Abstract:
BACKGROUND:Previous literature on epidural pneumatosis (pneumorrhachis, or air in epidural cavity) associated with forceful vomiting in a patient with diabetic ketoacidosis (DKA) has consisted of individual case reports without comprehensive syndrome characterization due to syndromic rarity, with the largest previous literature review comprising 6 cases. Presumed pathophysiology is air escaping from alveolar rupture from forceful vomiting via tissue planes to cause epidural pneumatosis. AIM:Systematically review literature to facilitate syndromic diagnosis, evaluation, and treatment. A new illustrative case is reported. METHODS:Systematic review of literature using 2 independent readers, 2 computerized databases, and the following medical terms/keywords: ["epidural pneumatosis" OR "pneumorrhachis"] AND ["diabetes" OR "diabetic ketoacidosis" or "DKA"]. Discrepancies between 2 readers were resolved by consensus using prospectively developed study inclusion criteria. Two readers independently abstracted case report. Prospective review protocol and patients, problems, intervene, comparison group, outcomes discussed in Methods section of paper. RESULTS-SYSTEMATIC-LITERATURE-REVIEW:Revealed 10 previously reported cases plus 1 new case (see below) that shows this syndrome presents rather stereotypically with the tentatively proposed following pentad (% of patients fulfilling individual criterion): 1-forceful vomiting (100%), 2-during DKA (100%), 3-pneumomediastinum from forceful alveolar rupture (100%), 4-epidural pneumatosis from air escape from pneumomediastinum (100%), and 5-no complications of Boerhaave syndrome or of focal neurological deficits (100%). Pentad is pathophysiologically reasonable because forceful vomiting can cause alveolar rupture, pneumomediastinum, and air entry into epidural space. RESULTS-ILLUSTRATIVE-CASE-REPORT:Epidural pneumatosis occurred in a 33-year-old-male with poorly controlled diabetes mellitus type 1 who presented with forceful vomiting while in DKA. Radiologic findings also included subcutaneous emphysema, pneumomediastinum, and small pneumothorax. The patient rapidly improved while receiving acute therapy for DKA, and was discharged after 2 hospital days. STUDY LIMITATIONS:Limited number of analyzed, retrospectively reported cases. Case reports subject to reporting bias. Specificity, positive predictive value, and negative predictive value not meaningfully analyzed in this homogeneous population. CONCLUSIONS:Based on systematic review, syndrome is tentatively proposed as a pentad with: 1-forceful vomiting, 2-during DKA, 3- pneumomediastinum, 4-epidural pneumatosis, and 5-no complications of Boerhaave syndrome or focal neurological deficits. Proposed pentad should be prospectively tested in a larger population including patients with this versus closely related syndromes.
journal_name
Medicine (Baltimore)journal_title
Medicineauthors
Gill I,Edhi AI,Cappell MSdoi
10.1097/MD.0000000000021001subject
Has Abstractpub_date
2020-08-28 00:00:00pages
e21001issue
35eissn
0025-7974issn
1536-5964pii
00005792-202008280-00003journal_volume
99pub_type
杂志文章相关文献
MEDICINE文献大全abstract:BACKGROUND:The prognostic significance of PBK/TOPK overexpression in solid tumors remains controversial. Therefore, we carried out a meta-analysis to evaluate the impact of PBK/TOPK overexpression in solid tumors on patients' overall survival (OS) and disease-free survival (DFS). METHODS:Relevant articles were identif...
journal_title:Medicine
pub_type: 杂志文章,meta分析
doi:10.1097/MD.0000000000014766
更新日期:2019-03-01 00:00:00
abstract:RATIONALE:Woven coronary artery is an extremely unusual congenital anomaly with unknown etiology. Because of normal flow after anomalous segment, this anomaly is considered to be benign. PATIENT CONCERNS:A 51-year-old man was admitted to our hospital with exertional dyspnea that he had experienced for half a year. Wov...
journal_title:Medicine
pub_type: 杂志文章
doi:10.1097/MD.0000000000008302
更新日期:2017-11-01 00:00:00
abstract:RATIONALE:Tolosa-Hunt syndrome (THS) is rare condition characterized by painful ophthalmoplegia that usually responds well to corticosteroid. About a half of THS patients experience recurrence within intervals of months to years from initial presentation. Recurrence is more common in younger patients, and can be ipsila...
