1/27. Diaphragmatic hernia of Morgagni.Most cases of Morgagni hernia are asymptomatic and diagnosed incidentally on routine chest x-ray film, but they may occasionally become symptomatic. Symptomatic Morgagni hernias may present in many different ways, making the diagnosis challenging. We describe a patient with a Morgagni hernia, resulting in intractable nausea and vomiting, give a brief review of symptoms, note the different types of abdominal contents herniated, and describe the methods used to make the diagnosis.- - - - - - - - - - ranking = 1keywords = content (Clic here for more details about this article) |
2/27. Fatal child abuse by forced water intoxication.BACKGROUND: Although water intoxication leading to brain damage is common in children, fatal child abuse by forced water intoxication is virtually unknown. methods: During the prosecution of the homicide of an abused child by forced water intoxication, we reviewed all similar cases in the united states where the perpetrators were found guilty of homicide. In 3 children punished by forced water intoxication who died, we evaluated: the types of child abuse, clinical presentation, electrolytes, blood gases, autopsy findings, and the fate of the perpetrators. FINDINGS: Three children were forced to drink copious amounts of water (over 6 L). All had seizures, emesis, and coma, presenting to hospitals with hypoxemia (PO2 = 44 /- 8 mm Hg) and hyponatremia (plasma Na = 112 /- 2 mmol/L). Although all showed evidence of extensive physical abuse, the history of forced water intoxication was not revealed to medical personnel, thus none of the 3 children were treated for their hyponatremia. All 3 patients died and at autopsy had cerebral edema and aspiration pneumonia. The perpetrators of all three deaths by forced water intoxication were eventually tried and convicted. INTERPRETATION: Forced water intoxication is a new generally fatal syndrome of child abuse that occurs in children previously subjected to other types of physical abuse. patients present with coma, hyponatraemia, and hypoxemia of unknown etiology. If health providers were made aware of the association, the hyponatremia is potentially treatable.- - - - - - - - - - ranking = 3.1271199545213keywords = aspiration (Clic here for more details about this article) |
3/27. Late presentation of Bochdalek hernia: clinical and radiological aspects.Three infants with late presentation of Bochdalek hernia are presented. The presenting symptoms were cough, intermittent vomiting, dyspnea, and cyanosis. Initial diagnoses of isolated paravertebral mass and foreign material aspiration were made in two infants, based on plain chest x-ray findings and history of the patients. Further radiological investigations, such as contrast upper gastrointestinal series or enema, computerized tomography, and magnetic resonance imaging of the chest, suggested the diagnosis of Bochdalek hernia. The hernia was found on the left side in two patients and on the right side in one. At operation, the stomach, small intestine, and spleen were found as herniated organs in one patient, ascending colon in one, and all of the small intestine together with ascending colon in the other. A congenital diaphragmatic defect should be suspected in every child presenting with unusual respiratory or gastrointestinal symptoms and with abnormal chest x-ray findings. The radiological findings vary greatly from one case to another, and even in the same case at different times because of differences in herniated organs and intermittent spontaneous reduction. The possibility of congenital diaphragmatic hernia should be kept in mind to avoid a wrong diagnosis, undue delay in diagnosis, and inappropriate treatment.- - - - - - - - - - ranking = 3.1271199545213keywords = aspiration (Clic here for more details about this article) |
4/27. death following cupric sulfate emesis.Case history: A 25-year-old woman who had ingested about 20 tablets of diazepam 2.5 mg in a suicide attempt was given cupric sulfate 2.5 g in 1750 mL water as an emetic, but died 3 days later. On autopsy, death was attributed to acute hemolysis and acute renal failure due to copper poisoning. copper concentrations were 5.31 microg/mL in whole blood, 19.0 microg/g in the liver, 8.9 microg/g in the kidney, 1.1 microg/L in the brain, 1.1 microg/g in the gastric wall, 1.5 microg/g in the jejunal wall, 0.3 microg/g in the colon wall, 4.6 microg/g in the gastric contents, and 12.6 microg/g in the intestinal contents (fresh weight). This case and 10 others from the Chinese medical literature provide additional evidence that cupric sulfate is a corrosive poison and contraindicated as an emetic.- - - - - - - - - - ranking = 2588.2982753507keywords = gastric content, content (Clic here for more details about this article) |
5/27. Complications of ultrarapid opioid detoxification with subcutaneous naltrexone pellets.Rapid and ultrarapid opioid detoxification (ROD and UROD) centers promise quick, painless, same-day detoxification treatment for patients with opioid addiction. The goal of ROD and UROD is to provide a rapid transition from opioid dependency to oral naltrexone therapy. The patient is given general anesthesia and high-dose opioid antagonists. This induces a severe withdrawal but spares the patient the experience. In theory, the process is complete within four to five hours. The patient awakens without opioid dependency and is started on oral naltrexone. Any subsequent, persistent withdrawal symptoms are treated symptomatically. A novel, unapproved approach is to compound a pellet of naltrexone and implant it in the subcutaneous tissue. In theory, this should result in continuous therapeutic levels for this drug, and avoid issues with noncompliance. CASE SERIES: This article reports six cases of complications from the same detoxification center that performed UROD with naltrexone pellet implantation, including pulmonary edema, prolonged withdrawal, drug toxicity, withdrawal from cross-addiction to alcohol and benzodiazepines, variceal rupture, aspiration pneumonia, and death. CONCLUSIONS: The risks of this procedure are great and further studies should assess its safety and the novel use of naltrexone.- - - - - - - - - - ranking = 3.1271199545213keywords = aspiration (Clic here for more details about this article) |
