Cases reported "Venous Thromboembolism"

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1/12. carcinoma of the colon in children: a report of six new cases and a review of the literature.

    Of six children with carcinoma of the colon, none had ulcerative colitis or a family history of carcinoma of the colon or colonic polyposis. In 75 cases traced in the literature, a common early symptom of carcinoma of the colon in children is acute, crampy abdominal pain. At laparotomy for suspected appendictis, the possibility of the acute pain being due to carcinoma of the colon should be borne in mind. Otherwise the symptoms of carcinoma of the colon in children do not differ substantially from those in adults. The prognosis is unfavorable; in only 2.5% of the cases on record did the children survive 5 yr after the operation.
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2/12. Primary repair of cornual rupture occurring at 21 weeks gestation and successful pregnancy outcome.

    The successful delivery in a 31 year old woman at 33 weeks gestation is reported, after repair to a cornual rupture which occurred at 21 weeks gestation. The patient exhibited acute abdominal pain and pending shock. Emergency laparotomy showed a cornual rupture and an intrauterine vital fetus having intact amnion membrane. On the patient's family's insistence, primary repair for a cornual rupture was performed and preservation of the fetus attempted. Postoperatively, tocolytic agent with ritodrine hydrochloride was administered and close follow-up of the patient was uneventful. The patient had a smooth obstetric course until 33 weeks gestation when premature rupture of the membranes occurred, soon followed by the onset of labour. She underwent an elective Caesarean section and delivered a normal male fetus weighing 2140 g with Apgar scores at 1, 5 and 10 min of 6, 8, and 9 respectively. Because of this successful outcome, we suggest that primary repair for such an unusual patient should be accepted.
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3/12. Case report: portal vein thrombosis associated with hereditary protein c deficiency: a report of two cases.

    protein c deficiency is one of the causes of curable or preventable portal vein thrombosis. We report two patients of portal vein thrombosis associated with hereditary protein c deficiency. The first patient presented with continuous right upper quadrant pain and high fever. The abdominal sonography revealed normal liver parenchyma but portal vein and superior mesenteric vein thrombosis. Based on a 55% (normal 70-140%) plasma protein C level, he was diagnosed as having protein c deficiency. A trace of his family history showed that his elder brother also had protein c deficiency with a 50% plasma C level. Both patients received anticoagulant therapy. The younger brother showed good response. Unfortunately, the elder one suffered from recurrent episodes of variceal bleeding and received a life-saving splenectomy and devascularization. We herein remind clinicians that early screening and therapy are helpful in preventing late complications of protein c deficiency with portal vein thrombosis.
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4/12. Acute abdomen--remember spontaneous perforation of the urinary bladder.

    Spontaneous perforation of the urinary bladder is a rare clinical condition presenting as an acute abdomen. It should be suspected in patients with a past history of radiotherapy to the pelvis, enterocystoplasty and those suspected of having a tumour in the bladder. Disproportionately elevated serum urea and creatinine should raise the index of suspicion. A case of spontaneous perforation of the bladder, five years following successful treatment of a bladder tumour by radiotherapy, is reported.
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5/12. Untraditional glucose fermenting actinomycetes as human pathogens. Part I: actinomyces naselundii as a cause of abdominal actinomycosis.

    actinomyces naeslundii was proved as a primary pathogen in the case of a fulminant abdominal infection of a 74 aged woman. The preliminary diagnosis of actinomycosis based on direct microscopical findings of microgranules in the pus was confirmed by the results of cultivation and casuistry in addition. The case was of a typical course for actinomycosis and penicillin following surgery was of life saving effect for the patient who was dismissed asymptomatic after 55 days of hospitalization. Actinomycotic microgranules were demonstrated in the pus from the natural infection and from experimentally infected mice and the causative agent actinomyces naeslundii TR 91/67 was defined. Nevertheless it was concluded that the judgment of the pathogenicity of actinomyces naeslundii and of the other members of the heterogenous group of etiological agents of human actinomycosis still remains a matter of delicacy in any actual case of their isolation. In practice however, the presumption of actinomycotic etiology of an actual infection may be supported in retrospect by the dramatical effect of penicillin without regard to the presence of concomitant microflora not necessarily sensitive to penicillin.
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6/12. Gastric perforation due to the ingestion of a hollow toothpick: report of a case.

