Severe Tenderness Research Articles

Successful Delivery After Myomectomy for Spontaneous Ruptured Pyomyoma: A Case Report and Literature Review

Abstract In this article, we report a case of spontaneous ruptured pyomyoma during pregnancy with successful delivery after myomectomy. A 35-year-old pregnant female (27 weeks of gestation) presented with lower abdominal pain. The patient had a history of uterine fibroids. Ultrasound, computed tomography, and magnetic resonance imaging confirmed a spontaneous ruptured pyomyoma (maximum diameter: 12.6 cm). Myomectomy was performed, and her abdominal distension and pain were significantly improved within 1 day; the condition of the fetus was normal. One month after surgery, severe tenderness was detected in the lower right side of the uterus. Considering the higher risk of uterine rupture and associated complications, a cesarean section was performed. The mother and neonate were discharged 3 and 42 days after delivery, respectively, in good condition. Myomectomy for spontaneous ruptured pyomyoma during pregnancy may be feasible and extend gestational age to improve outcomes for the mother and neonate.

Clostridial Myonecrosis: A Comprehensive Review of Toxin Pathophysiology and Management Strategies.

Clostridial myonecrosis, commonly known as gas gangrene (GG), is a rapidly progressing and potentially fatal bacterial infection that primarily affects muscle and soft tissue. In the United States, the incidence of GG is roughly 1000 cases per year, while, in developing countries, the incidence is higher. This condition is most often caused by Clostridium perfringens, a Gram-positive, spore-forming anaerobic bacterium widely distributed in the environment, although other Clostridium species have also been reported to cause GG. The CP genome contains over 200 transport-related genes, including ABC transporters, which facilitate the uptake of sugars, amino acids, nucleotides, and ions from the host environment. There are two main subtypes of GG: traumatic GG, resulting from injuries that introduce Clostridium spores into deep tissue, where anaerobic conditions allow for bacterial growth and toxin production, and spontaneous GG, which is rarer and often occurs in immunocompromised patients. Clostridium species produce various toxins (e.g., alpha, theta, beta) that induce specific downstream signaling changes in cellular pathways, causing apoptosis or severe, fatal immunological conditions. For example, the Clostridium perfringens alpha toxin (CPA) targets the host cell's plasma membrane, hydrolyzing sphingomyelin and phosphatidylcholine, which triggers necrosis and apoptosis. The clinical manifestations of clostridial myonecrosis vary. Some patients experience the sudden onset of severe pain, swelling, and muscle tenderness, with the infection progressing rapidly to widespread tissue necrosis, systemic toxicity, and, if untreated, death. Other patients present with discharge, pain, and features of cellulitis. The diagnosis of GG primarily involves clinical evaluation, imaging studies such as X-rays, computer tomography (CT) scans, and culture. The treatment of GG involves surgical exploration, broad-spectrum antibiotics, antitoxin, and hyperbaric oxygen therapy, which is considered an adjunctive treatment to inhibit anaerobic bacterial growth and enhance the antibiotic efficacy. Early recognition and prompt, comprehensive treatment are critical to improving the outcomes for patients affected by this severe and life-threatening condition.

Correlation Between General Satisfaction with the Breasts and Appearance of the Scars in Patients Undergoing Inverted T-Scar Reduction Mammaplasty: A Prospective PROMs-Based Study.

Inverted-T scar reduction mammaplasty is still the most chosen technique for breast reduction even if scars are relevant. Sometimes, surgical scars may be esthetically unpleasant and may cause severe pain, tenderness, sleep disturbances, anxiety, and depression in these patients. This study aimed to assess any possible correlation between general satisfaction with the breast and appearance of the scars in patients who underwent inverted T-scar reduction mammaplasty. Secondary aim was to evaluate average variations of BREAST-Q and SCAR-Q at different postoperative times. 121 patients who underwent breast reduction using Pitanguy technique with inferiorly based dermo-adipose flap according to Ribeiro were enrolled in this prospective cross-sectional study. All patients filled the BREAST-Q REDUCTION and SCAR-Q questionnaires in paper form at 1, 6 and 12 months after surgery. BREAST-Q REDUCTION "Satisfaction with breast" scale was also administered preoperatively. Values were exported in Prism 9 for the statistical analysis. Correlation index of Pearson between "Satisfaction with breast" and "Appearance of scar" was 0.09 at 1 month post-operative and - 0.07 and 0.21 at 6 and 12 months PO respectively. "Satisfaction with breast" mean value tends to rise over time. "Appearance of scar" mean value tends to decrease over time. No correlation at different postoperative times between the general satisfaction with the breast and appearance of the scars was found. Data showed that satisfaction with the breast and appearance of the scars in patients who underwent inverted T-scar reduction mammaplasty tend to improve over time. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

