North American Journal of Medical Sciences最新文献

{"title":"Demographic and Etiological Patterns of Gastric Outlet Obstruction in Kerala, South India","authors":"V. Sukumar, C. Ravindran, R. Prasad","doi":"10.4103/1947-2714.166220","DOIUrl":"https://doi.org/10.4103/1947-2714.166220","url":null,"abstract":"Background: In the modern era, the major cause of gastric outlet obstruction (GOO) is known to be a malignancy, especially in the developed world. Many books and articles do suggest that the benign causes continue to be the major cause of GOO in the developing world however, there is growing evidence proving the contrary. Males were (more commonly) affected females and individuals in their fifth and sixth decade have been the predominant age group in the majority of studies. There is a minimal data of GOO from South India. Aims: A retrospective analysis of the endoscopic findings of patients presenting with features of GOO to determine the demographic and etiological patterns. Materials and Methods: A retrospective study of the endoscopic findings of patients with GOO from January 2005 to January 2014 was done. The diagnosis of GOO was based on clinical presentation, and an inability during the upper endoscopy to enter the second portion of the duodenum as documented in the endoscopy registers. Patients who have already been diagnosed with malignancy prior to the endoscopy were excluded from the study; so were the patients with gastroparesis. Results: A total of 342 patients with GOO underwent the endoscopy during the study period. The causes for benign obstruction were predominantly peptic ulcer disease. The major cause for malignant obstruction was carcinoma of stomach involving the distal stomach. The male to female ratio was 3.2:1. The patients with malignancy were older than patients with benign disorders. Most of the patients were in the sixth and seventh decade. The risk of malignancy was higher with increasing age, especially in women. A fourth of all carcinoma stomach presented with GOO. Conclusion: The study demonstrates that the cause for GOO in Kerala, South India is predominantly malignancy. The etiological and demographic patterns were similar to the studies conducted in the developed nations.","PeriodicalId":19703,"journal":{"name":"North American Journal of Medical Sciences","volume":"49 1","pages":"403 - 406"},"PeriodicalIF":0.0,"publicationDate":"2015-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83649012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypoplasia of the Spleen: Review of Pathogenesis, Diagnosis, and Potential Clinical Implications.","authors":"Iswanto Sucandy,&nbsp;Harsha V Polavarapu,&nbsp;Christopher M Pezzi","doi":"10.4103/1947-2714.163645","DOIUrl":"https://doi.org/10.4103/1947-2714.163645","url":null,"abstract":"<p><strong>Context: </strong>Splenic aplasia is seen when the spleen is congenitally absent, has been surgically removed, or becomes atrophic secondary to episodes of arterial/venous occlusion, which result in splenic infarction. This rare condition is caused by a heterogenous group of diseases, which may present a wide spectrum of clinical manifestations. Splenic hypoplasia is defined as reduction in splenic mass and or functions caused by incomplete splenic development or secondary parenchymal involution. Splenic infarction may be clinically silent and only discovered incidentally during abdominal exploration for other conditions.</p><p><strong>Case report: </strong>We present an unusual case of hypoplastic spleen with calcifications, which was preoperatively found during radiologic workup for gastric carcinoma. An 88-year-old woman presented with coffee-ground emesis. Her past medical history was only significant for atrial fibrillation. Esophagogastroduodenoscopy demonstrated gastric carcinoma, for which a subtotal gastrectomy was planned. Preoperative computed tomography scan showed a hypoplastic spleen with calcifications in the left upper quadrant. Symptoms of immunologic deficiency were not present. During laparotomy, an atrophied and calcified spleen was identified and left in situ. The patient made an uneventful postoperative recovery. Splenic hypoplasia is an unique entity, which may be seen in the setting of atrial fibrillation and abdominal malignancy.</p><p><strong>Conclusion: </strong>Splenic hypoplasia may be detected incidentally during radiologic workup or abdominal exploration. Abdominal symptoms or immunologic deficiency are not always present.</p>","PeriodicalId":19703,"journal":{"name":"North American Journal of Medical Sciences","volume":"7 8","pages":"368-70"},"PeriodicalIF":0.0,"publicationDate":"2015-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f8/1a/NAJMS-7-368.PMC4561443.