by David Olorunfemi Samuel and Bello Ruth Nabe
Original Research
INTRODUCTION: Hiatus hernia is the protrusion of the stomach or part of it through the oesophagus or a defect in the diaphragm into the thoracic cavity. Hiatus hernia is associated mainly with obesity and is sometimes encountered in patients with dyspepsia. Hiatus hernia can make worse the symptoms of dyspepsia especially in patients with reflux disease where it can cause non- cardiac chest pain or interferes with the acid pocket where there is a postprandial reflux of acid into the esophagus from the fundic area of the stomach. AIM: The aim of this study was to enroll patients coming for upper GIT endoscopy because of dyspepsia or peptic ulcer disease and were found to have hiatus hernia accidentally or as part of the reasons for referral to the endoscopy clinic. OBJECTIVE: The objective of this survey was to determine solely the relationship between hiatus hernia and body mass index of patients who were sent to the endoscopy clinic for upper gastrointestinal endoscopy for the suspected diagnosis of peptic ulcer disease or gastroesophageal reflux disease. METHOD: This was a prospective study between June 2010 and June 2016, the survey was conducted in two different centres in the north central part of Nigeria. Two consultant Gastroenterologists who also performed endoscopy on regular basis participated in the study. Consecutive patients who presented to the endoscopy clinic for the diagnostic upper GIT endoscopy were enrolled in the study. Patients who were found to have hiatus hernia by Hills classification had their weight and height recorded and their body mass index calculated. RESULT: Hiatus Hernia was found to be commoner in women but it was not found to be associated with obesity. Patient with the BMI indicating overweight had the highest rate of herniation while the obese individuals had the lowest. CONCLUSION: Obesity was not found to be associated with hiatus hernia and it may be possible that the rate of hiatus hernia may have a negative correlation with increasing BMI above 30Kg/M2.
American Journal of Medical Case Reports. 2018, 6(4), 75-78. DOI: 10.12691/ajmcr-6-4-6
Pub. Date: May 19, 2018
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by Maria Pereira, Catherine Mary Healy, Carrie A. Mohila and Monica Marcus
Case Report
We present the first case of cat-scratch disease described to trigger juvenile polymyositis. A 15-year-old male presented with a prolonged febrile illness. He had been diagnosed with cat-scratch disease 4 weeks earlier based on his exposure to kittens and serologic testing. Treatment with antimicrobials provided partial relief. He continued to have unremitting fever and developed headache, jaw pain, blurry vision, myalgias and impaired ambulation. Imaging studies were most consistent with myositis of the lower extremities and muscles of mastication. A muscle biopsy of anterior tibialis muscle confirmed a diagnosis of polymyositis. Patient had an excellent response upon initiation of immunosuppressive treatment. Juvenile polymyositis is a rare disease and should be part of the differential diagnosis of patients presenting with prolonged fever and severe myalgias with normal muscle enzymes, particularly following a bartonella henselae infection.
American Journal of Medical Case Reports. 2018, 6(4), 72-74. DOI: 10.12691/ajmcr-6-4-5
Pub. Date: May 16, 2018
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by Christina George D.O, Sreelatha Penumalee M.D and David Minter D.O
Case Report
Dialysis disequilibrium syndrome (DDS) is a rare complication of dialysis leading to neurological symptoms which can vary in severity from a simple headache to coma and death. The debate continues on the specific causes of DDS and centers around two main theories; the reverse urea effect and cerebral acidosis. It can be a challenge to predict in which patients DDS will occur, and an even more difficult syndrome to treat while the best known treatment is prevention. A case where DDS led to irreversible brain damage despite preventative measures in place will be discussed along with a discussion of current literature surrounding dialysis disequilibrium syndrome (DDS) and its treatment.
American Journal of Medical Case Reports. 2018, 6(4), 68-71. DOI: 10.12691/ajmcr-6-4-4
Pub. Date: May 08, 2018
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by Zahra Janamiri, Yousef Moghimi Boldaji and Fardis Mosayebian
Original Research
Introduction: The lumbar spine consists of five adjacent vertebrae of the mid-lower vertebral column. They participate in the lumbar lordosis, a natural curve in the spine, that is convex anteriorly. We plan to investigate the radiographic parameters of sagittal axis of the spine to assess clinical correlation. Methods: We have prospectively defined three parameters, including lumbar lordotic angle (LLA), lumbosacral angle (LSA) and sacral horizontal angle (SHA). We have enrolled 70 patients with chronic low back pain referred to our neurology clinic in a private hospital in Tehran for radiographical assessment, with 90 cm distant from x-ray tube and further radiological analysis was performed by an expert radiologist to correlate with clinical significance of these patients, compared with 70 otherwise healthy cases in control group. We have used SPSS version 16 and Student T-test and Chi-square test for statistical analysis. Results: Our study group consists of 70 patients with chronic low back pain with mean age of 56.3 years and 70 otherwise healthy patients with no complaint of low back pain, with mean age of 60.1 years old in control group. We have found that LSA angle is statistically significant in both male and female patients of case group. (P value < 0.05) Also, we have found that LLA angle is a single factor which is significantly correlated with low back pain in patients in male patients of case group. (P value < 0.05) However, SHA angle did not exhibit statistically significant correlation in patients with chronic low back pain in both groups. (P value = 0.091). Conclusion: In this prospective study, we have correlated radiographic features of lumbosacral structure of patients suffering from chronic low back pain and we have found statistically significant correlation between LSA in both genders and LLA in male patients and these finding may prompt the importance of further evaluation and investigation of bony structure of spine for better understanding and management of these patients.
