Medicine
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We describe the unique case of a child with pneumonia presenting with acute scoliosis and abdominal pain, without any typical features of the disease. A 10-year-old girl presented to the emergency department on 3 consecutive days with right-sided abdominal pain. There were no associated features, in particular, no fevers or respiratory symptoms. ⋯ Despite treatment, the parapneumonic effusion enlarged rapidly and she developed respiratory distress, necessitating transfer to a tertiary centre. The diagnosis of pneumonia can be challenging because of a lack of respiratory signs, the masking of systemic features by antipyretic effects of first-line analgesics, and a high rate of false-negative chest radiographs. The development of acute scoliosis should lead the clinician to strongly consider pneumonia in such circumstances.
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Case Reports
Reversible splenial lesion syndrome after blood transfusion presents callosal disconnection syndrome: A case report.
Reversible splenial lesion syndrome (RESLES) is a reversible condition with an excellent prognosis in most patients. The clinical features include altered states of consciousness, delirium, headache, and seizures, but no callosal disconnection syndromes have been described in RESLES. ⋯ Neurologists should be aware of the symptoms of callosal disconnection syndrome in RESLES. In addition, caution should be taken when transfusing blood products in patients with gastrointestinal bleeding.
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Portal vein thrombosis (PVT) is relatively common in patients with liver cirrhosis waiting for liver transplantation (LT). Anticoagulation is an important non-invasive treatment strategy for patients with cirrhosis and PVT. ⋯ Patients with cirrhosis and PVT who are waiting LT can be effectively treated with LMWH anticoagulants. Careful use of anticoagulation is generally safe. Early initiation of anticoagulation treatment may be associated with a high rate of portal vein recanalization.
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Case Reports
Foreign body embedded in the lower esophageal wall located by endoscopic ultrasonography: A case report.
Ingested esophageal foreign bodies are commonly seen in adult population. In very few instances, esophageal foreign body may pass through the mucosal surface, re-epithelialize or migrate into surrounding soft tissues. ⋯ Our case showed that computed tomography is necessary to diagnose the esophageal foreign body, and EUS may help confirm the position of foreign body, especially those embedded in the esophageal submucosa. We advocate necessary surgery at the first accurate diagnosis in patient with esophageal foreign body when endoscopy is not possible.
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Positional asphyxia is a rare cause of sudden death and a difficult diagnosis, based mostly on the circumstances of the incident, along with particular external and internal findings, frequent in asphyxia (signs of sudden death). ⋯ Therefore, the current criteria for positional asphyxia are based on the obstruction of normal gas exchange caused by the body position, the impossibility to move to another position, and the exclusion of other causes of death. The forensic medical examination must also be started at the scene of the incident.