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34045243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hyperhomocysteinemia Association With Transient Global Amnesia: A Rare Case Report.","authors":"Rafay Khan,&nbsp;Mohammad A Hossain,&nbsp;Qiang Nai,&nbsp;Abdalla M Yousif,&nbsp;Shraman Sen","doi":"10.4103/1947-2714.163647","DOIUrl":"https://doi.org/10.4103/1947-2714.163647","url":null,"abstract":"<p><strong>Context: </strong>Transient global amnesia (TGA) is an intriguing condition that classically presents with an abrupt onset of temporary complete anterograde amnesia and partial retrograde amnesia. Most individuals who experience such a form of amnesia usually have only one attack but recurrent attacks are possible. Most attacks last for a few minutes or few hours and the ability to lay down new memories may also be affected but gradually improves, leaving only a dense amnestic gap for the duration of the episode. There has been some discussion about the etiology behind TGA; however, there has yet to be a consensus with regard to any significant association.</p><p><strong>Case report: </strong>We report the case of a 65-year-old male presenting with a sudden onset of memory loss that is typical of TGA and who was found to have elevated homocysteine levels. There has only been one other case previously reported that discussed a possible correlation between hyperhomocysteinemia and TGA. It is yet to be determined if increased homocysteine level is a significant risk factor for attacks of TGA.</p><p><strong>Conclusion: </strong>Although it was first described more than half a century ago, it can still be misdiagnosed frequently as many physicians are not familiar with this condition. Furthermore, there are quite a few medical conditions that may cause sudden memory impairment, such as epilepsy and stroke, which make it difficult to distinguish them from this form of amnesia. The knowledge of these clinical identities is necessary for a high index of suspicion, which may lead to a meticulous medical evaluation as required for proper diagnosis.</p>","PeriodicalId":19703,"journal":{"name":"North American Journal of Medical Sciences","volume":"7 8","pages":"374-6"},"PeriodicalIF":0.0,"publicationDate":"2015-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6f/85/NAJMS-7-374.PMC4561445.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34045245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Double Right Coronary Artery Originating from Separate Ostia: A Report of Two Cases.","authors":"M Natarajan,&nbsp;B N Kumarguru,&nbsp;Dayananda S Biligi,&nbsp;A R Raghupathi","doi":"10.4103/1947-2714.163646","DOIUrl":"https://doi.org/10.4103/1947-2714.163646","url":null,"abstract":"<p><strong>Context: </strong>Coronary artery anomalies are uncommon and most are incidental findings. Double right coronary artery (RCA) is a very rare coronary artery anomaly.</p><p><strong>Case report: </strong>We report two cases of double RCA incidentally found in electrocuted patients. Both cases showed double RCA arising from separate ostia. On microscopy, both right coronaries showed no significant pathology in the first case while in the second case, the posterior RCA showed features of obliterative arteritis.</p><p><strong>Conclusion: </strong>Although double coronary artery has been regarded as hemodynamically insignificant, it may be associated with atherosclerosis, acute coronary syndromes, and other anomalies. It is important to know the anatomic variants. Meticulous grossing and careful observation could unearth hidden anomalies.</p>","PeriodicalId":19703,"journal":{"name":"North American Journal of Medical Sciences","volume":"7 8","pages":"371-3"},"PeriodicalIF":0.0,"publicationDate":"2015-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ab/05/NAJMS-7-371.PMC4561444.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34045244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Pattern of Psoriatic Arthritis in Kashmir: A 6-Year Prospective Study.","authors":"Shagufta Rather,&nbsp;Nuzhatun Nisa,&nbsp;Tasleem Arif","doi":"10.4103/1947-2714.163643","DOIUrl":"https://doi.org/10.4103/1947-2714.163643","url":null,"abstract":"<p><strong>Background: </strong>The prevalence, clinical presentation, and patterns of psoriatic arthritis (PsA) vary in different parts of the world. The scenario of PsA in west is different from that of Asia. Moreover, the oligoarticular type which was considered most prevalent earlier has been replaced by polyarticular type.</p><p><strong>Aim: </strong>The study was to the clinical profile of psoriasis patients associated with PsA in Kashmir valley of India.