American Journal of Medical Case Reports. 2018, 6(4), 65-67. DOI: 10.12691/ajmcr-6-4-3
Pub. Date: May 08, 2018
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by John R. Woytanowski MD, Benjamin Bluen MD, Jennifer Maning, Ekamjeet Randhawa MD, Shara Epstein MD and Dong Heun Lee MD
Case Report
Lobar pneumonia as a cause of jaundice with non-obstructive conjugated hyperbilirubinemia is an uncommon complication of pneumococcus. More commonly seen in immunocompromised and elderly patients, it is believed that the offending microbe produces a toxin that directly causes hepatocellular injury and impairment of bilirubin excretion. Biopsies of patients with pneumococcal pneumonia-associated jaundice commonly depict patchy areas of hepatic necrosis and dilated biliary canaliculi without metastatic foci of infection. In the pre-antibiotic era, the prevalence of jaundice in patients with lobar pneumonia was reported to be about 14% and carried significant mortality rates. Seen less commonly today, mortality rates of invasive pneumococcal disease remain as high as 5% to 35%. We present a case of a 29 year-old-male with no medical history presented with subjective fevers, productive cough, dark urine and myalgias for three days. He was profoundly jaundiced without stigmata of chronic liver disease. Computerized tomography (CT) of the chest revealed a right lower lobe pneumonia. The patient had leukocytosis, significant elevation of transaminases, hyperbilirubinemia and was found to be influenza positive. Antibody for human immunodeficiency virus (HIV) was also positive and later confirmed with polymerase chain reaction (PCR). An extensive workup for his jaundice and hyperbilirubinemia was unrevealing and it was deemed that his clinical signs were a result of invasive pneumococcal infection from his pneumonia. The patient was treated with antimicrobials and highly active antiretroviral therapy (HAART). He ultimately had complete resolution of his jaundice and laboratory abnormalities. Although seen infrequently today, unusual manifestations of pneumococcal infection still occur and may be unrecognized in practice.
American Journal of Medical Case Reports. 2018, 6(4), 61-64. DOI: 10.12691/ajmcr-6-4-2
Pub. Date: May 03, 2018
10764 Views2777 Downloads
by Zahra Janamiri and Fariborz Faeghi
Original Research
Introduction:Inflammation of the optic nerve is one of the most common causes of unilateral and/or bilateral blindness. The most common cause of this phenomenon is demyelinating processes which involve central nervous system and the diagnosis is suspected via clinical finding and confirmed by Magnetic Resonance Imaging (MRI). In this study we plan to investigate whether isolated conventional MRI is a reliable and sufficient diagnosing tool in approach to patients with clinical finings of optic neuritis. Methods: This retrospective study was performed in patients referred to neurology department of a private hospital in Tehran from 2012 to 2014, and underwent brain MRI after clinical diagnosis has been established. Clinical diagnosis of optic neuritis was confirmed by neuro-ophthalmological examination, visual field assessment and visual evoked potential (VEP). We have utilized SPSS program for statistical analysis, along with Student T-test and Chi-Square test. Result: Demographic analysis and data gathering were performed for all of the patients. Ninety patients were enrolled in the study, which 58 cases (64.4%) showed MRI abnormality in their neuro-imaging. In this group, supratentorial and infratentorial lesions were existed in 34 cases (58.6%) and 24 cases (41.3%) respectively. The most common affected sites of supratentorial region were periventricular region (in 17 cases), followed by juxtacortical (in 6 cases), basal ganglia (in 3 cases), corpus callosum (in 3 cases), centrum semiovale (in 2 cases) and in optic nerve in 3 patients. In patients with lesions in their infratentorial region, the most common sites were cerebellum hemispheres (in 11 cases), followed by mesencephalon (in 6 cases), pons (in 4 cases) and medulla oblongata (in 3 cases). Conclusion: We have found that conventional MRI as a single approach is not reliable in detecting enhancing plaques of white matter tracts in 35.6% of our enrolled cases who their diagnosis of optic neuritis were confirmed by visual field assessment and VEP. This issue raises the importance of addition of other enhancing technique to MRI for better localization of enhancement for multi-disciplinary approach.
American Journal of Medical Case Reports. 2018, 6(4), 58-60. DOI: 10.12691/ajmcr-6-4-1
Pub. Date: April 27, 2018
6149 Views1537 Downloads