER] with generalized body swelling during her disease course. Investigations were ordered to confirm that the symptoms were due to acquired angioedema, and the patient was managed for this diagnosis. Knowing the association between acquired angioedema and lymphoproliferative disorder is crucial, because AAE can be treated medically and responds within hours but delayed diagnosis can lead to unnecessary invasive procedures or asphyxiation and death due to laryngeal oedema. Finally, treating the underlying cause as CLL in our case could prevent further recurrence of angioedema

Prehospital tracheal intubation versus emergency department intubation for trauma patients

Background: Patients with severe traumatic brain injury [TBI] are at high risk for airway obstruction and hypoxia at the accident scene, and routine prehospital endotracheal intubation has been widely advocated. Aim of the Study: to evaluate and compare the outcome and mortality rates of trauma patients undergoing Prehospital Tracheal Intubationversus those undergoing Emergency Department Intubation

Methods: A literature search was carried out on MEDLINE [including MEDLINE in-process], CINAHL, Embase and the Cochrane Library [from 1990 to October 2017]. Databases using "Prehospital Tracheal Intubation", "Emergency Department Intubation ", "Adults? trauma", and "mortality" as a MeSH heading and as text word. High yield journals were also had searched

Results: Eleven studies enrolling 17317 patients were included, out of which 4545 underwent PTI while 12772 underwent EDI. Median mortality rate in patients undergoing pre-hospital intubation was 52.12% [7.8-90.16%], compared to 27.98% [6.25-41.56%] in patients undergoing intubation in the emergency department. The overall quality of evidence was very low. Six of the eleven studies found a significantly higher mortality rate after pre-hospital intubation whilst five found no significant differences

Conclusion: Study outcome suggests that EDI was superior to PHI. Nevertheless, prehospital intubation was a marker for more severely ill patients who would have had higher mortality thus, the suggestion of the association between pre-hospital intubation and a higher mortality rate does not essentially oppose the importance of the intervention, but rather a need for further investigation of the possible causes for this finding

Acquired angioedema in a patient with chronic lymphocytic leukaemia

Acquired angioedema [AAE] is defined by acquired deficiency of C1 esterase inhibitor. It is a rare disorder characterized by recurrent angioedema without urticiaria, which may be associated with lymphoproliferative disorders [LPD]. We are reporting a case of 71 years old female, known case of Chronic Lymphocytic Leukaemia [CLL] who presented to the emergency room [ER] with generalized body swelling during her disease course. Investigations were ordered to confirm that the symptoms were due to acquired angioedema, and the patient was managed for this diagnosis. Knowing the association between acquired angioedema and lymphoproliferative disorder is crucial, because AAE can be treated medically and responds within hours but delayed diagnosis can lead to unnecessary invasive procedures or asphyxiation and death due to laryngeal oedema. Finally, treating the underlying cause as CLL in our case could prevent further recurrence of angioedema

Wound infection after laparoscopic cholecystectomy

Background: Surgeons are regularly not involved in the post discharge care of patients after uncomplicated laparoscopic cholecystectomy. The purpose of the current study was to document the symptomatic recovery of patients following laparoscopic cholecystectomy, because this has a bearing on the planning of a postoperative care package

Methods: The study was designed as a postoperative telephone questionnaire survey and was carried out prospectively between June2016 and February2017 in King Abdulaziz Hospital, KSA

Results: The study cohort comprised 51 patients who all completed the study. Postoperatively, only 3% of the patients had postoperative nausea/vomiting lasting >/=2 days. Pain was symptomatic in 12% of patients. Port-site wounds were a source of significant symptoms in 69% of the patients. Postoperative reviews by a nurse and primary-care doctor were necessary in 76% and 34% patients, respectively, with a combined average of 3.1 reviews per patient. Less than 4% of patients believed that they would benefit from a surgeon's review 6 weeks after LC. Median time taken to return to routine preoperative activity after surgery was 21 days [IQR, 16 to 33], which was affected by the degree of activity undertaken, wound-related symptoms persisting for >/=3 weeks, planned follow-up clinic appointment, and discharge as an outpatient

Conclusion: Wound-related symptoms are common after LC, require substantial input from the community health service in their management, and may delay return to preoperative routine