</p><p><strong>Materials and methods: </strong>This was a noninterventional, observational, prospective, hospital-based study involving 150 successive patients of PsA over a span of 6 years. Severity of the skin and nail involvement was assessed by Psoriasis Area and Severity Index (PASI) and Nail Psoriasis Severity Index (NAPSI), respectively. PsA was diagnosed by classification criteria for PsA. The number and pattern of swollen and tender joints was counted and classified by Moll and Wright's classification criteria.</p><p><strong>Results: </strong>Plaque-type psoriasis was the most common clinical type, observed in 122 (81.33%) patients followed by erythrodermic psoriasis in 10 (6.66%) patients and pustular psoriasis in eight (5.33%) patients. PsA occurred between 30 and 40 years of age in 105 (70%) patients. The cutaneous involvement occurred before joint involvement in 113 (75.33%), while they occurred simultaneously in 30 (20%) cases and the PsA preceded the skin involvement in seven (4.66%) cases. Symmetrical polyarthritis was the commonest clinical presentation and was seen in 90 (60%) patients. Nail involvement due to psoriasis was present in 120 (80%) patients. Commonest nail change found was pitting and seen in 60 (40%) patients.</p><p><strong>Conclusion: </strong>The clinical pattern of PsA varies in different parts of the world. Knowledge of the clinical presentation of PsA in a given area is necessary for the successful management of this disease.</p>","PeriodicalId":19703,"journal":{"name":"North American Journal of Medical Sciences","volume":"7 8","pages":"356-61"},"PeriodicalIF":0.0,"publicationDate":"2015-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f7/c2/NAJMS-7-356.PMC4561441.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34045241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Amplification of Cellular Oncogenes in Solid Tumors.","authors":"Ozkan Bagci,&nbsp;Serkan Kurtgöz","doi":"10.4103/1947-2714.163641","DOIUrl":"https://doi.org/10.4103/1947-2714.163641","url":null,"abstract":"<p><p>The term gene amplification refers to an increase in copy number of a gene. Upregulation of gene expression through amplification is a general mechanism to increase gene dosage. Oncogene amplifications have been shown in solid human cancers and they are often associated with progression of cancer. Defining oncogene amplification is useful since it is used as a prognostic marker in clinical oncology nowadays, especially v-erb-b2 avian erythroblastic leukemia viral oncogene homolog 2 (HER2) targeted agents are used in breast cancer patients with high level of HER2 overexpression as a therapeutic approach. However, patients without HER2 overexpression do not appear to benefit from these agents. We concluded that determination of oncogene amplification in solid tumors is an important factor in treatment of human cancers with many unknowns. We have referred to PubMed and some databases to prepare this article. </p>","PeriodicalId":19703,"journal":{"name":"North American Journal of Medical Sciences","volume":"7 8","pages":"341-6"},"PeriodicalIF":0.0,"publicationDate":"2015-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/98/e0/NAJMS-7-341.PMC4561439.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34045239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multidetector Computed Tomography and Magnetic Resonance Imaging Evaluation of Craniovertebral junction Abnormalities.","authors":"Rajshree U Dhadve,&nbsp;Shaileshkumar S Garge,&nbsp;Pooja D Vyas,&nbsp;Nirav R Thakker,&nbsp;Sonali H Shah,&nbsp;Sunila T Jaggi,&nbsp;Inder A Talwar","doi":"10.4103/1947-2714.163644","DOIUrl":"https://doi.org/10.4103/1947-2714.163644","url":null,"abstract":"<p><strong>Background: </strong>Craniovertebral junction (CVJ) abnormalities constitute an important group of treatable neurological disorders with diagnostic dilemma. Their precise diagnosis, identification of probable etiology, and pretreatment evaluation significantly affects prognosis and quality of life of patients.</p><p><strong>Aims: </strong>The study was to classify various craniovertebral junction disorders according to their etiology and to define the importance of precise diagnosis for pretreatment evaluation with multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI).</p><p><strong>Materials and methods: </strong>This is a prospective observational study of 62 patients referred to our department between October 2012 and September 2014. All patients suspected to have a craniovertebral junction disorder were included in the study, from all age groups and both genders. Detailed clinical history was taken. Radiographs of cervical spine were collected if available. All patients were subjected to MDCT and/or MRI.