1
|
Radcliffe K, Gohil K, Bedford JD. Presentation and multidisciplinary management of a unique case of lower limb dysmelia resulting from amniotic band syndrome. BMJ Case Rep 2024; 17:e258063. [PMID: 38490707 PMCID: PMC10946379 DOI: 10.1136/bcr-2023-258063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024] Open
Abstract
A neonate was born with a unique congenital lower limb dysmelia due to an abnormal presentation of amniotic band syndrome. An anomalous soft tissue tether from the plantar surface of the right foot to the right buttock caused extreme knee flexion, tibial rotation and malformation of the developing foot. This complex malformation required a multidisciplinary team (MDT) approach to decide between reconstruction and amputation. The band of tissue was released operatively at 73 days postdelivery, improving knee extension, and the tissue was banked on the thigh as a tube pedicle for future reconstruction. The patient underwent rehabilitation, which has been shown to be vital for synovial joint formation. At 18 months old, the decision was made to proceed with through-knee amputation and a prosthesis. The literature discussed shows the importance of an MDT approach in complex lower limb cases to give the best functional outcome for the patient.
Collapse
Affiliation(s)
- Katherine Radcliffe
- Burns and Plastic Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - Kajal Gohil
- Burns and Plastic Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - James D Bedford
- Burns and Plastic Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| |
Collapse
|
2
|
Basavaraju RM, Shetty S, Pugazhendhi P, Aradya A. Prosthodontic rehabilitation of patients with a unilateral subtotal maxillectomy using a customised subperiosteal zygomatic implant: a post-COVID-19 mucormycosis. BMJ Case Rep 2024; 17:e258338. [PMID: 38199654 PMCID: PMC10806840 DOI: 10.1136/bcr-2023-258338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Abstract
Restoring the maxillary resection defect involving the alveolar process, the hard and soft palate and the paranasal sinuses in terms of phonetics, mastication and deglutition is more challenging, especially with young patients with aesthetic concerns.This case report describes the prosthodontic rehabilitation of a young patient with a unilateral subtotal maxillectomy due to post-COVID-19 mucormycosis. A patient-specific subperiosteal implant was planned to rehabilitate the patient's bony defect. Using postsurgical CT, a customised subperiosteal titanium framework was fabricated by the direct metal laser sintering method using grade IV titanium alloy. The fabricated framework was implanted over the patient's zygomatic anatomic contour. Three months later, the patient-specific implant was unveiled to the oral cavity, an open-tray impression was made and the fixed implant prosthesis was fabricated.This case report opens a new realm of rehabilitation for severely compromised maxillary bony defects and impaired oral functioning with no other viable conventional reconstruction options.
Collapse
Affiliation(s)
- Ravi Marballi Basavaraju
- Prosthodontics and Crown & Bridge, JSS Dental college and Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Sujeeth Shetty
- Oral and Maxillofacial Surgery, JSS Dental College and Hospital, Mysore, Karnataka, India
| | - Prakash Pugazhendhi
- Prosthodontics and Crown & Bridge, JSS Dental college and Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Anupama Aradya
- Prosthodontics and Crown & Bridge, JSS Dental college and Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| |
Collapse
|
3
|
Shivakumar DS, Kamath NS, Naik A. Silica associated systemic sclerosis: an occupational health hazard. BMJ Case Rep 2023; 16:16/1/e253952. [PMID: 36653045 PMCID: PMC9853126 DOI: 10.1136/bcr-2022-253952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
A middle-aged male working in the sandblasting and stone-cutting industry was brought to the medicine department with skin tightness, dysphagia and discolouration of the skin for the last 1 year. On examination, he had skin thickening over the face and the extremities with restricted mouth opening. His hands were cold and showed peripheral cyanosis. Systemic examination was suggestive of diffuse cutaneous systemic sclerosis, further confirmed by the antinuclear antibody testing. Further, CT of the chest showed mediastinal lymphadenopathy with eggshell calcification and interstitial fibrosis consistent with silicosis and fibrotic non-specific interstitial pneumonitis. The patient was started on pulse monthly cyclophosphamide for six cycles, and steroids were given for 4 weeks and tapered. Tadalafil and amlodipine were given for his pulmonary artery hypertension and Raynaud's phenomenon, respectively. This case also highlights the importance of periodic screening of the workers exposed to silica dust to prevent silicosis.
Collapse
Affiliation(s)
| | | | - Anand Naik
- General Medicine, Manipal Academy of Higher Education, Manipal, India
| |
Collapse
|
4
|
Vukičević Lazarević V, Marković I, Šola AM. Adolescent and young adult allergic asthma treatment challenges. BMJ Case Rep 2022; 15:15/10/e251244. [PMID: 36316051 PMCID: PMC9628657 DOI: 10.1136/bcr-2022-251244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
The transition from paediatric care to adult care is often difficult, especially in children with chronic diseases like asthma. A significant number of children reach remission throughout puberty; consequently, they are not tracked down for subsequent follow-ups and are not included in transition programmes to adult care. This case report focuses on a young adult with asthma that began in childhood and went into remission during adolescence, only to experience a recurrence when the patient was a young adult. Due to failing to complete the transition process into adult care services, she had poor adherence to therapy and asthma control.Adherence and asthma control significantly improved after a multidisciplinary approach in an adult care setting. In conclusion, appropriate transition and a multidisciplinary approach are critical for the effective management of asthma in young adults.
Collapse
Affiliation(s)
- Vesna Vukičević Lazarević
- MSc Allergy, Faculty of Medicine, Imperial College London, London, UK .,Special Hospital for Pulmonary Diseases, Zagreb, Croatia
| | - Ivan Marković
- Special Hospital for Pulmonary Diseases, Zagreb, Croatia
| | | |
Collapse
|
5
|
Das AK, Panigrahi A, Gupta N. Central and bullous Descemet membrane detachment during cataract wound hydration: an insightful complication in a post-DALK eye. BMJ Case Rep 2022; 15:e249260. [PMID: 35277423 PMCID: PMC8919468 DOI: 10.1136/bcr-2022-249260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 11/04/2022] Open
Abstract
A 54-year-old man, with history of undergoing deep anterior lamellar keratoplasty (DALK) 20 months ago, presented with mature senile cataract in the same eye. While undergoing phacoemulsification, a large, central Descemet membrane detachment (DMD) was noted, separating the donor cornea from the host predescemetic layer. No DM tears were noted. Stromal puncture was done at the graft host junction to reduce the extent of DMD. This was followed by a large intracameral air bubble insertion, which resulted in complete resolution of DMD on the first postoperative day. DMD during hydration of wound is a unique complication to be anticipated while doing cataract surgery in an operated DALK eye.
