ABSTRACT
Background: The hyperemesis gravidarum is a severe illness of nauseas and vomit that is present in the first trimester of the pregnancy, it has an incidence of 0.3 to 2%, it has been associated to weight loss, electrolytic disturbances, ketonuria, dehydration and in very seldom cases spontaneous pneumomediastinum. Clinical case: A 21 years old female patient, primigest, in the first trimester of gestation, she started her disease with nauseas and vomiting more than 15 times during 6 hours period, odynophagia, dysphonia and pain in the cervical region, loss of 5 kilograms in the last month. The physical examination showed the patient in bad conditions, dehydration, neck with volume increased and emphysema subcutaneus, crakles until torax. Laboratory findings with hypokalemia, leukocytosis, acute kidney failure, and elevation of hepatic enzymes. The initial treatment was with intravenous fluids resuscitation, hydroelectrolytic balance restoration, antiemetic treatment and rest, it was taken TC of neck and torax, and was exclude any laryngeal and esophageal injury and perforation, but it showed air in the mediastinum. Conservative management with favorable evolution and completed resolution in 7 days. Conclusion: It is very important that the medical doctor must keep in mind the different diagnosis of and take an opportune decision in case of present those complications potentially fatal to the mother.
Subject(s)
Hyperemesis Gravidarum/complications , Mediastinal Emphysema/etiology , Pregnancy Complications/diagnosis , Antiemetics/administration & dosage , Diagnosis, Differential , Female , Fluid Therapy/methods , Humans , Hyperemesis Gravidarum/diagnosis , Hyperemesis Gravidarum/therapy , Mediastinal Emphysema/diagnosis , Mediastinal Emphysema/therapy , Pregnancy , Pregnancy Complications/therapy , Young AdultABSTRACT
OBJECTIVE: To assess the prevalence of otologic symptoms in patients undergoing surgical decompression for symptomatic Chiari I malformation. STUDY DESIGN: Cross-sectional, prospective, nonrandomized. SETTING: Urban tertiary referral center. PATIENTS: Patients with Chiari I malformation before surgical intervention. INTERVENTIONS: None. MAIN OUTCOME MEASURE: Results of completed questionnaire. RESULTS: Sixteen consecutive patients with Chiari I malformation completed the self-administered questionnaire. Eighty-one percent of patients reported episodic aural fullness, 81% reported tinnitus, 69% reported vertigo, and 56% reported fluctuating hearing loss. Headaches were reported as frequently as aural fullness and tinnitus. CONCLUSIONS: Most patients with Chiari I malformation have symptoms that mimic primary otologic pathologic changes. The existence of common pathophysiologic mechanisms is proposed.
Subject(s)
Arnold-Chiari Malformation/diagnosis , Headache/diagnosis , Hearing Disorders/diagnosis , Tinnitus/diagnosis , Vertigo/diagnosis , Adult , Aged , Audiometry, Evoked Response , Audiometry, Pure-Tone/methods , Cross-Sectional Studies , Evoked Potentials, Auditory, Brain Stem/physiology , Female , Humans , Male , Middle Aged , Otoacoustic Emissions, Spontaneous/physiology , Prospective Studies , Surveys and QuestionnairesABSTRACT
OBJECTIVES: Patients with facial purpura can have acute and dramatic illnesses. For this reason, the clinician must be aware of certain diagnoses that can present as facial purpura and know how to initiate treatment efficiently. According to our review of the literature, no paradigm currently exists for the diagnosis and management of facial purpura Our goal is to develop a schema for the identification and management of facial purpura. STUDY DESIGN: Case series. METHODS: A case series of five cases is presented followed by a systematic development of a differential diagnosis based on etiology of the lesion. RESULTS: Facial purpura can be classified into conditions that are primarily or secondarily vasculitic, thrombocytopenic, neoplastic, infectious, toxic, and miscellaneous, which encompasses episodic reports that do not fit into the other categories. A paradigm to diagnose patients with facial purpura is developed based on clinical presentation and etiology. To demonstrate the utility of our algorithm, the five cases presented are re-examined using the algorithm. To our knowledge, this represents the first reported series of facial purpura in the modern English literature. A flow chart based on our diagnostic paradigm is presented. CONCLUSION: Clinicians caring for patients with facial purpura must recognize the acute conditions that require emergent medical intervention. Once these diagnoses have been considered, the clinician can employ a systematic approach to the diagnosis based on etiology. This study provides a useful reference for the otolaryngologist when encountering a patient with facial purpura.
Subject(s)
Facial Dermatoses/etiology , Otorhinolaryngologic Diseases/etiology , Purpura/etiology , Adult , Algorithms , Diagnosis, Differential , Female , Humans , Male , Middle AgedABSTRACT
The caregivers of 61 eligible children (6 months to 12 years old) completed a 20-item (OSA-20) health-related quality-of-life survey after polysomnography was performed to psychometrically validate the OSA-20. Excellent test-retest reliability was obtained for the individual survey items (R>0.74). Construct validity was shown by significant correlation of the mean survey score with the respiratory distress index (R = 0.43) and adenoid size (R = 0.43). Two items with poor validity were dropped, reducing the survey to 18 items (OSA-18). The relationship between the OSA-18 summary score and respiratory distress index remained significant when adjusted for tonsil size, adenoid size, body mass index, and child age. On the basis of the total survey score, the impact of OSAS on quality of life was small for 20 children (33%), moderate for 19 (31%), and large for 22 (36%). The OSA-18 is a practical means of office-based determination of quality-of-life impact for obstructive sleep apnea syndrome in children.
Subject(s)
Awards and Prizes , Internship and Residency , Otolaryngology/education , Quality of Life , Sleep Apnea, Obstructive/psychology , Adenoidectomy , Child , Child, Preschool , Female , Humans , Infant , Male , Polysomnography , Sickness Impact Profile , Sleep Apnea, Obstructive/diagnosis , TonsillectomyABSTRACT
Simulated 3-dimensional (3-D) representation of computerized data is a valuable diagnostic tool in evaluation of tumors of the central nervous system. Several reports exist regarding the clinical value of 3-D imaging, but there is little objective evidence to quantify improved performance from the images. The purpose of this study was to quantify the efficacy of simulated 3-D versus 2-D image interpretation in a nonclinical model. A 3-tiered, 3-D model was constructed, and objects were placed in varied positions. CT was then performed on each of the models. Fifty-three subjects were shown the CT images and asked to reconstruct the model as depicted by either 2-D or simulated 3-D images. Performance between subject groups was different depending on clinical experience. In addition, it was found that the 3-D representation of data allowed for a significantly faster performance of the task of image interpretation and reconstruction of the model.
