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Pyloromyotomy
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Symptoms usually commence at 2–4 weeks of age, but can sometimes be seen in neonates or infants close to 2 months of age. Symptoms consist of projectile vomiting of non-bilious material, constipation, dehydration, lethargy, or seizures, and failure to thrive. Hematemesis has been documented in a few cases.
Dysphagia Six Weeks Following Accidental Corrosive Ingestion
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
Vikram Kate, R. Kalayarasan, N. Ananthakrishnan
The clinical features depend upon the phase and severity of injury. In the acute phase, patients present with odynophagia, drooling of saliva due to dysphagia, ulceration of the lips, tongue, and oral cavity mucosa. Airway involvement can result in stridor requiring emergency tracheostomy. Intent of ingestion of corrosive substances also determines the clinical presentation. In suicidal ingestion, patients have an idea of what they are taking that often produces initial hesitancy resulting in extensive damage to the upper aerodigestive tract. Accidental ingestion is associated with intake of a relatively large quantity of corrosive substance as the patients are unaware of what they are taking resulting in esophageal and gastric injury. Vomiting, common with gastric injury, aggravates esophageal damage due to regurgitated corrosives. Hematemesis, although rare, is a manifestation of gastric injury. Chest pain, pleural effusion, and mediastinitis suggest esophageal perforation while peritonitis indicates transmural gastric injury with perforation.
Fructose-1,6-diphosphatase deficiency
Published in William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop, Atlas of Inherited Metabolic Diseases, 2020
William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop
There may be convulsions or other manifestations of hypoglycemia. There may be flushing [2], or pallor and sweating. Vomiting may be complicated by hematemesis [14, 15]. Hypotonia and muscle weakness have been observed. The electroencephalograph (EEG) may be abnormal during the acute attack and normal later. Fast spindle-shaped bursts on a slow amplitude pattern have been described [2], as well as a slow-wave pattern [16]. Intellectual development is usually normal (Figures 49.2 and 49.3). Of course, impaired mental development, as well as death may accompany neonatal or early infantile hypoglycemic crises, but fasting tolerance improves with age, and patients normal by childhood usually develop normally. In addition to the lactic acidemia, analysis of the blood reveals increased concentrations of alanine and uric acid [17]. In some attacks, there may be acidosis without hypoglycemia. Glycerol and glycerol-3-phosphate have been found in the urine [18, 19].
Timing of embolic phenomena after hydrogen peroxide exposure – a systematic review
Published in Clinical Toxicology, 2023
Andrew King, Megan Fee, Erin McGlynn, Brandon Marshall, Katherine G. Akers, Benjamin Hatten
Twenty-seven of 49 patients with portal venous gas (55%) as the primary finding had gastrointestinal bleeding. Of those 27 patients, 19 (70%) presented with hematemesis, while 8 (30%) did not. Severity of the gastrointestinal bleeding is not described. However, all patients with isolated portal venous gas and gastrointestinal bleeding had a full recovery regardless of hyperbaric oxygen therapy. Nearly all patients (47 of 49) with portal venous gas presented with nausea, vomiting, or abdominal pain, while one patient presented with chest pain and one with a sore throat. Six cases with primary portal venous gas were low-concentration ingestions. Of those, four patients developed gastrointestinal hemorrhage, and two did not. Thus, most patients with portal venous gas experienced early gastrointestinal symptoms and more than half experienced gastrointestinal bleeding regardless of concentration. Symptoms typically resolved with supportive care.
Prolonged enoxaparin therapy compared with standard-of-care antithrombotic therapy in opiate-treated patients undergoing primary percutaneous coronary intervention
Published in Platelets, 2021
Wael Sumaya, William A.E. Parker, Heather M. Judge, Ian R. Hall, Rachel C. Orme, Zulfiquar Adam, James D. Richardson, Alexander M.K. Rothman, Kenneth P. Morgan, Julian P. Gunn, Robert F. Storey
It should be emphasized that clinical outcomes described here are only hypothesis-generating, as our study lacks sufficient power to demonstrate efficacy or safety. Furthermore, the rate of stent thrombosis in the SOC patients (4%) was higher than expected and likely due to chance since we have recently shown that introduction of our institutional guideline for the use of a 6-hour tirofiban regimen in opiate-treated patients undergoing PPCI was associated with a reduction in 30-day stent thrombosis rates to 0.6% [11]. These results, however, highlight the potential caveats with current SOC. Although the risk of stent thrombosis is small, consequences, as was the case in one of our patients, can be catastrophic. Furthermore, one patient developed stent thrombosis despite treatment with GPI, indicating that GPI may not be successful at preventing stent thrombosis in poor flow conditions. We also observed one patient developed fresh hematemesis while receiving GPI. This highlights the potential risk of using routine GPI in combination with heparin and dual oral antiplatelet therapy in view of the expected severe effect on hemostasis of this combination.
Predictive role of laboratory markers and clinical features for recurrent Henoch-Schönlein Purpura in childhood: A study from Turkey
Published in Modern Rheumatology, 2020
Şule Gökçe, Zafer Kurugöl, Güldane Koturoğlu, Aslı Aslan
The epidemiological and demographic data including age, gender, seasonal contact time were analyzed. Previous infections, vaccinations, and insect bites were all recorded as provided they were within two weeks prior to the first symptom. Fever was considered to be present if the temperature was >37.7 °C. Renal involvement was defined as follows: Microscopic hematuria was defined when the urine test result was > 5 erythrocytes/mm3; gross hematuria was defined when blood in the urine could be seen with the naked eye. Severe nephropathy was considered to be present when the patient had 1 of the following findings: nephrotic syndrome: defined as plasma albumin level under 25g/L and either 1g of proteinuria/d per m2 of body surface area in children, with or without the presence of edema; or acute nephritic syndrome that was defined as hematuria with at least 2 of the following features; hypertension, elevated plasma urea or creatinine serum levels, and oliguria. Rash location means purpura mainly concentrated in parts of the body. The joint involvement was described as the presence of joint swelling and/or limitation of joint movement. Gastrointestinal involvement was defined as bowel angina (characterized by the presence of diffuse abdominal pain), gastrointestinal bleeding (melena or hematochezia or the child had a positive stool Guaiac test), and nausea and vomiting in the context of the clinical duration of vasculitis. Stomachache and hematemesis also support gastrointestinal involvement.