Collapse
Affiliation(s)
- Amit Kumar Das
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Arnav Panigrahi
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Noopur Gupta
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
6
|
Li B, Prabhudesai V, Wheatcroft M, Qadura M. Myocardial ischaemia secondary to ruptured abdominal aortic aneurysm. BMJ Case Rep 2022; 15:e248271. [PMID: 35115331 PMCID: PMC8814742 DOI: 10.1136/bcr-2021-248271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2021] [Indexed: 11/04/2022] Open
Abstract
A 63-year-old man presented to an outside hospital with presyncope, back pain, hypotension and inferior ST segment elevations. He received aspirin, ticagrelor and heparin and was transferred to our institution as a Code STEMI (ST-segment elevation myocardial infarction). A coronary angiogram demonstrated multivessel disease but no occlusive lesion for acute intervention. The following day, he developed worsening abdominal/back pain. A CT angiogram (CTA) showed a ruptured infrarenal abdominal aortic aneurysm. He underwent urgent percutaneous endovascular aneurysm repair. CTA on postoperative day (POD) 10 demonstrated a patent stent graft with no endoleak. The patient was discharged on POD 12 in stable condition.
Collapse
Affiliation(s)
- Ben Li
- Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Vikramaditya Prabhudesai
- Division of Interventional Radiology, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Mark Wheatcroft
- Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Mohammad Qadura
- Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
7
|
Abstract
Type 1 diabetes is typically a disease of young but can present at any age. We present a case of a 93-year-old woman who presented with 10 days history of feeling lethargic, polydipsia and decreased appetite. Her capillary blood glucose was raised at 25 mmol/L with significant ketonaemia and venous blood gas showing metabolic acidosis. She had a background of primary hypothyroidism and vitamin B12 deficiency with weakly positive parietal cell antibodies. Laboratory investigations confirmed diabetes with HbA1c of 117 mmol/mol (12.9%). In view of high clinical suspicion of type 1 diabetes, her diabetes autoantibodies were checked which showed strongly positive anti-GAD antibody with titre of >2000 IU/mL (range<10) confirming our diagnosis. She was treated with diabetic ketoacidosis protocol with intravenous fluids and intravenous insulin. On recovery, she was discharged home on once daily insulin with aim to self-manage diabetes with support from district nurses and to avoid hypoglycaemia.
Collapse
Affiliation(s)
- Waqar Ahmad
- Department of Endocrinology and Diabetes, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Catherine Bates
- Department of Endocrinology and Diabetes, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Laura Dale
- Department of Endocrinology and Diabetes, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Naveen Siddaramaiah
- Department of Endocrinology and Diabetes, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| |
Collapse
|
8
|
Agius T, Gatt M, Falzon D, Babic D. A complex case of a granulosa cell tumour. BMJ Case Rep 2021; 14:e242224. [PMID: 34920995 PMCID: PMC8686012 DOI: 10.1136/bcr-2021-242224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2021] [Indexed: 11/03/2022] Open
Abstract
This is a case of a 73-year-old woman who first presented in 2020 with a fullness in her abdomen. After several thorough investigations and unforeseen complications, the fullness was diagnosed as a granulosa cell tumour. In 2003, she had been diagnosed with a granulosa cell tumour of the ovary. Complete excision was performed, however she was not given a follow-up appointment after the procedure. This case highlights the importance of frequent follow-up of these tumours, the high recurrence rate, the severe complications which may result and the awareness of possible variations in this tumour's histologic appearance.
Collapse
Affiliation(s)
- Theresa Agius
- General Surgery, Mater Dei Hospital, L-Imsida, Malta, Malta
| | | | | | - Darko Babic
- Histopathology, Mater Dei Hospital, L-Imsida, Malta
| |
Collapse
|
9
|
Patel R, Pallikadavath S, Graham-Brown MPM, Singh A. Shared decision making in athletes with cardiovascular disease: what we can learn from a masters athlete. BMJ Case Rep 2021; 14:e245822. [PMID: 34887289 PMCID: PMC8663107 DOI: 10.1136/bcr-2021-245822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2021] [Indexed: 11/04/2022] Open
Abstract
A 75-year-old male cyclist began suffering from palpitations on exertion. Symptoms terminated spontaneously with cessation of physical activity. The episodes caused significant distress with an impact on physical performance and quality of life. An echocardiogram showed a dilated left atrium, and an exercise ECG demonstrated that episodes of atrial fibrillation developed when his ventricular rate was above 140 beats per minute. Rate control could not be offered due to a history of sinus bradycardia nor rhythm control due to low likelihood of success. Anticoagulant therapy was commenced but discontinued at patient request as he considered risks to outweigh benefits given his desire to continue cycling. Management of athletes with atrial fibrillation is based on guidelines for the general population; however, treatment goals for athletes may differ. Shared decision making is essential to allow patients to make informed decisions about their care, accepting that individuals view treatment risks and benefits differently.
Collapse
Affiliation(s)
- Roshan Patel
- Leicester Medical School, College of Life Sciences, University of Leicester, Leicester, UK
| | - Susil Pallikadavath
- College of Life Sciences, University of Leicester, Leicester, UK
- Departmet of Cardiovascular Sciences, University of leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Matthew P M Graham-Brown
- Departmet of Cardiovascular Sciences, University of leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
- John Walls Renal Unit, Leicester General Hospital, Leicester, UK
| | - Anvesha Singh
- Departmet of Cardiovascular Sciences, University of leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| |
Collapse
|
10
|
Abstract
A 57-year-old woman diagnosed with primary melanoma was managed with a wide variety of treatments over 18 years. Given her long history of disease, the array of therapies she has received range from those no longer recommended to those recently approved. This case highlights the extraordinary rate at which both the medical and surgical melanoma treatment landscape has evolved, alongside how professional consensus has changed over the past two decades. It also demonstrates the innovation and collaboration required between the patient and the multidisciplinary team, as well as how external factors such as national guidelines, eligibility for clinical trials and drug funding in the National Health Service (NHS) alter a management plan, presenting yet another set of challenges when managing cancer patients in the modern era.