#1814 Infection associated pancreatitis in peritoneal dialysis, a case report

Abstract Background and Aims Peritoneal dialysis (PD) patients seem to have a higher incidence of acute alithiasic pancreatitis. Though rare and with some suggested triggers described in the literature, this is still a poorly understood and potentially life-threatening complication. We present a 60 years old woman concluding antimicrobial therapy with an icodextrin night-dwell regimen for peritonitis presenting with epigastric pain. This work reviews our approach to cloudy effluent from non-infectious causes during an infection while managing acute pancreatitis in the PD setting. We report diagnostic difficulties and treatment considerations with a positive outcome. Method We present a 60 years old woman on PD for one year presenting to the emergency room in November of 2023 with severe epigastric pain, nausea and emesis. She suffered from stage 5 chronic kidney disease due to autosomal dominant polycystic kidney disease and had disease complications as anemia and secondary hyperthyroidism controlled within targets. She was on automated PD (APD) with glucose based solutions. She was on the 17th of 21 days antibiogram guided treatment (ceftazidime) for a Enterobacter ludwigii PD-related peritonitis with good clinical evolution and peritoneal effluent (PE) leukocyte count per μl from 1258 to 91 in 5 days. In the previous 3 months she had had 2 other infectious episodes. A bacteremic urinary tract infection to E. coli associated with peritonitis treated with antibiogram guided therapy (ceftazidime) followed by C. difficile colitis treated with oral vancomycin. During each infection period she transitioned from APD to continuous ambulatory peritoneal dialysis with an icodextrin night dwell. On admission she presented with normal vital signs, no fever, and abdominal distention with severe epigastric tenderness to palpation without muscular guarding. Her dwell exchange showed blood-tinged cloudy PE. She had hemoglobin of 11.3 g/dl, otherwise normal blood cell counts, and raised amylase (213 UI/l) and lipase (1467 UI/l). There was no elevation of transaminases, cholestatic enzymes, C-reactive protein or procalcitonin and lipidemia or hyperbilirubinemia were normal. PE cell count showed 213/μl leukocytes and 202/μl erythrocytes. Abdominal ultrasound showed no evidence of an obstructive cause. She was admitted in the surgical care unit for a conservative and watchful approach. Results On presentation we accounted for the peritonitis still under treatment, acute pancreatitis, drug therapy and recently introduced icodextrin solution. The acute alithiasic pancreatitis diagnosis was established but there was still a possible causative role of icodextrin or infection and refractory peritonitis could also not be promptly excluded. The literature suggests icodextrin and other drugs as causes for acute pancreatitis in some patients but also mentions the possibility of cloudy or hemorrhagic effluent due to abdominal inflammation processes. Considering the clinical stability, the multiple possible contributing causative agents and the differential diagnosis of refractory peritonitis we closely monitored PE cell count evolution keeping the icodextrin dwell and ceftazidime prescriptions and collected samples for bacterial and fungal culture. The cultures were negative and stability of leukocyte count and mononuclear cell predominance (Fig. 1) helped us exclude the peritonitis hypothesis and attribute the PE changes to the pancreatitis process. Conclusion Inpatient monitoring and identifying all possible causes are essential to ensure good outcomes in PD patients suffering from acute pancreatitis. Full anamnesis, physical examination and close attention to laboratory findings were key in allowing adequate antibiotic therapy and resolution of the abdominal inflammatory process at hand while maintaining an adequate PD prescription.

