The American journal of emergency medicine
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Abdominal pregnancy is defined as an implantation in peritoneal cavity, exclusive of tubal, ovarian, or intraligmentary pregnancy. These pregnancies are rarely encountered and can go undiagnosed until advanced period of gestation [1]. Frequency of abdominal pregnancy has been directly related to the frequency of ectopic gestation as constituting 2% of ectopics and nearly 0.01% of all pregnancies [2-4]. ⋯ Diagnostic challenge with oxytocin stimulation, abdominal x-ray, hysterosalpingography, and ultrasonography has been used as tools to assist in diagnosis [10,11]. Magnetic resonance imaging is found to complement sonography in making accurate diagnosis and can be useful to demonstrate the relationship between fetus, the cervix, and the myometrium [12]. We hereby report a successful operative delivery of a live baby after a term extrauterine abdominal pregnancy in a multigravida in whom the diagnosis was made after laparotomy.
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Kikuchi disease is a self-limited disease characterized primarily by regional lymphadenopathy. Kikuchi disease was first described in 1972 as a lymphadenitis with specific histopathologic findings. ⋯ We also review the epidemiology, clinical presentation, and laboratory findings typically found in patients with Kikuchi disease. Inclusion of Kikuchi disease in the differential diagnosis for meningitis may help establish a diagnosis in patients also presenting with regional lymphadenopathy.
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Case Reports
An atypical misplacement of a temporary pacing catheter diagnosed and resolved by ultrasound.
Temporary transvenous pacing catheter placement is an important and critical procedure for emergency physicians. Ultrasound can be used to guide placement and to diagnosis correct or incorrect catheter placement. This case report discusses a patient with an acute ST elevation myocardial infarction leading to unstable arrhythmias requiring emergent transvenous cardiac pacing. ⋯ There was some difficulty placing the catheter, but successful capture with a left bundle-branch block pattern was obtained. However, ultrasonographic evaluation after placement showed the pacing wire curled in the Inferior Vena Cava (IVC) with the tip in the right ventricle. Ultrasound examination and guidance can prevent misplacement of the transvenous pacer catheter, which would not be apparent by electrocardiographic means.
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Klebsiella pneumonia is a common human pathogen, and endogenous endophthalmitis is a vision-threatening infection presentedwith pain, redness, decreased vision acuity, and intraocular inflammation. Endogenous endophthalmitis caused by Klebsiella pneumoniae is uncommon and usually happens in patients with immunosuppression conditions. Diabetes is a predisposing risk factor, and liver abscess is a major source of Klebsiella pneumonia endogenous endophthalmitis (KPEE). Here, we report a case of KPEE in a patient who lost his vision in one eye after treatment.
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Hamate fractures represent only 2% to 4% of all carpal bone fractures because they require a large degree of force to the hand or wrist. This is a case report of a patient with hamate and capitate fractures after a punch injury. It details the minute change seen in routine 3-view radiographic imagery and indications for computed tomography. ⋯ The risks to not detecting a hamate body fracture are nonunion of the bone, posttraumatic arthritis, decreased grip strength, and decreased range of motion of the hand. Because of rarity, there is no criterion standard therapy, but the general approach is open reduction and internal fixation using Kirschner wires and wrist immobilization for a minimum of 8 weeks. A high degree of clinical suspicion on examination is required for the proper approach to confirm a hamate fracture.