Collapse
Affiliation(s)
| | - Suzanne Murphy
- Department of Plastic and Reconstructive Surgery, Addenbrooke's Hospital, Cambridge, UK
| | - Amer Durrani
- Department of Plastic and Reconstructive Surgery, Addenbrooke's Hospital, Cambridge, UK
| | - Pippa Corrie
- Department of Oncology, Addenbrooke's Hospital, Cambridge, UK
| |
Collapse
|
11
|
Drakou A, Koutsogewrgopoulou L, Boutzios G, Psifis M. Staged correction of varus knee and lateral thrust in an achondroplastic (ACH) juvenile patient who underwen t limb lengthening with IM nails: tips for proper timing and prioritisation of procedures. BMJ Case Rep 2021; 14:e242033. [PMID: 34593545 PMCID: PMC8487189 DOI: 10.1136/bcr-2021-242033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We present the case of a fifteen-year-old achondroplastic (ACH) woman who requested to have her femurs lengthened by intramedullary nails. She had undergone bilateral tibial lengthening at the age of eleven and presented with a varus deformity of the right lower limb, lateral thrust of the right knee and valgus deformity of the left lower limb. We performed deformity analyses based on mechanical axis measurements, and we came with a staged surgical plan. In ACH adolescences, correction of bony deformity needs to encounter continuous fibula growth dynamics. Lateral knee thrust was corrected by gradual distal translation of the fibula head via an Ilizarov frame and the amount of translation we decided clinically. Tibial lengthening and valgus osteotomy of the distal femur accentuate lateral collateral ligament (LCL) complex laxity. In patients with ACH, tibial lengthening and valgus osteotomy of the distal femur-if needed-should precede LCL complex tightening, and femoral lengthening should follow.
Collapse
|
12
|
Kothari K, Jayakumar N, Razzaque A. Multidisciplinary management of temporomandibular joint ankylosis in an adult: journey from arthroplasty to oral rehabilitation. BMJ Case Rep 2021; 14:e245120. [PMID: 34531239 PMCID: PMC8449976 DOI: 10.1136/bcr-2021-245120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2021] [Indexed: 11/04/2022] Open
Abstract
Ankylosis of the temporomandibular joint is a debilitating condition resulting in progressive trismus and facial disfigurement. Common trigger factors include paediatric mandibular trauma, middle ear infection or traumatic childbirth. Although diminishing in incidence among urban population, it is still prevalent in the underprivileged world. Substandard child safety norms, delayed presentation, lack of access to specialties like maxillofacial surgery in rural areas and absence of follow-up contribute to ankylosis. Afflictions in ankylosis are multipronged, involving aesthetic, functional, psychological and nutritional implications to name a few. The damage this pathology causes to the young mind and their morale is humongous. Although well documented, a complete presentation of cases with follow-up till oral and myofascial rehabilitation is seldom reported. This paper describes multidisciplinary management of a young female patient with temporomandibular joint ankylosis. Staged management commencing from interpositional arthroplasty until dental restoration with a 2-year follow-up is presented in this paper.
Collapse
Affiliation(s)
| | - Naveenkumar Jayakumar
- Head - Oral and Maxillofacial Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | | |
Collapse
|
13
|
Pradhan S. Psychological burden of anaphylaxis and the fight for an EpiPen. BMJ Case Rep 2021; 14:e243838. [PMID: 34479890 PMCID: PMC8420693 DOI: 10.1136/bcr-2021-243838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2021] [Indexed: 11/03/2022] Open
Abstract
A university student with a background of atopy presented to her general practitioner (GP) 2 weeks following an episode of throat tightening and dizziness occurring after touching cashew nut to her lip. She took antihistamine medication immediately and went to sleep, fearing for her life. On waking, she felt astounded to be alive. Her symptoms resolved gradually over the following week. She waited 2 weeks for an appointment with her GP, who referred her to allergy clinic. Eight months later, she was still waiting for her clinic appointment, and was left fearing a future fatal reaction, having been provided with no interim treatment. Not all patients who have severe allergic reactions present to the emergency department. Living with the constant fear of anaphylaxis can be overwhelming for patients and their families, and it can negatively impact mental health. Therefore, we advise early allergy counselling and early EpiPen prescription.
Collapse
Affiliation(s)
- Sara Pradhan
- Postgraduate Centre, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| |
Collapse
|
14
|
Jain M, Parija D, Kumar P, Naik S. Misdiagnosed sternoclavicular tuberculosis presenting as a non-healing ulcer. BMJ Case Rep 2021; 14:e244454. [PMID: 34426429 PMCID: PMC8383862 DOI: 10.1136/bcr-2021-244454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Mantu Jain
- Department of Orthopaedics, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, Orissa, India
| | - Debasish Parija
- Department of Orthopaedics, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, Orissa, India
| | - Pankaj Kumar
- Department of General Surgery, All India Institute of Medical Sciences - Bhubaneswar, Bhubaneswar, Odisha, India
| | - Suprava Naik
- Department of Radiodiagnosis, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, India
| |
Collapse
|
15
|
Giuffrida M, Ledingham NS, Machi P, Czarnetzki CA. Rapid arousal from anaesthesia after reversal of deep rocuronium-induced neuromuscular block with sugammadex in a neuroradiological procedure. BMJ Case Rep 2021; 14:14/8/e242820. [PMID: 34417232 PMCID: PMC8382267 DOI: 10.1136/bcr-2021-242820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
We describe the case of a 42-year-old man undergoing elective embolisation of an arteriovenous malformation at the level of the right posterior cerebral artery under propofol anaesthesia. We used the SedLine Brain Function Monitor (Masimo) to titrate the anaesthetic depth with propofol. At the end of the procedure, the patient aroused from anaesthesia very rapidly after the reversal of deep neuromuscular block with sugammadex, despite still significant calculated doses of propofol at the effect site. This rapid arousal was monitored using the SedLine Brain Function Monitor.