Kikuchi-Fujimoto disease: A rare case of pyrexia of unknown origin

A young male was referred to a clinician for a complaint of fever of short duration with non-specific joint pain and treated for 1 week but after some time again presented with the same complaints with severe epigastric tenderness and vomiting. There was no past medical history before this episode. When cervical lymph node biopsy was performed gave us the diagnosis of histiocytic necrotizing lymphadenitis (Kikuchi-Fujimoto disease). A rare form of necrotizing lymphadenitis is an uncommon, benign, self-limiting disorder of obscure etiology. It affects mostly young adults of both genders. Clinically, it presents with fever and lymphadenopathy of a firm to rubbery consistency frequently involving cervical lymph nodes while weight loss, splenomegaly, and leukopenia in severely ill patients.

Evaluation of Antioxidant and Xanthine Oxidase Inhibitory Potential of Ethanolic Seed Extract of Illicium Verum (Star Anise)

Illicium verum is a dark-coloured spice found in tropical areas of Asia. It is known for its medicinal value, flavoring properties and cosmetic properties. It helps in dispelling cold and relieving pain. Gout is a form of arthritis that is characterized by severe pain, redness and tenderness of joints. This is due to accumulation of uric acid crystal. Anti-gout activity of the herbal extract can be analyzed by its xanthine oxidase inhibitory potential.

Isolated Renal Mucormycosis by Apophysomyces in an Immunocompetent Adult

ABSTRACT Isolated renal mucormycosis (IRM) in an apparently healthy immunocompetent adult is a rare entity with most cases reported from India and China. Fever not responding to antibiotics, sterile pyuria, and characteristic imaging findings are strong pointers toward renal mucormycosis. We report a rare case of IRM due to Apophysomyces elegans in an apparently healthy young adult who underwent bilateral nephrectomy and ultimately succumbed to sepsis. Clinical indicators such as fever not responding to antibiotics, severe flank tenderness, sterile pyuria, and characteristic computed tomography findings (diffuse or patchy areas of absent contrast enhancement, perinephric fat stranding, and thickened Gerota’s fascia) are strong pointers toward renal mucormycosis. Aggressive surgical debridement and timely antifungal is imperative for favorable patient outcome in this aggressive infection.

A classical review on Guduchi Taila

Guduchi Taila is an exquisite referred to in administration of Vatarakta. Guduchi Taila is one of the efficient medicines which contain Guduchi Kwath, Guduchi Kalka, Dugdha, processed in Til Taila only used with the aid of Vaishya’s in Vatarakta. Gouty Arthritis can be well correlated to Vata-Pithadhika Vatarakta. Gout is a pathological response of joint or periarticular tissues which result from deposition of monosodium urate monohydrate crystal in joint and tissues. Vatarakta is one of the fundamental articular diseases which are characterized through severe ache, tenderness, inflammation and burning sensation in the affected joints. Due to its anti-inflammatory analgesic and arthritis properties Guduchi Taila is extensively used in Saruk, Daha, Shopha Vatarakta, these are the signs and symptoms of Vatapittasdika Vatarakta. So, the pharmacology properties and probable mode of action of Guduchi Taila has been discussed in this article.