    A perforation due to the ingestion of a toothpick is a condition seldom seen in the stomach. We herein describe an 80-year-old woman with a perforation of the stomach due to an ingested hollow toothpick. The toothpick was easily removed during a mini-laparotomy. The site of perforation was closed with absorbable sutures and omentum was used to function as an overlying patch. The postoperative course was uncomplicated. The hollow toothpick functioned as a fistula between the contents of the stomach and the peritoneal cavity. This resulted in a very different clinical picture from that observed in "classical wooden" toothpick injury, where the toothpick is not able to function as a fistula. To the best of our knowledge, this is the first description of a hollow toothpick perforating the stomach. A hollow toothpick perforation must be considered in any patient with symptoms of intestinal perforation, even when there is no history of swallowing toothpicks. Removal of a toothpick and subsequent suturing of the puncture site is a simple and relatively minor surgical procedure, which may have a lower morbidity and mortality as compared to other causes of gastric perforation. A precaution to observe, is the potential danger that one of the members of the operating team might perforate a finger.
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7/12. Cryptococcal mesenteric lymphadenitis: an unusual cause of acute abdomen.

    Cryptococcal infection of intraabdominal organs or tissues is extremely rare. Herein we report a child with mesenteric cryptococcal lymphadenitis who presented with an acute abdomen misdiagnosed as acute appendicitis. Definitive diagnosis was established with 2nd look and lymph node biopsy. Clinicians should remember that cryptococcal infection of mesenteric lymph nodes may rarely mimic an acute abdomen and cause delay in diagnosis.
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8/12. Polymicrobial bacteremia caused by escherichia coli, edwardsiella tarda, and shewanella putrefaciens.

    edwardsiella tarda, a member of enterobacteriaceae, is found in freshwater and marine environments and in animals living in these environments. This bacterium is primarily associated with gastrointestinal diseases, and has been isolated from stool specimens obtained from persons with or without clinical infectious diseases. shewanella putrefaciens, a saprophytic gram-negative rod, is rarely responsible for clinical syndromes in humans. Debilitated status and exposure to aquatic environments are the major predisposing factors for E. tarda or S. putrefaciens infection. A 61-year-old woman was febrile with diarrhea 8 hours after ingesting shark meat, and two sets of blood cultures grew escherichia coli, E. tarda and S. putrefaciens at the same time. She was successfully treated with antibiotics. We present this rare case of polymicrobial bacteremia caused by E. coli, E. tarda and S. putrefaciens without underlying disease, which is the first found in taiwan. This rare case of febrile diarrhea with consequent polymicrobial bacteremia emphasizes that attention should always be extended to these unusual pathogens.
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9/12. Visceral larva migrans presenting as acute abdomen in a child.

    An unusual presentation of visceral larva migrans observed in a patient is reported. A 5-year-old boy suffering fever, abdominal pain, tenderness, and rigidity in the right lower and upper quadrant of the abdomen was operated on, with the false diagnosis of acute abdomen, and exploratory surgery was carried out. The pathological examination of the liver biopsy revealed eosinophil-rich necrotizing granulomatous inflammation with toxocara spp larva. The diagnosis was also confirmed by serologic results. Clinicians should remember that toxocaral visceral larva migrans may rarely mimic an acute abdomen and cause unnecessary operations.
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10/12. Perforation of the colon in an adolescent girl.

    We report a case of a 13-year-old girl who presented with acute abdominal pain secondary to a sigmoid colon perforation. history, physical examination, and laboratory and radiographic studies were all suggestive, though not diagnostic, of an abdominal catastrophe. Her father died at the age of 30 from complications of bowel perforations and a vascular aneurysm. The unusual operative findings in our patient, together with her father's medical history, lead to the underlying diagnosis of ehlers-danlos syndrome. knowledge of this family history at the time of presentation could have aided in diagnosis. Clinical manifestations and etiology of ehlers-danlos syndrome are discussed.
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