Collapse
Affiliation(s)
- Matteo Giuffrida
- Division of Anaesthesiology, Department of Anaesthesiology, Intensive care and Emergency Medecine, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Nicola Susan Ledingham
- Division of Anaesthesiology, Department of Anaesthesiology, Intensive care and Emergency Medecine, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Paolo Machi
- Division of Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
| | - Christoph Andreas Czarnetzki
- Division of Anaesthesiology, Department of Anaesthesiology, Intensive care and Emergency Medecine, Ente Ospedaliero Cantonale, Lugano, Switzerland .,Division of Anaesthesiology, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medecine, University of Geneva, Geneva, Switzerland
| |
Collapse
|
16
|
Uleanya O, McCallin K, Khanem N, Sabir S. Recurrent uterine rupture in third trimester of pregnancy. BMJ Case Rep 2021; 14:e241987. [PMID: 34389587 PMCID: PMC8365815 DOI: 10.1136/bcr-2021-241987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2021] [Indexed: 11/04/2022] Open
Abstract
We report a case of recurrent upper segment uterine rupture in a 31-year-old woman at 32+5/40 weeks of gestation. She had fundal uterine rupture 3 years ago in her first pregnancy at 40 weeks of gestation. There was no history of uterine malformation or prior uterine surgery. However, we noted that she had had three laparoscopic procedures for endometriosis treatment. She was scheduled to have an elective repeat caesarean section at 34+6/40 weeks of gestation in the index pregnancy. Unfortunately, she presented at 32+5/40 weeks with features of acute abdomen and signs of fetal distress. She had a category 1 caesarean section and was found to have fundal uterine rupture at the same site. She had a smooth uneventful recovery following a timely intervention and discharged home on day 5 postoperatively in a good condition with her baby girl.
Collapse
Affiliation(s)
- Obiefula Uleanya
- Department of Obstetrics and Gynaecology, Barnsley District General Hospital, Barnsley, UK
| | - Kate McCallin
- Department of Obstetrics and Gynaecology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Noor Khanem
- Department of Obstetrics and Gynaecology, Barnsley District General Hospital, Barnsley, UK
| | - Sabahat Sabir
- Department of Obstetrics and Gynaecology, Barnsley District General Hospital, Barnsley, UK
| |
Collapse
|
17
|
Abstract
Robotic-assisted surgery for the management of hepatic echinococcosis was introduced in 2016. The advantage it offers over laparoscopy is less rigidity with the use of the 360° rotation of the Endo-Wrist technology, thus allowing the preservation of the integrity of the liver tissue. Herein, we report the first successful robotic resection of the left lobe of the liver for hydatid disease in the Middle East. Our patient is a 71-year-old man found to have a large left hepatic lobe hydatid disease on CT scan. The hydatid liver disease was resected completely with an operation time of 130 min and minimal intraoperative blood loss. Patient did well postoperatively and was discharged home on day 2. Our experience shows that robotic surgery for hydatid disease of the liver can be safely performed, with an excellent outcome to the patient. It also provides unique technical advantages in the field of minimal-invasive surgery.
Collapse
Affiliation(s)
- Marita Yaghi
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maya Zorkot
- Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mariam Kanso
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Walid Faraj
- Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| |
Collapse
|
18
|
van Gaalen MD, van der Stelt M, Vas Nunes JH, Brouwers L. People with amputations in rural Sierra Leone: the impact of 3D-printed prostheses. BMJ Case Rep 2021; 14:e236213. [PMID: 34127498 PMCID: PMC8204157 DOI: 10.1136/bcr-2020-236213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2021] [Indexed: 11/03/2022] Open
Abstract
We report the case of a man with a transhumeral amputation in a rural area of Sierra Leone. The patient had fractured his humerus during a football match. Due to lack of transportation and medical centres nearby, the patient was seen by a traditional healer. Although the traditional healer expected the fractured bone to heal within 3 days, the open fracture became infected. This finally resulted in a transhumeral amputation. The patient began to have a lack of self-confidence and felt excluded from society. He could not afford a conventionally fabricated prosthesis. Fourteen years later, the patient received a lightweight three-dimensional-printed arm prosthesis developed at the Masanga Hospital. The patient was very satisfied because the prosthesis met his criteria of aesthetics and functionality. His story highlights the socioeconomic hardship of being a person with an amputation in Sierra Leone and the need for affordable technological solutions.
Collapse
Affiliation(s)
- Melissa D van Gaalen
- Technical Medicine, Delft University of Technology Faculty of Mechanical Maritime and Materials Engineering, Delft, The Netherlands
- Masanga Medical Research Unit, Masanga Hospital, Masanga, Sierra Leone
| | - Merel van der Stelt
- Masanga Medical Research Unit, Masanga Hospital, Masanga, Sierra Leone
- Radboud UMC 3D Lab, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Lars Brouwers
- Masanga Medical Research Unit, Masanga Hospital, Masanga, Sierra Leone
- Trauma Surgery, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands
| |
Collapse
|
19
|
Rahul M, Sultan F, Tewari N, Mathur V. Orofacial characteristics and dental management in a child with moyamoya disease. BMJ Case Rep 2021; 14:14/5/e241211. [PMID: 34020988 DOI: 10.1136/bcr-2020-241211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Moyamoya disease is a chronic, progressive intracranial arteriopathy. It is characterised by progressive stenosis/occlusion of distal intracranial carotid and cerebral arteries. It is associated with a high risk of ischaemic and haemorrhagic stroke. Hereditary, infectious and inflammatory factors have been found to be associated with this condition; however, its aetiology is still unclear. The estimation of disease prevalence is approximately 1.6 to 16.1 in 100 000 live births. This article presents the case of a 5-year-old girl child diagnosed with moyamoya disease, placing emphasis on the clinical and radiographic orofacial characteristics of the case and its dental management.