SAT537 Thyroid Cancer Mimicking Acute Coronary Syndrome

Abstract Disclosure: N.M. Rodrigues: None. B. Alexander: None. J. Palacios Merchan: None. Background: The use of thyrotropin –alpha for preparation of remnant ablation is associated with superior short-term quality of life and similar rates of remnant ablation as thyroid hormone withdrawal. Usually treatment with thyrotropin-alpha is well tolerated, but we need to be aware of the potential side effects. Clinical case: 61-year-old Hispanic female with multinodular goiter, underwent total thyroidectomy for compressive symptoms. The pathology report showed 4 cm invasive papillary carcinoma, well-differentiated follicular variant, with invasion of an adjacent parathyroid gland. The margins were negative, and no nodal involvement was noted. Due to the extra thyroidal extension, the plan was to undergo radioactive iodine ablation. She received two doses of thyrotropin-alpha. On the following day, 24 hours after the second thyrotropin-alpha, she complained of severe left sided chest pain and went to the emergency room. Initial workup for acute coronary syndrome was negative. CT angiography done to rule out aortic dissection showed diffuse multifocal bilateral pulmonary nodules and a 2.4 cm lytic lesion on the superior aspect of the manubrium suggesting osseous metastasis. She had severe tenderness to palpation of her chest - mostly of the sternum. We decided to perform a whole-body scan to determine if the lesions were iodine avid. Due to down trending TSH at 25 microIU/mL, she received another dose of thyrotropin-alpha. Her TSH subsequently increased to 209.4 microIU/mL with a thyroglobulin level of 2250 ng/mL. Whole body scan showed evidence of metastatic disease to the lungs bilaterally and bone metastatic lesions in the manubrium and left proximal femur. . The pain did not improve with morphine but responded well to oral diclofenac. One week later, she again received two doses of thyrotropin-alpha in preparation for radioactive iodine ablation with 200 mCi of I-131 due to the metastatic lesions. She started taking prednisone 50 mg daily for 1 week before the thyrotropin- alpha injection and continued prednisone 25 mg for five additional days. She remained asymptomatic during the radioactive iodine treatment. Conclusion: Thyrotropin-alfa has a manufacturer warning that it can lead to an increase in tumor burden resulting in severe pain and inflammation, especially at the metastatic sites. Even though imaging to look for metastasis is usually not part of the protocol before radioactive iodine ablation, it could be considered in patients with high-risk features on the surgical pathology report. This could prevent possible complications related to thyrotropin-alpha by identifying patients at risk. It is recommended that patients with cancer near their trachea, in their central nervous system, or in their lungs receive treatment with glucocorticoids to reduce inflammation. This pretreatment is shown to be very effective in preventing these complications. Presentation Date: Saturday, June 17, 2023

Long-standing Ulnar Wrist Pain Caused by an Anatomic Variant of the Ulnar Nerve

Case: We present a 28-year-old woman with long-standing left ulnar wrist pain. Physical examination revealed severe tenderness over the pisiform; imaging findings were normal. Surgical exploration revealed compression of an aberrant branch, likely Kaplan's accessory branch, around the pisiform. Complete symptom relief was achieved after nerve decompression. Conclusion: Clinical symptoms associated with Kaplan's accessory branch are rare, indicating that many branches may be asymptomatic or overlooked despite the presence of symptoms. Kaplan's accessory branch should be considered as a potential differential diagnosis for refractory ulnar wrist pain.

Starting Mandibular Advancement Device Therapy in Patients with Good Protrusive Capacity: A Randomized Pilot Study.

Discomfort has been related to the poor acceptance of a mandibular advancement device (MAD) in patients with obstructive sleep apnea. The present study compared severe initial side effects between a smaller and a larger degree of mandibular advancement in patients with a good protrusive capacity. Consecutive patients with obstructive sleep apnea and a good protrusive capacity (≥8 mm) were randomized to start treatment with the mandible advanced by either 70% of maximum protrusion (Adv70%) or by 4 mm (Adv4mm) in a pilot study with a parallel design. The main outcome was tenderness or pain in the teeth or jaws using a 0-10 visual analogue scale (VAS) (from "not at all" to "very extensive") or excluded use because of side effects during the first week of treatment. Secondary outcomes included salivation problems and bite changes. Eighteen patients were randomly selected and 17 patients fulfilled the study protocol. Four patients in the Adv70% group and none in the Adv4mm group reported severe tenderness or pain (VAS ≥7) on five or more of the seven days (p=0.03). The degree of mandibular advancement measured in millimeters correlated with the number of days with severe side effects, r=0.64 (p=0.006). The secondary side effects were minor. Starting MAD treatment with 70% mandibular advancement was related to more severe side effects during the first week of treatment compared with a smaller fixed millimeter value in patients with a good protrusive capacity in this pilot study.

Glomangioma in the hand: diagnosis, treatment, and challenges.

In this paper, we have analysed all hand glomangioma cases referred to our clinic in the context of symptoms, time to diagnosis, and the role of surgical resection of the lesion. We have collected the following data: the presence of risk factors, manifestation, time to diagnosis, the treatment applied, and follow-up of patients. We have collected medical records from six patients, three males and three females. The median age was 45 (IQR: 29.5-65.75). The main symptom in all patients was severe pain and tenderness. The first-choice physician(s) were: general practitioners, general surgeons, and neurologists. The median time to diagnosis was 7 (IQR: 5-10) years. The main complaint of our patients was severe pain - 9 (IQR: 9-10) on the VAS scale, which was significantly alleviated after surgical treatment - 0 (IQR: 0-0; p = 0.043). Extremely long times to final diagnosis, and excellent outcomes of surgical treatment, highlight the necessity of raising awareness of glomangiomas among clinicians.

