Cases reported "Arrhythmias, Cardiac"

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1/9. gallbladder torsion: case report and review of 245 cases reported in the Japanese literature.

    We report here a case of torsion of the gallbladder in a 73-year-old woman. The patient was admitted to our hospital with right hypochondralgia. ultrasonography and computed tomography demonstrated a distended gallbladder, with a multilayered wall, which contained no stones. Since the symptoms did not respond to antibiotics, laparotomy was performed. The gallbladder was found to be twisted around its pedicle and to be gangrenous. cholecystectomy was performed, and the patient had an uneventful postoperative course. We also reviewed 245 cases reported in the Japanese literature. The clinical features of gallbladder torsion, which include low frequency of fever and jaundice, poor response to antibiotic therapy, and acute onset of abdominal pain, may be helpful in the differential diagnosis from acute cholecystitis. Moreover, a highly suggestive sign of gallbladder torsion observed by ultrasonography or computed tomography is a markedly enlarged "floating" gallbladder with a continuous hypoechoic line indicating edematous change in the wall.
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2/9. Small bowel perforation after extracorporeal shockwave lithotripsy of an ureter stone.

    A 60-year-old man was treated by extracorporeal shock wave lithotripsy (ESWL) for an impacted ureter stone. Two days after the procedure he developed an acute abdomen. On laparotomy, a small bowel perforation in the area of an adhesion to the abdominal wall was found. The adherent intestinal segment was located exactly in the range of the ESWL field, so that excluding further reasons the shockwave lithotripsy must be assumed to be causative.
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3/9. Heterotopic pregnancy: case report.

    Heterotopic pregnancy in a spontaneous cycle is a rare entity with an estimated frequency below one per 30,000 pregnancies. Its incidence evidently has increased in accordance with the widespread use of in vitro fertilization and ovulation induction. We report a case of heterotopic pregnancy in a 40-year-old woman who presented with acute abdominal pain. We also present findings from transvaginal ultrasound imaging.
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4/9. Diagnostic peritoneal lavage for assessing acute abdomen in pediatric oncology and stem cell transplantation patients.

    Diagnostic peritoneal lavage (DPL) is a technique designed to sample the peritoneal cavity for evidence of catastrophic pathology, while incurring minimum risk. The authors describe two unstable pediatric patients, one with acute lymphoblastic leukemia and shock and one with fanconi anemia on high-frequency oscillation after stem cell transplantation, both presumed to have intra-abdominal perforation. DPL was uneventfully performed at the bedside in both patients. The authors suggest DPL be considered as an alternative to laparotomy in critically ill pediatric oncology and stem cell transplantation patients.
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5/9. Acute abdomen in a case with noncommunicating rudimentary horn and unicornuate uterus.

    Unicornuate uterus with a rudimentary horn is the rarest congenital anatomic anomaly of the female genital system, causing many obstetrical and gynecologic complications. The frequency of this pathology is approximately 1/100 000. A rudimentary horn usually develops following insufficient development of mullerian ducts. These patients present with dysmenorrhea, dyspareunia, and chronic pelvic pain because of endometriosis and rarely with acute abdominal symptoms following distention and torsion of the noncommunicating rudimentary horn. The case of a patient referred for acute abdomen after distention of a noncommunicating rudimentary horn is presented herein.
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6/9. Mesenteric panniculitis mimicking acute abdomen in a 4-year-old child.

    A 4-year-old boy with mesenteric panniculitis diagnosed after laparotomy and biopsy is reported. It is stressed that during the childhood, the frequency of disease might be higher than reported.
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7/9. abdominal pain due to enterobius vermicularis.

    The authors describe an unusual case of an 11-year-old girl who had right lower quadrant pain due to unilateral salpingitis, suppurative omentitis and periappendicitis. The etiologic agent was the parasite enterobius vermicularis. A review of the literature revealed that pinworm may be the cause not only of appendicitis, but of inflammatory reactions in other intra-abdominal sites and that the frequency of this occurrence is probably higher than has previously been suspected.
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8/9. Colonic ulceration associated with nonsteroidal anti-inflammatory drugs. Report of three cases.

    Nonsteroidal anti-inflammatory drugs (NSAIDs) are associated with a variety of gastrointestinal side effects. Effects on the large intestine have been reported with increasing frequency. Recognition of NSAID-induced colonic lesions has been confounded by variable clinical presentations, variable pathologic findings, and unfamiliarity of this entity among clinicians. We have recently seen three cases of NSAID-induced cecal ulcerations in patients undergoing right colectomy. A correct preoperative diagnosis was not made in our patients, one of whom presented with an acute abdomen and two in whom there was an inability to rule out carcinoma. The gross, radiographic, and histologic findings in each case consisted of a characteristic transverse ulceration with thin diaphragm-like scarring. NSAID-induced cecal ulcers can have a variety of presentations to the general surgeon, are likely to be misdiagnosed preoperatively, but may be recognized based on characteristic gross features evident by radiography and colonoscopy, along with a careful history. review of recent literature suggests that laparotomy can be avoided when diagnosis is considered, but operation is indicated for complications, such as hemorrhage, obstruction, or perforation, and when carcinoma cannot be adequately excluded.
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9/9. immunoblastic lymphadenopathy presenting as an acute abdomen and mixed bacteremia with eikenella corrodens and group C streptococci.

    eikenella corrodens and group C streptococci have been noted to occur with increased frequency in patients with underlying malignancies and immunosuppressive states. We report a case where these organisms were isolated from a patient with immunoblastic lymphadenopathy and discuss the possible association between these two conditions.
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