Background Clostridium perfringens can cause various infections, including food poisoning, gas gangrene, cellulitis and fasciitis. C. perfringens septicemia is rare, but is a known cause of hemolysis by damaging red blood cell, and often proves rapidly fatal in emergency department (ED) situations. Case presentation A previously healthy 76-year-old man presented to the ED 8 h after onset of acute abdominal pain and diarrhea. Laboratory examination revealed a large discrepancy between the red blood cell count of 1.91 × 10 6 /mm 3 and the hemoglobin level of 10.3 g/dL, suggesting massive intravascular hemolysis. Computed tomography revealed liver abscesses with gas. During ED treatment, the state of the patient rapidly deteriorated and he entered cardiopulmonary arrest. Blood cultures finally identified C. perfringens . Conclusion Intravascular hemolysis and red blood cell (RBC) / hemoglobin (Hb) discrepancy in the presence of infection should prompt ED physicians to consider C. perfringens septicemia and to act quickly to provide appropriate treatment.
Background Previous clinical studies have reported that Shakuyaku‐kanzo‐to (SKT) has a therapeutic effect on muscle cramps, but few studies have clarified how SKT acts to treat muscle cramps. The aim of this study was to perform an updated systematic review of clinical trials for SKT in patients with muscle cramps. Methods The literature was systematically reviewed to assess the effects of SKT in patients with muscle cramps. PubMed, Web of Science, Cochrane Library, Google Scholar, and Ichushi‐Web were searched using the terms “Shakuyaku‐kanzo‐to” (“shakuyakukanzoto”, etc), “clinical trials” and “muscle cramps”. Two quality assessments were conducted independently by three authors. Data were extracted using a standardized extraction tool, and a qualitative synthesis of evidence was performed. Results Three randomized controlled articles were identified and enrolled in this study. A systematic review, but not a meta‐analysis, was performed because of the high heterogeneity and limited number of studies. In patients with liver cirrhosis, the odds ratio (OR) for improvement with SKT compared to placebo was 1.27 (95% confidence interval [CI], 0.445‐2.086) and compared to Goshajinkigan was 0.81 (95%CI, −1.734‐0.114). The OR for improvement with SKT compared with eperisone hydrochloride in patients with lumbar spinal stenosis was 2.86 (95%CI, 0.980‐4.744). Conclusions Current evidence appears insufficient to allow a meta‐analysis of the effects of SKT, but SKT might show efficacy in treating muscle cramps in patients with cirrhosis or lumbar spinal stenosis.
Introduction:The abrupt onset of sensorimotor deficits is a neurologic emergency that requires immediate management. Acute spontaneous spinal cord infarction (SCI) is rare, but can cause the sudden onset of quadriplegia or quadriparesis. Magnetic resonance imaging (MRI) is an essential imaging modality to diagnose SCI.Case presentation:A 75-year-old man with a history of diabetes mellitus type 2, hypertension, and dyslipidemia was transferred to our facility for further workup of the sudden onset of quadriplegia. Diffusion-weighted contrast MRI (DWI) on hospital day 8 revealed hyperintense signals predominantly at the grey matter, and a contrast T2 signal abnormality with a decreased apparent diffusion coefficient (ADC). Steroid pulse therapy was initiated because myelitis could not be completely ruled out, but this did not improve the neurological deficits. Spontaneous SCI was finally diagnosed as an exclusion diagnosis. Symptoms were gradually recovered with rehabilitation, and he was transferred to a rehabilitation facility on hospital day 40.Conclusion:MRI with DWI of the spine should be considered for an early diagnosis of SCI. A combination of DWI with ADC maps is recommended to distinguish SCI from other differential disorders.
Killian‐Jamieson diverticulum ( KJD ) is a rare disease of the cervical esophagus, often misidentified as thyroid nodules on ultrasonography. We performed carotid artery ultrasonography for an asymptomatic 68‐year‐old man. The ultrasound showed an oval nodule with heterogeneous echogenicity surrounded by a multilayered rim in the posterior left thyroid gland. As endoscopy and computed tomography confirmed pharyngoesophageal diverticulum in the anterolateral wall of the esophagus, we reached a final diagnosis of KJD . In cases where a thyroid nodule is detected by ultrasound, physicians should be aware of the possibility of KJD before performing invasive procedures.
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