</p><p><strong>Results: </strong>In our study of 62 patients; 39 were males and 23 were females, with male to female ratio of 1.6:1. Most common age group was 2(nd) -3(rd) decade (19 patients, 30.64%). Developmental anomalies (33 patients, 53.22%) were the most common etiology group followed by traumatic (10 patients, 16.12%), degenerative (eight patients, 12.90%), infective (four patients, 6.45%), inflammatory and neoplastic (three patients each, 4.8%), and no cause found in one patient.</p><p><strong>Conclusions: </strong>CVJ abnormalities constitute an important group of treatable neurological disorders, especially in certain ethnic groups and are approached with much caution by clinicians. Thus, it is essential that radiologists should be able to make a precise diagnosis of craniovertebral junction abnormalities, classify them into etiological group, and rule out important mimickers on MDCT and/or MRI, as this information ultimately helps determine the management of such abnormalities, prognosis, and quality of life of patients.</p>","PeriodicalId":19703,"journal":{"name":"North American Journal of Medical Sciences","volume":"7 8","pages":"362-7"},"PeriodicalIF":0.0,"publicationDate":"2015-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0f/17/NAJMS-7-362.PMC4561442.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34045242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Myanmar: An Endemic Country for Oral Cancer.","authors":"Aung Zaw Win","doi":"10.4103/1947-2714.163648","DOIUrl":"https://doi.org/10.4103/1947-2714.163648","url":null,"abstract":"Dear Editor, \u0000 \u0000Betel nut (paan, Areca nut) chewing existed in Myanmar (Burma) since ancient times and it was done by both the kings and princes in the Burmese court and also by the ordinary people. The Burmese kings used golden containers studded with jewels to put the ingredients for betel quid (betel nut, betel leaf, caustic lime, and tobacco), whereas the common people used a lacquerware box. According to historical annals, court ladies offered paan to heroes returning from battles as a sign of respect and affection. It is also a Burmese custom to offer visitors and guests pickled tea leaves, paan, and hot green tea in Myanmar households. These act as stimulants and have effects similar to that of drinking coffee. \u0000 \u0000The Burmese love the betel nut so much that tens of thousands of acres are dedicated to its cultivation.[1] Consequently, the number of betel nut stalls is also growing in towns and cities across Burma.[1] In Myanmar, the practice of chewing paan is increasing among both sexes and it is more popular among rural people than urban dwellers.[1] It tends to stain the lip and the teeth red but this does not signal bad aesthetics in Burmese culture. It is addictive and the Burmese believe that it can aid in digestion, and prevent halitosis and flatulence. After chewing, the end product, i.e., red betel juice has to be spit out. It creates a stain and this has become a concern for sanitation in modern times. Today, in Myanmar, there is a ban on spitting betel juice in public places. This is a big issue in the United States. Burmese immigrants were banned from a laundromat in Fort Wayne, Indiana for spitting betel juice inside the store.[2] Many of the Burmese immigrants are refugees and political asylees and have come from refugee camps along the Thailand-Burma border. They have low levels of education and have difficulty with the acculturation process in America. \u0000 \u0000Various compounds present in the nut, most importantly arecoline, are carcinogenic and contribute to histologic changes in the oral mucosa. People who chew betel nut are 10 times more likely to have oral cancer than those who do not.[1] About 90% of males with oral cancer in Myanmar had histories of habitual betel nut chewing.[3] Chewing paan causes oral submucous fibrosis (OSMF), a precancerous lesion that lies on the causal pathway to oral cancer.[4] Areca nut causes fibroblastic proliferation and an increased collagen formation.[5] In Myanmar, the tongue is commonly affected followed by the palate, and diseases like lichen planus, oral leukoplakia, and erythroplakia can be observed, in addition to submucous fibrosis.[3,6] \u0000 \u0000Even though it has been proved that chewing betel nut causes oral cancer, there are very few education or intervention programs in Myanmar. Monks, men, women, and even kids as young as 10-year-olds chew betel nuts in Myanmar. Myanmar has the highest prevalence of betel nut chewing in the region - about 51.4% of adult males chew paan daily.[7] Compare","PeriodicalId":19703,"journal":{"name":"North American Journal of Medical Sciences","volume":"7 8","pages":"377-8"},"PeriodicalIF":0.0,"publicationDate":"2015-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a3/a9/NAJMS-7-377.PMC4561446.