Collapse
Affiliation(s)
- Morankar Rahul
- Division of Pedodontics and Preventive Dentistry, Center for Dental Education and Research, AIIMS, New Delhi, Delhi, India
| | - Farheen Sultan
- Division of Pedodontics and Preventive Dentistry, Center for Dental Education and Research, AIIMS, New Delhi, Delhi, India
| | - Nitesh Tewari
- Division of Pedodontics and Preventive Dentistry, Center for Dental Education and Research, AIIMS, New Delhi, Delhi, India
| | - Vijay Mathur
- Division of Pedodontics and Preventive Dentistry, Center for Dental Education and Research, AIIMS, New Delhi, Delhi, India
| |
Collapse
|
20
|
Abstract
Dorsal root ganglion stimulation (DRGS) therapy is a rapidly emerging tool being used by pain physicians in the treatment of chronic pain. Complex regional pain syndrome (CRPS), a debilitating disease whose mechanism is still has yet to be fully elucidated, is a common pathology targeted by DRGS therapy, often better results than traditional spinal cord stimulation. DRGS therapy, however, is not bereft of complications. Lead migration and fracture are two examples in particular that are among the most common of these complications. The authors report an unusual case of lost efficacy due to lead fractures in patients with CRPS treated with DRGS. The case report narrates identification, management and probable mechanism of DRGS lead fracture. The structural instability of DRGS leads can yield distressing symptoms at any point during the therapy, and physicians should be cognisant of the complications of DRGS therapy.
Collapse
Affiliation(s)
- Gaurav Chauhan
- Anesthesiology, Chronic Pain Divison, UPMC, Pittsburgh, Pennsylvania, USA
| | - Brandon I Roth
- Pain Management, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Nagy Mekhail
- Pain Management, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| |
Collapse
|
21
|
Nasse SA. Autoimmune haemolytic anaemia: emergency blood transfusion. BMJ Case Rep 2021; 14:14/5/e242378. [PMID: 34011642 DOI: 10.1136/bcr-2021-242378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 50-year-old woman, with a background of autoimmune haemolytic anaemia, presented to the emergency department with lethargy and shortness of breath. Investigations revealed a haemoglobin level of 50 g/L. High dose steroids were administered and blood transfusion prescribed. However, the blood transfusion was delayed due to a positive antibody screen and concerns regarding administering blood when the patient was pyrexic. The delay resulted in a significant deterioration in the patient's clinical state with her haemoglobin level falling to 26 g/L 24 hours later. She was urgently transfused with blood and made a full recovery. This report analyses the delays for transfusion and how these could have been minimised. First, guidelines advise that emergency blood should be considered in life-threatening circumstances. Second, fever is not always a contraindication for transfusion, particularly in an emergency setting.
Collapse
|
22
|
Nguyen NT, Shakir MKM, Hoang TD. Calcinosis cutis in a renal transplant patient. BMJ Case Rep 2021; 14:e242610. [PMID: 33975849 PMCID: PMC8117999 DOI: 10.1136/bcr-2021-242610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 11/03/2022] Open
Abstract
Calcinosis cutis is an unusual disorder characterised by calcium-phosphate deposition into cutaneous and subcutaneous tissues. There are five subtypes: dystrophic, metastatic, idiopathic, iatrogenic and calciphylaxis. Our objective was to report a patient with a history of haemodialysis-dependent end-stage renal disease (ESRD) who developed metastatic calcinosis cutis, which is usually associated with abnormalities of calcium-phosphate metabolism in renal failure. In our patient, the serum calcium and phosphate levels were normal. Additionally, we describe the diagnostic approach and the difficulties involved in the management of calcinosis cutis in patients with haemodialysis-dependent ESRD.
Collapse
Affiliation(s)
- Nguyen T Nguyen
- Endocrinology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Mohamed K M Shakir
- Endocrinology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Endocrinology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Thanh Duc Hoang
- Endocrinology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Endocrinology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| |
Collapse
|
23
|
Yadollahikhales G, Blenkush N, Cunningham M. Response patterns for individuals receiving contingent skin shock aversion intervention to treat violent self-injurious and assaultive behaviours. BMJ Case Rep 2021; 14:e241204. [PMID: 33962925 PMCID: PMC8108683 DOI: 10.1136/bcr-2020-241204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2021] [Indexed: 11/03/2022] Open
Abstract
A small proportion of patients with intellectual disabilities (IDs) and/or autism spectrum disorder (ASD) exhibit extraordinarily dangerous self-injurious and assaultive behaviours that persist despite long-term multidisciplinary interventions. These uncontrolled behaviours result in physical and emotional trauma to the patients, care providers and family members. A graduated electronic decelerator (GED) is an aversive therapy device that has been shown to reduce the frequency of severe problem behaviours by 97%. Within a cohort of 173 patients, we have identified the four most common patterns of response: (1) on removal of GED, behaviours immediately return, and GED is reinstated; (2) GED is removed for periods of time (faded) and reinstated if and when behaviours return; (3) a low frequency of GED applications maintains very low rates of problem behaviours; and (4) GED is removed permanently after cessation of problem behaviours. GED is intended as a therapeutic option only for violent, treatment-resistant patients with ID and ASD.
Collapse
Affiliation(s)
| | - Nathan Blenkush
- Division of Applied Behavioral Analysis, Judge Rotenberg Educational Center, Canton, Massachusetts, USA
| | - Miles Cunningham
- Department of Psychiatry, Harvard Medical School, McLean Hospital, Belmont, Massachusetts, USA
| |
Collapse
|
24
|
Knightly N, Finnegan L, Qayyum T, Kelly JL. Novel steroid infiltration technique of the carpal tunnel. BMJ Case Rep 2021; 14:e240764. [PMID: 33910798 PMCID: PMC8094330 DOI: 10.1136/bcr-2020-240764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2021] [Indexed: 11/28/2022] Open
Abstract
This report describes a novel technique of steroid infiltration of the wrist to treat symptomatic carpal tunnel syndrome. Our approach potentially reduces direct trauma to the median nerve when compared with current conventional techniques. The use of a cannula allows infiltration directly into the carpal tunnel and advancement of the blunt tip minimises the risk of sharp trauma to the median nerve and adjacent tendons. This avoids the unpleasant, shooting pain frequently experienced by patients using traditional needle infiltration. We anticipate this would be of particular benefit in reducing pain associated with the procedure.