journal_title:Medicine
pub_type: 杂志文章
doi:10.1097/MD.0000000000019882
更新日期:2020-04-01 00:00:00
abstract::The objective of this study is to assess the association between levels of empathy and burnout of emergency professionals in all the assistance levels.A cross-sectional observational study was conducted in the health region of Lleida and the Pyrenees with 100 professionals from the field of Urgency. Participation reac...
journal_title:Medicine
pub_type: 杂志文章
doi:10.1097/MD.0000000000008030
更新日期:2017-09-01 00:00:00
abstract:RATIONALE:With the progress of sequencing technology, an increasing number of atypical primary immunodeficiency (PID) patients have been discovered, including Janus kinase 3 (JAK3) gene deficiency. PATIENT CONCERNS:We report a patient who presented with chronic active Epstein-Barr virus (CAEBV) infection but responded...
journal_title:Medicine
pub_type: 杂志文章,评审
doi:10.1097/MD.0000000000007989
更新日期:2017-10-01 00:00:00
abstract::To use a new method to estimate the prevalence of drug addicts in Xichang for the first time and to suggest that Chinese Center for Disease Control and Prevention should strengthen surveillance and intervention for them.The Capture-Mark-Recapture (CMR) method of 3 correlated sources under the simple random sampling an...
journal_title:Medicine
pub_type: 杂志文章
doi:10.1097/MD.0000000000013919
更新日期:2019-01-01 00:00:00
abstract:BACKGROUND:To investigate the relationship between intracerebral hemorrhage hematoma expansion with low serum calcium level. METHODS:We will search the following electronic bibliographic databases: MEDLINE, Embase, PubMed, The Cochrane Library, and Web of Science. All sources have to be searched from the earliest date...
journal_title:Medicine
pub_type: 杂志文章
doi:10.1097/MD.0000000000018844
更新日期:2020-01-01 00:00:00
abstract::Echocardiography and cardiac biomarkers, such as cardiac troponin I (cTnI) and N-terminal pro-B-type natriuretic peptide (NT-pro BNP) are useful tools to evaluate cardiac dysfunction. Left ventricular systolic dysfunction (LVSD) is common in pediatric severe sepsis. The aim of this study is to evaluate the prognostic ...
journal_title:Medicine
pub_type: 杂志文章
doi:10.1097/MD.0000000000015070
更新日期:2019-03-01 00:00:00
abstract::Many people exposed to torture later suffer from torture-related post-traumatic stress disorder (TR-PTSD). The aim of this study was to analyze the morphologic and functional brain changes in patients with TR-PTSD using magnetic resonance imaging (MRI) and positron emission tomography (PET). This study evaluated 19 su...
journal_title:Medicine
pub_type: 杂志文章
doi:10.1097/MD.0000000000003387
更新日期:2016-04-01 00:00:00
abstract::Occupational exposure remains a serious problem for medical staff, especially those working in operation rooms. Hepatitis B virus (HBV) is prevalent in patients undergoing surgery, and anesthesiologists are at risk of occupational acquisition of blood-borne HBV infection. To the best of our knowledge, there are no dat...
journal_title:Medicine
pub_type: 杂志文章
doi:10.1097/MD.0000000000016416
更新日期:2019-07-01 00:00:00
abstract::Prostate cancer (PCa) is a highly aggressive malignant tumor and the biological mechanisms underlying its progression remain unclear.We performed weighted gene co-expression network analysis in PCa dataset from the Cancer Genome Atlas database to identify the key module and key genes related to the progression of PCa....
journal_title:Medicine
pub_type: 杂志文章
doi:10.1097/MD.0000000000021158
更新日期:2020-07-10 00:00:00
abstract::This study aims to evaluate the clinical and radiographic treatment outcomes of comminuted Mason type II radial head fractures, which underwent open reduction and internal fixation (ORIF) using a new implant (mother-child screw, MCS).This study included 16 patients (7 male and 9 female patients; mean age: 40.9 years, ...