Juke Stick: A Case ofPediatric Atraumatic Compartment Syndrome.

Compartment syndrome is usually due to trauma but can also have atraumatic causes. It is defined as a compromise of neurovascular and muscle function that presents symptomatically with the six P's: pain, pallor, paresthesia, paralysis, poikilothermia, and pulselessness. Diagnosis is confirmed by a delta pressure of <30 mmHg (diastolic blood pressure minus the compartment pressure). This case details a 15-year-old male football player with atraumatic compartment syndrome in the lateral compartment of the right lower leg. Symptoms of swelling and pain began 2weeks before presentation after the patient was "juked." The patient's symptoms improved after a week of rest but worsened when he returned to practice. In the emergency department, the patient was able to ambulate with pain and declined pain medication. Examination revealed severe tenderness, mildly decreased strength, decreased sensation, and edema in the lateral compartment via bedside ultrasound. Because of the concern for compartment syndrome, pressure was checked with a disposable manometer (Compass CT disposable pressure transducer) revealing a delta pressure of 26 mmHg. The patient consequently underwent fasciotomy, eventually returning to baseline function without deficits. Awareness of this atypical presentation of compartment syndrome will assist providers in making a critical diagnosis and preventing severe complications and disability. This case also demonstrates the potential of disposable pressure transducers for cost-effective and accurate diagnostic confirmation of compartment syndrome in the emergency department.

MULTIPLE SCHMORL’S NODES ON YOUNG ADULT WITH MYOFASCIAL PAIN SYNDROME: A CASE REPORT

Background: Schmorl’s node (SN) is described as intraosseous disc herniations which penetrate into the spinal canal, which is caused by the weakening of the cartilaginous endplate and subchondral bone. SN is usually detected on imaging which appears small, focal, and rounded with varying degrees of adjacent reactive sclerosis. Case Report: We present a rare case of symptomatic SN in 25-year-old male patient with complaints of discomfort and muscle strain in the back. These complaints were exacerbated by physical exercise. Severe tenderness was found at several levels of the thoracic vertebrae during palpation, where the trigger points were found in the lower trapezius muscle. Computerized tomography (CT) scan of the vertebra showed multiple bony lesions, noted as Schmorl’s nodes, at the inferior endplates of the T6-T11, and superior endplate of the T11 vertebra, in accordance to the location of severe pain during palpation. Conclusion: SN is associated with disc degeneration due to osteonecrosis process which leads to ischemia in the vertebral body. Microtrauma from excessive physical exercise could also contribute to the herniation through the weak points of the vertebral endplates. Knowledge and awareness of SN as one of the causes for acute or chronic back pain is essential for deciding early examination and diagnosis. Therefore, appropriate management could be delivered.

A Case Report on Complex Sacral Fracture Treated by Spinopelvic Fixation

Abstract Unstable sacral fractures are mostly associated with spinopelvic instability. This type of fracture occurs following a fall from height or a high-energy mechanism. Roy–Camille’s classification system helps in identifying and treating those fractures. Lumbopelvic fixation or spinopelvic fixation is an option to be considered for treating these unstable fractures. The principle of treating these fractures is to maintain the sacropelvic stability. A 54-year-old male patient presented with a history of falling from a tree from a height of 9–11 feet on his back. On further examination, he was having severe tenderness over the sacral region and dorsal spine region. His power was normal on both lower limbs, with numbness over the base of the scrotum with intact sensation distally. Deep tendon reflexes and plantar reflexes were normal. Radiographs show fracture over D12 (AO A5 – stable incomplete burst fracture) and the sacrum. Computerized tomography and magnetic resonance imaging were taken to decode the sacral fracture and to assess the neurology and posterior ligament integrity. His sacral fracture was classified by Roy–Camille type 3, U-shaped fracture, and Denis type 2 fracture.