Collapse
Affiliation(s)
- Nauar Knightly
- Plastic and Reconstructive Surgery, Galway University Hospitals, Galway, Ireland
| | - Laura Finnegan
- Plastic and Reconstructive Surgery, Galway University Hospitals, Galway, Ireland
| | - Tayyab Qayyum
- Plastic and Reconstructive Surgery, Galway University Hospitals, Galway, Ireland
| | - Jack L Kelly
- Department of Plastic Surgery, Galway University Hospitals, Galway, Ireland
| |
Collapse
|
25
|
Patel SU, Khurram R, Lakhani A, Quirk B. Guillain-Barre syndrome following the first dose of the chimpanzee adenovirus-vectored COVID-19 vaccine, ChAdOx1. BMJ Case Rep 2021; 14:14/4/e242956. [PMID: 33888484 PMCID: PMC8070856 DOI: 10.1136/bcr-2021-242956] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Prevention strategies for COVID-19 transmission are at the forefront of healthcare paradigms worldwide, the main emphasis of which is vaccination. We present an interesting case of a 37-year-old man who, 3 weeks following his first dose of the chimpanzee adenovirus-vectored COVID-19 vaccine, ChAdOx1, presented to hospital with a rapidly progressive ascending muscle weakness and back pain in the absence of any other triggers. He also had a negative COVID-19 swab during admission. A diagnosis of Guillain-Barre syndrome was confirmed by correlating the clinical features with cerebrospinal fluid analysis, nerve conduction studies and MRI of the brain and whole spine. The patient received treatment with 5 days of intravenous immunoglobulin and did not require any respiratory support. He was also regularly reviewed by a multidisciplinary team consisting of neurologists, speech and language therapists, and physiotherapists and is on the course to a recovery.
Collapse
|
26
|
Yoham AL, Sinawe H, Schnur J, Casadesus D. Aggressive progression of a facial super giant basal cell carcinoma. BMJ Case Rep 2021; 14:14/4/e240617. [PMID: 33858891 PMCID: PMC8054050 DOI: 10.1136/bcr-2020-240617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Super giant basal cell carcinoma (BCC) is a rare oncological entity. A 52-year-old man with a history of a left upper facial lesion for 11 years was transferred to our facility seeking an evaluation. He frequented multiple hospitals where he was treated with antibiotics for this condition. He reported having the Mohs procedure 8 months prior to this hospital visit but he did not follow-up with the other institution. The physical examination revealed an ulcer involving the upper left orbito-fronto-parieto-temporal area with bone exposure. Both CT and MRI of the face and the brain demonstrated dehiscence of the left lateral orbital roof and left frontal bone. The biopsy confirmed advanced BCC. He was discharged against medical advice and lost to follow-up. He returned 1 month later with left eye discharge and vision loss. He was diagnosed with cerebral abscess, treated with antibiotics and discharged to hospice.
Collapse
Affiliation(s)
| | - Hadeer Sinawe
- Internal Medicine, Jackson Memorial Hospital, Miami, Florida, USA
| | - Jack Schnur
- Internal Medicine, Jackson Memorial Hospital, Miami, Florida, USA
| | - Damian Casadesus
- Internal Medicine, Jackson Memorial Hospital, Miami, Florida, USA
| |
Collapse
|
27
|
Johnson-Arbor K, Verstraete R. Use of hyperbaric oxygenation as an adjunctive treatment for severe pernicious anaemia in a bloodless medicine patient. BMJ Case Rep 2021; 14:14/4/e240619. [PMID: 33846184 PMCID: PMC8048014 DOI: 10.1136/bcr-2020-240619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Severe anaemia in patients who cannot receive blood transfusion is an indication for the use of hyperbaric oxygen therapy (HBO). Most reports of the use of HBO for anaemia involve patients with acute blood loss. This report details a case of HBO used for a patient with severe pernicious anaemia. A 35-year-old Jehovah's Witnesses believer presented to a hospital with fatigue, dyspnoea and haemoglobin of 26 g/L. She was diagnosed with pernicious anaemia. As she could not receive blood transfusion due to her religious beliefs, vitamin B12 supplementation and HBO were administered and resulted in significant improvement in her condition. The mechanisms of action of HBO, including increased systemic plasma oxygenation, can alleviate signs and symptoms of anaemia regardless of its aetiology. HBO administration can greatly enhance the plasma arterial oxygen content, leading to clinical improvement in patients with anaemia who cannot receive blood transfusion.
Collapse
Affiliation(s)
- Kelly Johnson-Arbor
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC, USA .,MedStar Institute for Quality and Safety, Washington, DC, USA
| | - Richard Verstraete
- Bloodless Medicine and Surgery Program, MedStar Georgetown University Hospital, Washington, DC, USA
| |
Collapse
|
28
|
Webster A, Singh R, Stebbing J. Enterocutaneous fistula secondary to retained intraperitoneal fragment of a ventriculoperitoneal shunt in a 48-year-old man with spina bifida. BMJ Case Rep 2021; 14:14/4/e240634. [PMID: 33795276 DOI: 10.1136/bcr-2020-240634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report the case of a 48-year-old man with spina bifida and history of previous ventriculoperitoneal (VP) shunt placement for hydrocephalus. On attempted removal of the shunt 2 years prior to presentation at a neurosurgical unit, the peritoneal component was left in situ due to difficulties with removal. He presented acutely to our general surgical department with an enterocutaneous fistula precipitated by the retained fragment discharging to the right upper abdominal quadrant that required urgent surgical intervention. Although abdominal complications of VP shunts are documented, there is minimal literature as to the risks of remnant catheters being left in situ. This case demonstrates the possible risks with retained VP shunt catheters and the necessity to remove any redundant foreign bodies to prevent significant delayed complications.