journal_title:Medicine
pub_type: 杂志文章
doi:10.1097/MD.0000000000010086
更新日期:2018-03-01 00:00:00
abstract:BACKGROUND:Early diagnosis and treatment of the osteonecrosis of the femoral head (ONFH), a refractory disease, is imperative to prevent femoral head collapse; however, the existing solutions remain controversial. This study assessed the safety and efficacy of extracorporeal shock wave therapy (ESWT) combined with mult...
journal_title:Medicine
pub_type: 杂志文章,随机对照试验
doi:10.1097/MD.0000000000022598
更新日期:2020-10-02 00:00:00
abstract::Human T lymphotropic virus type 1 (HTLV-I) is a retrovirus which is prevalent in southern Japan, the Caribbean Basin, and Africa. Recent seroprevalence studies in the United States suggest that there are about 50,000 infected individuals. The identification of 5 individuals with HTLV-I-associated leukemia/lymphoma ref...
journal_title:Medicine
pub_type: 杂志文章,评审
doi:10.1097/00005792-198811000-00004
更新日期:1988-11-01 00:00:00
abstract::The free antiretroviral therapy (ART) program in India has scaled up to register second largest number of people living with HIV/AIDS across the globe. To assess the effectiveness of current first-line regimen we estimated virological suppression on completion of 1 year of ART. The study describes the correlates of vi...
journal_title:Medicine
pub_type: 杂志文章
doi:10.1097/MD.0000000000004886
更新日期:2016-09-01 00:00:00
abstract::The aim of this study was to assess the levels of self-perceived burden (SPB) and self-management behavior in elderly stroke survivors during the first 3 months after acute stroke, and to explore the correlation between them.A total of 203 consecutive hospitalized elderly patients diagnosed with stroke were recruited....
journal_title:Medicine
pub_type: 杂志文章
doi:10.1097/MD.0000000000022862
更新日期:2020-10-30 00:00:00
abstract:BACKGROUND:Because of aging of population, osteoporotic vertebral compression fracture (OVCF) appears an increasing incidence rate. Conservative therapy (CT) and balloon kyphoplasty (BKP) have been used to treat OVCFs. However, an increase in new vertebral compression fractures at nontreated levels following BKP is of ...
journal_title:Medicine
pub_type: 杂志文章,meta分析,评审
doi:10.1097/MD.0000000000012666
更新日期:2018-10-01 00:00:00
abstract::Immune-checkpoint inhibitor (ICI) efficacy in patients with non-small cell lung cancer (NSCLC) harboring molecular alterations remains poorly elucidated. This study was undertaken to determine ICI efficacy against epidermal growth-factor receptor (EGFR)/anaplastic lymphoma kinase (ALK)/c-ros oncogene 1 (ROS1)-mutated ...
journal_title:Medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/MD.0000000000018726
更新日期:2020-01-01 00:00:00
abstract:BACKGROUND:Optic atrophy (OPA) is a very tricky disorder. Presently, no effective management is available for this condition. Previous studies have reported that acupuncture may be effective for the treatment of OPA. However, its effectiveness is still inconclusive. Thus, this study will aim to assess the effectiveness...
journal_title:Medicine
pub_type: 杂志文章
doi:10.1097/MD.0000000000016879
更新日期:2019-08-01 00:00:00
abstract::The incidence of type II diabetes mellitus (T2DM) is increasing worldwide and affecting the quality of people's life. This study was designed to evaluate the effect of care intervention on body weight and glycemic parameters in obese T2DM patients.One hundred twenty-six obese T2DM cases were randomly divided into 2 gr...
journal_title:Medicine
pub_type: 杂志文章,随机对照试验
doi:10.1097/MD.0000000000007524
更新日期:2017-10-01 00:00:00
abstract:RATIONALE:Historically, traumatic injuries include penetrating and blunt lesions. Impalement injury represents one of the rarest and potentially dramatic forms of penetrating trauma. If patient reaches hospital alive and is hemodynamically stable, there is a good chance that patient overcomes the traumatic event. Howev...
