Lemmel syndrome is an uncommon pancreaticobiliary consequence of duodenal diverticula. We herein present a case of an 80-year-old male who presented with upper abdominal discomfort. Based on lab values and relevant clinical history, a diagnosis of obstructive jaundice was made. A contrast-enhanced CT scan of the abdomen revealed gross dilatation of intra-hepatic and extra-hepatic bile duct, cystic duct, common bile duct, major and minor pancreatic duct. A contrast-filled outpouching was seen from the medial wall of the second part of the duodenum with duodenal diverticulum and papilla within it. The abrupt termination of the common bile duct and main pancreatic duct adjacent to the thickened wall of the diverticulum was the cause of the patient's pancreaticobiliary obstruction. In the absence of cholelithiasis or tumor, the duodenal diverticulum that manifests as obstructive jaundice is known as Lemmel syndrome. Prompt identification of Lemmel syndrome can avoid dangerous complications and unnecessary investigations. Gallstones, cholangitis, and bile duct stones are more common in patients with duodenal diverticula. Treatment depends on patient presentation and may involve conservative management, surgical procedures in the form of excision of the diverticulum, or even endoscopic sphincterotomy or stenting.
Papillary thyroid carcinoma is one of the most common thyroid malignancy, often has excellent prognosis and low incidence of distant metastatic conditions. Brain metastases from papillary thyroid carcinoma has a rare occurrence, with patients presenting with non-specific symptoms such as headaches, cognitive changes etc., and poor survival outcomes. The standard protocol for diagnosis and treatment remains controversial. We report a patient who presented with cerebral metastasis prior to the diagnosis of papillary thyroid carcinoma, review the current literature, and explain our approach on the basis of clinical, pathological, and radiological data. A 60-year-old hypertensive male presented with lower back pain, bilateral lower limb weakness, occasional episodes of frontal headache and personality changes. The diagnostic evaluation included computed tomography (CT) scan, magnetic resonance imaging (MRI) with and without contrast enhancement, and color Doppler. Intra-axial complex solid cystic mass lesion in the right parieto-occipital region with significant perilesional oedema, and imaging characteristic of neoplastic etiology were observed. He was posted for excision of tumor and underwent right occipital craniotomy. Histopathological analysis of the surgical specimen confirmed papillary carcinoma of the thyroid gland. Brain metastases from thyroid malignancy is a sign of detrimental prognosis, hence, thorough clinical, radiological and pathological evaluation for rapid detection is critical. Neurosurgical removal along with radiotherapy should be considered as treatment of choice. The information obtained contributes towards better management and overall long-term outcomes.
Background and Aim: The only way to survive a sudden cardiac arrest is when the CPR is performed immediately after the arrest. The focus of the present research study is to assess the effectiveness of a pre-and post-simulation-based BLS training (BLS) and the outcome was measured on the basis of patient survival after the cardiac arrest. Study Design: This pre-and post-training BLS/CPR training study enrolled all nursing staff, all hospital residents, internees, throughout the hospital in a simulation-based BLS training as per the standards of American Heart Association (AHA), to make them respond to immediate resuscitation and code blue activation during the cardiac arrest within the hospital premises including ED, wards, ICUs, MRI, CT and all miscellaneous areas. The providers completed self-efficacy questionnaires as per the AHA protocol before being certified and were evaluated during the emergency in hospital cardiopulmonary arrest. Results: 296 nursing staff, 206 non-healthcare professionals, 143 residents, 212 internees, and 98 medical staff grade doctors completed the BLS training (total 955 hospital staff-providers) were graded for the response by pre-and post-training testing. In the course of pre-BLS training period out of the 250 cardiac arrest patients, 68 patients (27.2%) had ROSC, while after instituting the BLS training period, 143 individuals (40.86%) of the 350 patients who had cardiac arrest had ROSC
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