Glomus tumor mimicking as cervical radiculopathy

Glomus tumors are rare, painful, and usually benign neoplasms typically occurring at the subungual aspect of digits. Patients usually complain of extremely painful episodes. Symptoms occur spontaneously or elicited by local compression and cold environment, in special if the tumor has an acral location. We describe a case of cervical radiculopathy caused by glomus tumor which developed spontaneously causing pain at the right index finger. Pain was excruciating, which increased on touching and sudden striking on objects. There was no neck pain, no sensory loss, and no weakness. Pain radiates to the elbow and sometimes shoulders. The patient was given trial of neuropathic medications without much relief. Nerve conduction studies were normal. Magnetic resonance imaging spine minimal disk bulge at C5–C6 level with no neural compression. On examination, the neck movements were normal and power, tone, and reflexes were normal. Neurological examination was normal. Severe tenderness on palpating the right index finger nail. MRI of the right index finger revealed a glomus tumour. Glomus tumor was diagnosed and the patient underwent surgical excision. There can be a delay in diagnosis in glomus tumours.Cervical radiculopathy may be diagnosed erroneously in patients if careful physical examination and investigations are not done.

Man With Chest Pain After a Traffic Crash.

A 40-year-old man had been involved in a scooter crash and presented to the emergency department with chest pain. His vital signs were blood pressure, 160/84 mmHg; pulse, 109 beats/min; respiratory rate 24 breaths/min, and temperature, 37.5 °C. Physical examination revealed severe local tenderness in the mid-chest region. Plain radiography (Figure 1) and point-of-care ultrasonography of the chest (Figure 2 and Video 1) were performed, and the diagnosis was confirmed by contrast-enhanced computed tomography.Figure 2The point-of-care ultrasound at the site of pain showed a breach in the anterior cortex of the sternal body (arrowhead) and a mass with mixed echogenicity around the fracture indicating hematoma (asterisk).View Large Image Figure ViewerDownload Hi-res image Download (PPT) Sternum fracture. Plain radiography revealed a suspicious mild depression fracture of the sternum. Point-of-care ultrasound imaging, using a high-frequency linear transducer at the site of pain, showed a discontinuous outline of the sternum. A chest computed tomography (Figure 3) image was obtained for confirmation of the diagnosis and to detect possible concomitant associate injuries, such as great vessel disruption, cardiac contusion, and pulmonary contusion. Sternum fracture is characterized by chest pain, which worsens with deep inspiration and shortness of breath. Motor vehicle crashes are the leading cause of sternum fracture, typically due to hitting the steering wheel without an airbag.1Oyetunji T.A. Jackson H.T. Obirieze A.C. et al.Associated injuries in traumatic sternal fractures: a review of the National Trauma Data Bank.Am Surg. 2013; 79: 702-705Crossref PubMed Google Scholar,2Knobloch K. Wagner S. Haasper C. et al.Sternal fractures occur most often in old cars to seat-belted drivers without any airbag often with concomitant spinal injuries: clinical findings and technical collision variables among 42,055 crash victims.Ann Thorac Surg. 2006; 82: 444-450Abstract Full Text Full Text PDF PubMed Scopus (55) Google Scholar Conventional chest radiography has variable diagnosis accuracy, and most sternal fractures may be missed by chest radiography alone.3Perez M.R. Rodriguez R.M. Baumann B.M. et al.Sternal fracture in the age of pan-scan.Injury. 2015; 46: 1324-1327Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar The point-of-care ultrasound can be considered a useful technique in identifying sternum fractures.4You J.S. Chung Y.E. Kim D. et al.Role of sonography in the emergency room to diagnose sternal fractures.J Clin Ultrasound. 2010; 38: 135-137PubMed Google Scholar https://www.annemergmed.com/cms/asset/9b3c776c-e7a2-4271-9e98-27acc23ff9ab/mmc1.mp4Loading ... Download .mp4 (3.14 MB) Help with .mp4 files Video 1The point-of-care ultrasound at the site of pain showed a breach in the anterior cortex of the sternal body (arrowhead) and a mass with a mixed echogenicity around the fracture indicating hematoma (asterisk).

