Case Of Late Diagnosis Research Articles

Anomalies of intestinal rotation and fixation: consequences of late diagnosis beyond two years of age

The malrotation and no well fixation anomalies of the digestive tract is also frequent in older child, young and adult, with characteristic and specific clinical presentation. Actually, the diagnostic and treatment seem to be late, after suffering prolonged symptoms and/or in emergency. We present nine cases of anomalies in the embryonic development of the digestive tract which were diagnosed and treated in infants or young, all above 2 years old. Eight cases were of more or less complete intestinal malrotation; one of them was a complete malrotation with an intrinsic duodenal stenosis associated (no bands of Ladd) and another one was a right paramesocolic hernia, always accompanied by malrotation. The association with other extra-digestive anomalies, especially urological, was 70%. The predominant symptom was intermittent abdominal pain (IAP)-80%-sometimes accompanied by vomiting (35%) and episodes of diarrhoea (25%). In all the cases, while the clinical background was early, diagnosis was late. Indeed, in 60% of the cases diagnosis was made intra-operatively in emergency surgical interventions. The imaging procedures employed were scanning and Doppler ultrasound, CT scan, and contrast gastrointestinal series (GIS). Up to 30% of errors in interpretation occurred, although they were eventually corrected with other tests. The most reliable diagnostic procedures were GIS and CT scan with contrast, although partial interpretation errors occurred with the latter procedure. Surgery was essential in 80% of the pre-operative cases, and in another two it was required as a preventative measure. Post-operatively, there was notable persistence of SBS in the cases of intestinal necrosis, and of other lesser symptoms in the rest. We conclude that: intestinal malrotations and malfixations are still being diagnosed very late, with serious systemic consequences such as intestinal obstructions or necroses, and prolonged clinical suffering. This could all be avoided if more attention were paid to the digestive symptoms associated with IAP, and to subocclusion or other abdominal phenomena (distension,...), together with, in the case of doubt about the findings with the previous procedures, the opportune imaging tests (e.g., abdominal Doppler ultrasound, CT scan with contrast, and barium GIS). Unlike other authors, we consider that the morbidity/mortality associated with cases of late diagnosis of these anomalies is high, and calls for earlier surgical treatment.

Late Developmental Dislocation of the Hip After Initial Normal Evaluation

Developmental dysplasia of the hip (DDH) denotes a wide spectrum of pathologies ranging from hip instability to frank dislocation. The current understanding is that cases of late diagnosis were missed during the newborn period. However, there is some evidence that a number of hip subluxations or dislocations may have been clinically stable in the neonatal period, but dislocate late. We present 5 cases of otherwise healthy children with normal physical examinations and hip radiographs in the first 3 months of life who later developed hip dislocations. Four of the 5 cases required surgical open reduction. In light of these cases and others in the literature, normal neonatal screening for DDH does not assure that continued normal development of the hip joint will happen. Our study confirms the existence of another entity in the wide spectrum of DDH: the late hip dislocation. Therefore, hip evaluations should be continued beyond the neonatal period until the child begins to walk. Parents should be informed that hip dislocation can occur in a late form, and they should be encouraged to take their children for repeated evaluations even if the neonatal screening is normal.

Inversión uterina puerperal crónica: presentación de caso y revisión de la literatura

Se presenta un caso de diagnóstico tardío de inversión uterina poco frecuente en la literatura médica. El cuadro clínico de la paciente incluía sangrado genital moderado persistente y dispareunia de 14 meses de evolución. La técnica de reposicionamiento uterino se realizó por vía vaginal con revisión posterior por víalaparoscópica y evolución satisfactoria. Se hace una revisión de la literatura.

Benefits of early diagnosis and preemptive treatment of biliary tract complications after major blunt liver trauma in children

Background/Purpose: Nonoperative management of blunt liver trauma may delay diagnosis of related biliary complications leading to delayed surgical intervention and related morbidity. The aim of this study was to see whether technetium (tc) 99 trimethylbromo-im-indolacetic acid (TBIDA) nuclear scan would allow noninvasive early diagnosis of bile leak and pre-emptive management. Methods: Retrospective analysis of the patient records and radiologic investigations of 7 patients admitted between April 1998 and December 2000 with “major” blunt liver trauma (parenchymal fracture of less than 4 cm on computed tomography [CT] scan or involving porta hepatis) and various types of biliary complications. Patients with or without early TBIDA diagnosis were compared. Results: There were 7 patients. The first 2 patients were treated conventionally without TBIDA, and late diagnosis was associated with further related problems (sepsis, life-threatening hemorrhage in both cases) and prolonged hospital stay. The subsequent 5 consecutive patients benefited from early diagnosis (TBIDA scan, 2 to 4 days after trauma), and preemptive management was done (tailored to each case). There was no further or related morbidity. All 7 patients currently are alive and well. Conclusions: A TBIDA nuclear medicine scan was efficient in providing an early diagnosis of biliary leakage, thus, allowing adequate preemptive management. In turn, this may have helped avoid related added morbidity compared with cases of late diagnosis. Early TBIDA scan should be performed routinely when the initial CT scan confirms liver trauma graded as “major.” J Pediatr Surg 37:1287-1292. Copyright 2002, Elsevier Science (USA). All rights reserved.