Collapse
Affiliation(s)
- Andrew Webster
- General Surgery, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Rishabh Singh
- General Surgery, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - John Stebbing
- General Surgery, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| |
Collapse
|
29
|
Abstract
Kimura's disease (KD) is a rare, chronic inflammatory disorder of unknown aetiology, which commonly affects men of the Asian race. Here, we present a case capsule of a 39- year-old man with KD of the left cheek, managed initially by surgery alone. He developed local recurrence after 6 months and was treated with steroids and isotretinoin. Eventually, steroids were discontinued due to toxicity and the lesion progressively increased in size. The patient was successfully treated using intensity-modulated radiotherapy with simultaneous integrated boost as a primary modality with minimal adverse effects. The patient has good local control and cosmetic outcome with no radiation-related toxicity at a follow-up period of 28 months.
Collapse
Affiliation(s)
- Jeyaanth Venkatasai
- Dr Ida B Scudder Cancer Centre, Department of Radiation Oncology, Christian Medical College and Hospital, Vellore, India
| | - Arvind Sathyamurthy
- Dr Ida B Scudder Cancer Centre, Department of Radiation Oncology, Christian Medical College and Hospital, Vellore, India
| | - Jeba Karunya Ramireddy
- Dr Ida B Scudder Cancer Centre, Department of Radiation Oncology, Christian Medical College and Hospital, Vellore, India
| | - Thomas Samuel Ram
- Dr Ida B Scudder Cancer Centre, Department of Radiation Oncology, Christian Medical College and Hospital, Vellore, India
| |
Collapse
|
30
|
Affiliation(s)
- Keiko Shimamoto
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kenichiro Yamagata
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Chizuko Kamiya
- Department of Perinatology and Obstetrics, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kengo Fukushima Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| |
Collapse
|
31
|
Tiwari L, Gupta P, Singh CM, Singh PK. Persistent positivity of SARS-CoV-2 nucleic acid in asymptomatic healthcare worker: infective virion or inactive nucleic acid? BMJ Case Rep 2021; 14:14/3/e241087. [PMID: 33658220 PMCID: PMC7931751 DOI: 10.1136/bcr-2020-241087] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Asymptomatic individuals positive for SARS-CoV-2 RNA constitute a significant proportion of the infected population and play a role in the transmission of the virus. We describe a healthcare worker who presented with fever and malaise and was diagnosed with mild COVID-19. The symptoms resolved within 4 days but there was persistent positivity of viral RNA in the upper respiratory tract for more than 58 days, which is the longest reported duration of persistence of SARS-CoV-2 in a healthcare worker. In this case report, we discuss clinical and administrative issues such as the role of asymptomatic cases in the transmission of the virus to patients and coworkers as an occupational hazard, interpretation of persistent positivity of nucleic acid test, duration of isolation and return-to-work guidelines pertinent to researchers and global health policymakers.
Collapse
Affiliation(s)
- Lokesh Tiwari
- Pediatrics, All India Institute of Medical Sciences, Patna, India
| | - Prakriti Gupta
- Pediatrics, All India Institute of Medical Sciences, Patna, India
| | - Chandra Mani Singh
- Community and Family Medicine, All India Institute of Medical Sciences, Patna, India
| | | |
Collapse
|
32
|
Sicsic I, Chacon AR, Zaw M, Ascher K, Abreu A, Chediak A. A case of SARS-CoV-2 reinfection in a patient with obstructive sleep apnea managed with telemedicine. BMJ Case Rep 2021; 14:e240496. [PMID: 33526540 PMCID: PMC7852971 DOI: 10.1136/bcr-2020-240496] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2021] [Indexed: 12/26/2022] Open
Abstract
The novel coronavirus (SARS-CoV-2) has produced millions of infections and deaths worldwide. It is believed that adaptive immunity to the virus occurs although with variation in its pattern and duration. While uncommon, confirmed reinfection with the novel coronavirus has been reported. Telemedicine has emerged as a viable tool for the delivery of healthcare in lieu of in-person patient contact. The variable and occasionally rapid course of clinical disease raises safety concerns of using telemedicine in the clinical management of acute infection with the novel coronavirus. We present a case of novel coronavirus infection in an immunocompetent individual with obstructive sleep apnea (OSA) who failed to manifest an adaptive immune response to acute infection and was subsequently reinfected. The case highlights the use of telemedicine in managing novel coronavirus respiratory disease and the potential role of OSA as a disease facilitator.
Collapse
Affiliation(s)
- Isabelo Sicsic
- Department of Sleep Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Andres R Chacon
- Department of Sleep Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Moe Zaw
- Department of Sleep Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Kori Ascher
- Department of Sleep Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Alexandre Abreu
- Department of Sleep Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Alejandro Chediak
- Department of Sleep Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| |
Collapse
|
33
|
Treharne C, Coleman H, Iyer A. Spontaneous pneumomediastinum: an uncommon clinical problem with a potential for missed or delayed diagnosis. BMJ Case Rep 2021; 14:14/2/e238700. [PMID: 33526530 PMCID: PMC7852997 DOI: 10.1136/bcr-2020-238700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
A 15-year-old man presented with an acute history of facial swelling following a bout of forceful eructation after eating. Subcutaneous emphysema was noted on examination of his left face and neck. He was initially managed with intravenous antibiotics for suspected facial infection. A chest radiograph performed on day 3 of admission identified subcutaneous emphysema of the upper thorax and neck. CT with oral contrast confirmed extensive subcutaneous emphysema of neck, thorax and upper abdomen, with associated pneumomediastinum. The site of air leak was not identified. He subsequently underwent upper gastrointestinal endoscopy and this was normal. Despite the delay in diagnosis, he remained haemodynamically stable, and repeated radiography showed improvement reflecting the benign course of this condition as described in existing literature. There are no previous published reports of spontaneous pneumomediastinum following eructation; therefore, high clinical suspicion should be maintained in this presentation.
Collapse
|
34
|
Affiliation(s)
- Gaurav Chauhan
- Chronic Pain Division, Department of Anesthesiology and Perioperative Medicine, UPMC, Pittsburgh, Pennsylvania, USA
| | - Aman Upadhyay
- Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Health System, Detroit, Michigan, USA
| |
Collapse
|
35
|
Abstract
We describe a case of a middle-aged woman who presented with progressive jaundice and was suspected to have rebound choledocholithiasis, which was initially managed with balloon extraction through endoscopic retrograde cholangiopancreatography at her first presentation. Healthcare in Pakistan, like many other developing countries, is divided into public and private sectors. The public sector is not always completely free of cost. Patients seeking specialised care in the public sector may find lengthy waiting times for an urgent procedure due to a struggling system and a lack of specialists and technical expertise. Families of many patients find themselves facing 'catastrophic healthcare expenditure', an economic global health quandary much ignored.