6/27. Morgagni hernia: case report.This is a case report of an elderly woman who presented with a history of epigastric pain and persistent vomiting diagnosed initially as a duodenal ulcer, later as a pyloric stenosis and at laparotomy was found to have an anterior diaphragmatic hernia with gastric volvulus. hernia of Morgagni occurs through a congenital defect in the diaphragm but usually presents in adulthood. It could be an incidental diagnosis or can present with obstructing symptoms of the herniated viscera. Treatment is surgical with reduction of hernia and repair of the diaphragmatic defect. If misdiagnosed, this can lead to considerable morbidity and occasionally mortality due to the obstructed/strangulated hernial contents.- - - - - - - - - - ranking = 1keywords = content (Clic here for more details about this article) |
7/27. Protection from aspiration with the LMA-ProSeal after vomiting: a case report.PURPOSE: To describe a case of vomiting with a laryngeal mask airway ProSeal(TM) (PLMA) in situ. The new design features of the PLMA and their role in protection from aspiration are discussed. CLINICAL FEATURES: A 27-yr-old female underwent bilateral reduction mammoplasty under general anesthesia utilizing a PLMA for airway management. During transfer to the postanesthesia care unit, she had an episode of active vomiting with the PLMA still in situ. The vomitus was expelled via the drain tube bypassing the pharynx entirely. Clinically, there was no evidence of aspiration and the patient had an uneventful recovery. CONCLUSION: This case provides evidence that the drain tube of the PLMA directs vomitus away from the airway when properly positioned and may have prevented aspiration in an anesthetized patient.- - - - - - - - - - ranking = 21.889839681649keywords = aspiration (Clic here for more details about this article) |
8/27. Obstructive jaundice and renal masses.An 82-year-old patient with obstructive jaundice secondary to simple renal cyst also suffered pain and vomiting from partial duodenal obstruction. The symptoms were relieved by aspiration of 1,750 ml of fluid. This reaccumulated over a five-year period when aspiration again relieved his symptoms, which then only consisted of epigastric fullness. review of the literature shows jaundice to be an extremely rare symptom of renal cyst.- - - - - - - - - - ranking = 6.2542399090426keywords = aspiration (Clic here for more details about this article) |
9/27. Activated charcoal laryngitis in an intubated patient.Activated charcoal is useful in the management of poisonings, but it is not harmless. We report the case of a patient who developed obstructive laryngitis secondary to aspiration of activated charcoal with a protected airway. CASE: A 2-year-old girl presented acute mental alteration secondary to presumed poisoning. Mechanical ventilation was initiated, and a single dose of activated charcoal was administered. She had an episode of vomiting during the respiratory weaning. Black-tinted tracheal secretions were suctioned through the tube immediately. Pulmonary auscultation and radiologic examination were normal. When she was extubed, she developed obstructive laryngitis. Fiberbronchoscopy was performed and showed edema and a significant amount of charcoal particles on the epiglottis, arytenoids, and arytenoepiglottic folds. charcoal particles were removed by bronchoscopy successfully. Later evolution was normal, and no symptoms were present when she was discharged at home. COMMENTS: Obstructive laryngitis is a new major complication of activated charcoals use in upper airway. It is remarkable that this complication occurred in a protected airway. charcoal is not an innocuous agent. This case shows that nasogastric administration of activated charcoals presents a significant degree of risk.- - - - - - - - - - ranking = 3.1271199545213keywords = aspiration (Clic here for more details about this article) |
10/27. Reflux of metrizamide into the lateral ventricles in vomiting.Two cases are presented in which metrizamide refluxed into the lateral ventricles after vomiting, the contrast having been brought in intrathecally by lumbar route for CT-scanning of the basal cisterns. It is suggested the intrathoracic and intraabdominal pressures transority achieved in vomiting are transmitted to the spinal canal through the vertebral venous plexus. This results in a pressure which is transmitted through the C.S.F. to the posterior fossa, and from there, for anatomical reasons, to the ventricular system. Transitory dilatation of the ventricles results in aspiration fluid from the fourth ventricle, and hence reversal of normal flow in the aqueduct of Sylvius.- - - - - - - - - - ranking = 3.1271199545213keywords = aspiration (Clic here for more details about this article) |
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