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34045246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimation of 10-Year Risk of Coronary Heart Disease in Nepalese Patients with Type 2 Diabetes: Framingham Versus United Kingdom Prospective Diabetes Study.","authors":"Daya Ram Pokharel, Dipendra Khadka, Manoj Sigdel, Naval Kishor Yadav, Lokendra Bahadur Sapkota, Ramchandra Kafle, Sarthak Nepal, Ravindra Mohan Sapkota, Niraj Choudhary","doi":"10.4103/1947-2714.163642","DOIUrl":"10.4103/1947-2714.163642","url":null,"abstract":"<p><strong>Background: </strong>Predicting future coronary heart disease (CHD) risk with the help of a validated risk prediction function helps clinicians identify diabetic patients at high risk and provide them with appropriate preventive medicine.</p><p><strong>Aim: </strong>The aim of this study is to estimate and compare 10-year CHD risks of Nepalese diabetic patients using two most common risk prediction functions: The Framingham risk equation and United Kingdom Prospective Diabetes Study (UKPDS) risk engine that are yet to be validated for Nepalese population.</p><p><strong>Patients and methods: </strong>We conducted a hospital-based, cross-sectional study on 524 patients with type 2 diabetes. Baseline and biochemical variables of individual patients were recorded and CHD risks were estimated by the Framingham and UKPDS risk prediction functions. Estimated risks were categorized as low, medium, and high. The estimated CHD risks were compared using kappa statistics, Pearson's bivariate correlation, Bland-Altman plots, and multiple regression analysis.</p><p><strong>Results: </strong>The mean 10-year CHD risks estimated by the Framingham and UKPDS risk functions were 17.7 ± 12.1 and 16.8 ± 15 (bias: 0.88, P > 0.05), respectively, and were always higher in males and older age groups (P < 0.001). The two risk functions showed moderate convergent validity in predicting CHD risks, but differed in stratifying them and explaining the patients' risk profile. The Framingham equation predicted higher risk for patients usually below 70 years and showed better association with their current risk profile than the UKPDS risk engine.</p><p><strong>Conclusions: </strong>Based on the predicted risk, Nepalese diabetic patients, particularly those associated with increased numbers of risk factors, bear higher risk of future CHDs. Since this study is a cross-sectional one and uses externally validated risk functions, Nepalese clinicians should use them with caution, and preferably in combination with other guidelines, while making important medical decisions in preventive therapy of CHD.</p>","PeriodicalId":19703,"journal":{"name":"North American Journal of Medical Sciences","volume":"7 8","pages":"347-55"},"PeriodicalIF":0.0,"publicationDate":"2015-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ff/ff/NAJMS-7-347.PMC4561440.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34045240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emphysematous Cystitis: A Rare Disease of Genito-Urinary System.","authors":"Shilpi Singh,&nbsp;Waqas Jehangir,&nbsp;Jay Littlefield,&nbsp;George Hanna,&nbsp;Gretchen Bowling,&nbsp;Abdalla Yousif,&nbsp;John R Middleton","doi":"10.4103/1947-2714.161253","DOIUrl":"https://doi.org/10.4103/1947-2714.161253","url":null,"abstract":"<p><strong>Context: </strong>Emphysematous cystitis (EC) is a rare infection of the urinary tract that results in gas production in the bladder. It is more common in diabetic and female patients, and can be associated with more serious complications, including pyelonephritis.</p><p><strong>Case report: </strong>We describe a case of recurrent bacterial cystitis caused by Escherichia coli (E. coli). An incidental finding in our patient of pneumaturia on computed tomography (CT) scan prompted further work-up. Differential diagnoses for pneumaturia include infection, trauma, and fistula, most commonly colovesicular. The patient history ruled out trauma and CT scanning ruled out a fistula; culture of the urine then showed a bacterial load greater than 100,000 E. coli/mL. The patient was then diagnosed with EC. She was treated with ceftriaxone and released in stable condition.</p><p><strong>Conclusion: </strong>The literature was scarce when it came to diagnoses of EC based on bacterial load. We present this case to increase health care providers' awareness of recurrent EC with a urine culture bacterial load greater than 100,000 E. coli/mL.</p>","PeriodicalId":19703,"journal":{"name":"North American Journal of Medical Sciences","volume":"7 7","pages":"332-3"},"PeriodicalIF":0.0,"publicationDate":"2015-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/22/5a/NAJMS-7-332.PMC4525393.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33908504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}