Cases reported "Intellectual Disability"

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11/16. Intestinal invasion and disseminated disease associated with penicillium chrysogenum.

    BACKGROUND: Penicillium sp., other than P. marneffei, is an unusual cause of invasive disease. These organisms are often identified in immunosuppressed patients, either due to human immunodeficiency virus or from immunosuppressant medications post-transplantation. They are a rarely identified cause of infection in immunocompetent hosts. CASE PRESENTATION: A 51 year old African-American female presented with an acute abdomen and underwent an exploratory laparotomy which revealed an incarcerated peristomal hernia. Her postoperative course was complicated by severe sepsis syndrome with respiratory failure, hypotension, leukocytosis, and DIC. On postoperative day 9 she was found to have an anastamotic breakdown. pathology from the second surgery showed transmural ischemic necrosis with angioinvasion of a fungal organism. Fungal blood cultures were positive for penicillium chrysogenum and the patient completed a 6 week course of amphotericin b lipid complex, followed by an extended course oral intraconazole. She was discharged to a nursing home without evidence of recurrent infection. DISCUSSION: penicillium chrysogenum is a rare cause of infection in immunocompetent patients. diagnosis can be difficult, but Penicillium sp. grows rapidly on routine fungal cultures. prognosis remains very poor, but aggressive treatment is essential, including surgical debridement and the removal of foci of infection along with the use of amphotericin b. The clinical utility of newer antifungal agents remains to be determined.
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12/16. Emergency surgery and refractory immune thrombocytopenic purpura. A case report.

    A 35-year-old woman with post-splenectomy refractory immune thrombocytopenia presented with an acute abdominal emergency requiring laparotomy. Her platelet count was raised from 10 to 96 X 10(9)/l using a combination of high-dose methylprednisolone, plasma exchange against fresh-frozen plasma, infusion of gammaglobulin and a single mega-unit of platelets. The surgical procedure was uneventful, and with no further therapy the platelet count rose to a peak of 244 X 10(9)/l, but over the following 7 days fell back slowly to 10 X 10(9)/l, at which time the patient was discharged well.
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13/16. Acute abdominal pain in chronic pancreatitis: hemorrhage from a pseudoaneurysm?

    An alcoholic, 67-year old retired male nurse complained of abdominal pain, loss of appetite and weight loss of 10 kg within one year. Based on elevated serum enzyme levels, ultrasonography and computed tomography examinations, an acute attack of chronic pancreatitis with several pancreatic pseudocysts was diagnosed. Ultrasonographically, an 1.8 cm phi, echo-free, pulsatile, space-occupying lesion, suggestive of a pancreatic pseudoaneurysm, was found at the right lateral margin of an almost echo-free pseudocyst measuring 6.8 x 5.6 x 5.0 cm in the head of the pancreas. Shortly before the planned discharge when the patient felt well, he developed acute abdominal pain. An immediate ultrasound examination showed an inhomogenous and echo-dense pseudocyst, in short, an acute hemorrhage. rupture of the pseudoaneurysm of the Arteria gastroduodenalis was suspected and later confirmed by angiography and laparotomy. After proximal an distal ligation of the vessel and fibrin sealing of the inner surface of the cyst, the patient recovered and, under alcohol abstinence, has been free of symptoms since one year.
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14/16. A case of tetanus mimicking acute abdomen.

    A 47-year-old man presented with backache and signs of acute abdomen. An exploratory laparotomy was performed. Post-operatively he developed hypoxaemia in the operating theatre and was brought to the Surgical intensive care Unit for ventilatory support and further investigations. history was then retaken and revealed a minor foot injury one month ago with subsequent development of muscle spasm and dysphagia. The diagnosis of tetanus was made. The patient was then treated with human antitetanus immune globulin and crystalline penicillin. Ventilatory support was continued, aided by infusion of morphine, diazepam and alcuronium. The recovery course was complicated by chest infection, urinary tract infection and sympathetic overactivity. He improved later and ventilatory support was discontinued three weeks after admission. He then made uneventful recovery and was discharged from the hospital forty days after admission.
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15/16. High-grade endometrial stromal sarcoma in a 16-year-old girl.

    Endometrial stromal sarcoma (ESS) is a rare uterine malignancy with a variety of morphologic characteristics and clinical courses. We describe a case of high-grade malignant ESS in an adolescent girl, arising in a rudimentary uterine horn and presenting symptoms of an acute abdomen. The patient underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy and omentectomy due to a stage IVA high-grade ESS. An adjuvant chemotherapy and radiotherapy treatment was recommended, but 10 days after her discharge the condition of the patient deteriorated, with diffused metastases into the lungs and the abdomen, and finally she succumbed to the disease 1 month after her first admission to the hospital.
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16/16. Intraperitoneal rupture of the urinary bladder: the value of diagnostic laparoscopy and repair.

    A 50-year-old woman was admitted for acute onset of lower abdominal pain. Diagnostic laparoscopy revealed a rupture of the urinary bladder. Laparoscopic biopsy and cystorrhaphy were performed. Our patient was discharged 2 days after surgery, and after 2 more weeks of treatment with an indwelling catheter, she was back to her normal lifestyle. The rupture was considered idiopathic, and the present case underlines the value of diagnostic laparoscopy in acute abdominal pain.
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