journal_title:Medicine
pub_type: 杂志文章
doi:10.1097/MD.0000000000015824
更新日期:2019-05-01 00:00:00
abstract::To characterize the current frequency of HIV-1 coreceptor usage in China and assess the candidacy of CCR5 antagonists for treatment of HIV infections. In addition, we aimed to evaluate the potential of X4/DM virus transmission in recently infected men who have sex with men (MSM) individuals.Viral tropism testing was p...
journal_title:Medicine
pub_type: 杂志文章
doi:10.1097/MD.0000000000005017
更新日期:2016-09-01 00:00:00
abstract:BACKGROUND:This protocol for a systematic review describes the methods that will be used to evaluate the efficacy and safety of non-pharmacological interventions for patients with dementia. METHODS:We will search ALOIS, the specialized register of the Cochrane Dementia and Cognitive Improvement Group (CDCIG), without ...
journal_title:Medicine
pub_type: 杂志文章,meta分析
doi:10.1097/MD.0000000000017279
更新日期:2019-09-01 00:00:00
abstract:BACKGROUND:Scapulohumeral periarthritis is a disease that seriously affects human daily work and life, and greatly reduces peoples quality of life and affects human health all over the world. Now, many studies have shown that acupuncture and rehabilitation have a significant effect on scapulohumeral periarthritis. In t...
journal_title:Medicine
pub_type: 杂志文章,meta分析
doi:10.1097/MD.0000000000023085
更新日期:2020-12-18 00:00:00
abstract:BACKGROUND:Programmed death-1 (PD-1) and programmed death ligand-1 (PD-L1) inhibitors are immune therapies that have shown great promise in the treatment of multiple cancers. However, immune-related adverse events of PD-1 and PD-L1 inhibitors may limit their use in non-small cell lung cancer (NSCLC). Given the rising n...
journal_title:Medicine
pub_type: 杂志文章
doi:10.1097/MD.0000000000021613
更新日期:2020-08-07 00:00:00
abstract::This study aimed to report our institution's experience in the diagnosis and treatment of chronic lateral ankle instability (CLAI) with ligamentum bifurcatum (LB) injury.This retrospective study included 218 consecutive patients with CLAI who underwent surgery from January 2012 to December 2015. The 218 patients recei...
journal_title:Medicine
pub_type: 杂志文章
doi:10.1097/MD.0000000000010028
更新日期:2018-03-01 00:00:00
abstract::Whether statin use has any impact on survival of esophageal cancer patients remains controversial. Therefore, we conducted a meta-analysis focusing on current topic for the first time.We systematically searched the following databases for relevant studies comparing survival between statin users and non-users among eso...
journal_title:Medicine
pub_type: 杂志文章,meta分析
doi:10.1097/MD.0000000000016480
更新日期:2019-07-01 00:00:00
abstract:ABSTRACT:Shoulder arthroscopy requires a large of irrigation for a better surgical view, leading circulatory overload. This study was performed to prove whether pulmonary edema will be lead by a large of irrigation.General anesthesia with interscalene block was induced before operation. The primary outcome was ultrasou...
journal_title:Medicine
pub_type: 杂志文章
doi:10.1097/MD.0000000000023713
更新日期:2020-12-18 00:00:00
abstract::Diabetes mellitus (DM) is a group of metabolic diseases resulting from impaired insulin secretion and/or action. DM is characterized by hyperglycemia that can lead to the dysfunction or damage of organs, including the salivary glands.The aim of this study was to compare the levels of salivary lactate dehydrogenase (LD...
journal_title:Medicine
pub_type: 杂志文章
doi:10.1097/MD.0000000000005211
更新日期:2016-11-01 00:00:00
abstract:OBJECTIVES:To explore that if mid-regional sequence of pro-A-type natriuretic peptide (MR-proANP) may have a good value of diagnosis in heart failure with preserved ejection fraction (HFpEF) compared with N-terminal pro-B-type natriuretic peptide (NT-proBNP). METHODS:Participants with cardiovascular disease who were e...
journal_title:Medicine
pub_type: 杂志文章
doi:10.1097/MD.0000000000012277
更新日期:2018-09-01 00:00:00