CONCEPT OF VATARAKTA IN AYURVEDA W.S.R TO GOUTY ARTHRITIS

According to the theory of Ayurveda both the body and the diseases are made of Diet. Where the wholesome diet constructs the body, but the reverse causes the diseases. Changing food habits, lack of physical activities, and different environmental factors, nowadays a number of diseases are manifesting including Vatarakata. Due to the above-mentioned factors, the metabolism of proteins takes place improperly resulting in the formation of a number of free radicals which deposit in different sites of the body according to their affinity towards the same tissue resulting in a number of serious diseases. The disease Vatarakta is described as one of the diseases of Sammurchhna of Vata and Rakta. It is a disease, that occurs due to the Avarana of Vata Dosha by the aggravated Rakta dosha. It as a Vata dosha pradhana Tridoshaja Vyadhi where the main Dushya is Rakta. Hence Vatarakta is a disease where both Vata and Rakta are afflicted by distinct etiological factors. The references of Vatarakta are found in Bruhattrayee &amp; the text of other Acharya in respective chapters. After the keen vision of etiological factors and symptomatology, Vatarakta may be correlated to gouty arthritis.[1] It is a disorder of defective purine metabolism, which is characterized by hyperuricemia &amp; deposition of monosodiumurate crystals in joints due to its affinity for elastic tissue. It is a chronic metabolic disorder of the musculoskeletal system. [2] Severe pain, tenderness, inflammation and burning sensation in affected joints are the clinical features of it. It has been called "The disease of Kings" due to its association with people having sedentary lifestyles. Due to severe morbidity, chronicity, and incurability with associated complications, management of Vatarakta always remain a challenge for the Ayurveda physician as there is no exact treatment in the allopathy system also. So, it is very much necessary to know the concept of Vatarakta before its management.[2]

Management of Gout with Individualised Homoeopathy: A Case Report

AbstractGout is a metabolic disorder in which deposition of monosodium urate crystals leading to inflammatory joint disease. The metabolic derangement leading to supersaturation of blood and body fluids with the urate ion to the point of crystal formation is responsible for the presentation. Gout with acute arthritis or chronic arthritis is treated with non-steroidal anti-inflammatory drugs, colchicine, corticosteroids and drugs that lower levels of uric acid in the blood, but these drugs have their impact on different organs of the body. Homoeopathic system of medicine can treat gouty arthritis effectively without any other sequelae. A case of gout in a 52-year-old male patient who presented with severe pain, swelling and tenderness was successfully treated with homoeopathy medicine, Natrum sulph. The medicine prescribed in totality alleviated not only the symptoms of the patient but also lowered the serum uric acid levels to normal.

Surgery versus antibiotics in pyocele: a case report

BackgroundEpididymitis has several etiologies that can be related to infectious and non-infectious causes, autoimmune conditions, aseptic causes, and even certain pharmaceutical medications (amiodarone and chemotherapeutic agents). Some cases of epididymitis are complicated with pyocele formation that requires emergent surgical intervention to prevent testicular gangrene. This report describes the case of a 66-year-old male who developed severe bilateral epididymitis complicated by bilateral pyocele and ensuing sepsis. Astonishingly, the condition resolved completely without surgical intervention.Case presentationWe are presenting a case of a non-sexually active male who developed bilateral severe epididymitis complicated by pyocele that led to the development of septic shock. Further history revealed that the patient was not sexually active with male or female partners and denied any form of trauma. Physical examination demonstrated scrotal swelling and erythema on inspection and severe tenderness on palpation. Digital rectal examination as well as abdominal examinations was unremarkable. Laboratory investigations disclosed severe leukocytosis with a neutrophil predominance (39,000 K/UL, normal range 4500–11,000 K/UL), as well as an elevation of systemic inflammatory markers such as erythrocyte sedimentation rate and C-reactive protein. Urine culture was positive for Escherichia coli. Ultrasound revealed bilateral epididymitis and pyocele. This patient was managed with a course of meropenem, resolving the epididymitis and pyocele without the need of surgical intervention.ConclusionsSurgical intervention is considered the standard of care and the approved management for pyocele to avoid further complications such as Fournier’s gangrene. However, this patient was treated solely with antibiotics, and his condition was stabilized without the need of surgical intervention that would result in additional cost and length of stay for the patient. This case raises further questions regarding the potentially better bioavailability of this antibiotic in the scrotum compared to elsewhere in the body and the potential for a non-surgical alternative approach in the management of patients with pyocele and requires further research.