Diabetes mellitus tipo 2: incidencia y diagnóstico en un centro de atención primaria

To find the annual incidence and reasons for type-2 Diabetes Mellitus (DM2), and the methods used to diagnose it, on the basis of the validation of a computerised record for 1991-1995. Retrospective, longitudinal study. Primary care centre. Of the 387 diabetics registered as new cases in the 1991-1995 period out of 17031 people over 14 who were seen, 21 were not diabetics, 60 were cases of late diagnosis or late recording, 75 came from another centre and 9 were type-1. All these were excluded. The mean age of the 222 (57.4%) real new cases was 59 (ED 11.4). 53% were women. The most common causes of diagnosis were the existence of previous with diagnostic hiperglycemia (50.9%) and the application of protocols for other cardiovascular risk factors (19.8%). The diagnostic methods were two basal glucaemias > or = 140 mg/dl (70.7%), 1 glucaemia > or = 200 mg/dl with typical clinical picture (6.7%) and oral overload of glucose (23%). 97% of cases were diagnosed at the centre itself. The density of annual incidence was 30.1 per 10,000 inhabitants. Prevalence at start and end of the study was 4.4 and 4.9%. The incidence and prevalence described are greater than described in other studies. The most common reasons for diagnosis were the existence of previous nondiagnostic hyperglycemia and the application of protocols for other risk factors.

Laparoscopic cholecystectomy and gallbladder cancer: a diagnostic and therapeutic dilemma

The correct treatment strategy of patients with unsuspected gallbladder cancer undergoing laparoscopy, and the prevention of delayed diagnosis are current issues. We report a case of late diagnosis with umbilical metastasis and poor survival. A policy of careful inspection of the gallbladder and a cautious strategy in the case of gross alteration of its external morphology seems advisable during laparoscopic cholecystectomy. Although no agreement exists concerning the best treatment in the event of delayed diagnosis, the adopted strategy is contingent on patient status, disease stage and the possibility of performing appropriate follow-up.

Developmental Dislocation of the Hip: A Clinical Overview

Introduction The most common musculoskeletal evaluation in the neonatal period and infancy is assessing the child's hips. Treatment of hip dislocation is most successful when begun early, making it imperative that all children undergo repeated, careful hip examinations beginning in infancy until walking age. Those physicians entrusted with the initial examination should have a clear understanding of the etiology, prevalence, and presentation of developmental dysplasia of the hip as well as the appropriate physical examination for this entity. Historically, the term "congenital dislocation/dysplasia of the hip" (CDH) has been used. Reports illustrating cases of late diagnosis of hip abnormalities in patients who previously have had normal clinical and/or radiographic examinations as well as recognition of the wide spectrum of abnormalities from dislocation to dysplasia have led the orthopedic and pediatric communities to adopt the term developmental dislocation/dysplasia of the hip (DDH). This term now is preferred. Definitions and Categorization Hip dislocation can be categorized as "typical" or "teratologic." Teratologic dislocations are uncommon and usually are associated with neuromuscular abnormality, arthrogryposis, or myelomeningocele and typically are high, fixed dislocations. In contrast, "typical" DDH occurs in neurologically normal infants and encompasses a wide spectrum of deformity and presentation. It is important to recognize that previously stable hips may become unstable during infancy, and repeated examinations are needed until the child is of walking age.

Survival after trauma ‐ experience at an acute‐care general hospital

To assess the effectiveness of the management of acute traumatic illness at an acute-care general hospital. The study was conducted prospectively for the calendar year 1989. The Trauma Score (TS) and the revised Trauma Score (RTS) were calculated on arrival at hospital. These clinical indices were used, with the Injury Severity Score (ISS) and the age, to predict the probability of survival (Ps) and the probability of mortality. The predicted probabilities were compared with the probabilities of survival and mortality derived from a recognised baseline. The Trauma Service of The Sutherland Hospital Caringbah, including the Emergency and Intensive Care Departments and the Departments of Surgery and Anaesthetics. 74 patients of all ages who were brought to the Emergency Department because of acute traumatic illness with an ISS greater than 16. Only patients with signs of life on arrival were included in the study group. Data were complete in all 74 patients. There were 60 survivors and 14 deaths compared to figures predicted using data from the baseline group of 52.6 survivors and 21.4 deaths. There were no preventable deaths. There were five survivors whose probability of survival was less than 0.50. Three cases of late diagnosis were noted; the late diagnoses did not significantly affect the outcomes--they occurred because specialist assessment was delayed. It is possible, with few resources, to quantitatively and qualitatively assess the effectiveness of a trauma care service.

Successful surgical repair of a patent arterial duct (ductus arteriosus) in a 63-year-old woman

We describe a case of late diagnosis and successful surgical correction of a patent arterial duct (ductus arteriosus) in a 63-year-old woman

Correction of neurologic and cosmetic deficits secondary to untreated zygoma fracture: Abbreviated case report

A case of late diagnosis and treatment of a 4-month-old fractured zygoma is reported.

ACETABULAR DYSPLASIA AND FAMILIAL JOINT LAXITY: TWO ETIOLOGICAL FACTORS IN CONGENITAL DISLOCATION OF THE HIP

1. A survey of genetic and other etiological factors has been carried out in 589 index patients with congenital dislocation of the hip and their families, with special investigation of acetabular dysplasia, familial joint laxity and a comparison of neonatal and late-diagnosis cases. 2. It is believed that there are two etiological groups with congenital dislocation of the hip, i) a group with acetabular dysplasia which is inherited as a multiple gene system and is responsible for a high proportion of cases diagnosed late, and ii) a group with joint laxity which is responsible for a high proportion of neonatal cases. 3. Evidence is presented to show that acetabular dysplasia is a separate heritable system in some families. 4. Other findings relating to the genetic aspects of the survey are summarised.

Some issues of diagnosis and treatment of breast cancer

The availability of the mammary gland for examination and the developed characteristics of precancerous processes in it, along with a wide coverage of preventive medical examinations of women, could help to reduce the incidence of this form of cancer and eliminate advanced forms of the disease. However, unfortunately, there are still frequent cases of late diagnosis of such tumors, for which each of us, doctors, should consider ourselves responsible.