Collapse
|
36
|
Eguchi H, Katsuki NE, Yamamoto KI, Tago M. Safely replacing a percutaneous endoscopic gastrostomy tube using a portable X-ray system at a patient's home. BMJ Case Rep 2021; 14:14/1/e238462. [PMID: 33431464 PMCID: PMC7802697 DOI: 10.1136/bcr-2020-238462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
An 81-year-old woman who underwent percutaneous endoscopic gastrostomy (PEG) a year before, after cerebral infarction was receiving home medical care. The first accidental PEG tube removal occurred after clinic hours, and the home-care doctor visited her home to quickly reinsert the tube. After the narrowed fistula was dilated, the tube was reinserted with a guide wire. An X-ray taken with a CALNEO Xair, which is an easily portable X-ray system launched in 2018, confirmed that the tip of the PEG tube was successfully placed in the stomach. A similar accidental removal occurred 2 months later, and we managed it in the same way. Both events were resolved with a single radiograph without significant difficulty. With in-home medical care, PEG tube replacement can be performed easily and safely with a handy portable X-ray system.
Collapse
Affiliation(s)
| | - Naoko E Katsuki
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | | | - Masaki Tago
- Department of General Medicine, Saga University Hospital, Saga, Japan
| |
Collapse
|
37
|
Abstract
Squamous cell carcinoma (SCC) of the lip typically has a good prognosis when diagnosed at an early stage and treated properly. We present a 65-year-old man with a 3-month history of an ulcerative lesion of the lower lip. On physical examination, he had an ulceration of approximately 5×5 cm in the mucosa of the lower lip, extending through 50% of the lip, and multiple mandibular and neck lymph nodes. The biopsy confirmed SCC of the lip. Surgical treatment was recommended, but the patient was lost to follow-up. The patient eventually returned to the hospital for medical treatment. However, the physical examination, and the images obtained showed progression of the disease. Chemotherapy was started with improvement in the primary site, but he then developed a large submental mass compatible with SCC. The tumour was considered incurable at that time. Palliative radiation therapy was offered; however, he refused any further procedures or treatment.
Collapse
Affiliation(s)
- Jack Schnur
- Internal Medicine, Jackson Memorial Hospital, Miami, Florida, USA
| | | | - Lorenzo R Carnio
- Internal Medicine, Jackson Memorial Hospital, Miami, Florida, USA
| | - Damian Casadesus
- Internal Medicine, Jackson Memorial Hospital, Miami, Florida, USA
| |
Collapse
|
38
|
Abstract
This report describes the case of a 45-year-old woman with a history of Behçet's disease and complex regional pain syndrome of her legs who presented with severe pain and swelling in her left lower extremity. The patient was initially diagnosed with exacerbation of complex regional pain syndrome, which fit the symptom complex of hyperalgesia, oedema and skin temperature changes. However, after unsuccessful attempts at significant pain relief during admission, CT angiography demonstrated occlusion of the left common and external iliac arteries, a limb-threatening emergency. This case describes an example of anchoring bias, a type of cognitive bias in which there is a tendency to rely too heavily on an initial piece of information, the 'anchor', when making decisions. This report emphasises that clinicians should be aware of biases when making decisions and avoid anchoring bias by asking themselves if their diagnosis is influenced by any leading pieces of information.
Collapse
Affiliation(s)
- Hussain Khawaja
- Internal Medicine, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Cristina Font
- Internal Medicine, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| |
Collapse
|
39
|
Diachkova E, Abramova EV, Blagushina NA, Tarasenko S. Surgical treatment with dental implants in a patient with secondary loss of teeth and osteoporosis caused by an imbalance of vitamin D. BMJ Case Rep 2020; 13:13/11/e235585. [PMID: 33257353 DOI: 10.1136/bcr-2020-235585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
In recent years, the success of long-term dental implants has remained problematic, especially because of the increasing rate of mineral balance changes in patients with partial loss of teeth, regardless of their age, race and sex. This article describes the experience of 6 years of treatment with dental implants in a patient with secondary loss of tooth and mineral imbalance (osteopenia) due to vitamin D deficiency, in collaboration with endocrinologist. Along with basic dental care, special medicine was prescribed for this pathology. The bone system was monitored through regular blood tests, skeletal bone densitometry and X-ray of the maxillofacial region. This management plan allowed dental implants to be maintained in good condition for 7 years.
Collapse
Affiliation(s)
- Ekaterina Diachkova
- Dental Surgery, I M Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Elizaveta V Abramova
- Dental Surgery, I M Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Natalia A Blagushina
- Dental Surgery, I M Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Svetlana Tarasenko
- Dental Surgery, I M Sechenov First Moscow State Medical University, Moscow, Russian Federation
| |
Collapse
|
40
|
Eswaran S, Ayyaswamy A, Saravanam PK. Necrotising fasciitis following accidental injection of intraoral xylene: a preventable medication error. BMJ Case Rep 2020; 13:e236018. [PMID: 33229474 PMCID: PMC7684648 DOI: 10.1136/bcr-2020-236018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2020] [Indexed: 11/03/2022] Open
Abstract
The most common cause of preventable mortality and morbidity to the patient in a healthcare system is medication error. Medication errors have got a significant impact on the patient health and healthcare system. These errors are multidisciplinary and can occur at various stages of drug therapy. Physicians, nursing staff, pharmacists, hospital administration all have an important role in preventing medication errors from recurring. The most common causes include wrong patient, wrong drug prescription, look-alike sound-alike drugs, faulty drug administration, wrong dosage, drug storage, delivery problem, lack of staff, patient and physician education and failure to monitor closely. This case illustrates the importance of incorporating protocol and cross-checking before administering a drug during the procedure. Here, we discuss a case of accidental intraoral injection of xylene instead of xylocaine (local anaesthetic agent), which was a sound-alike drug that resulted in significant morbidity to the patient.
Collapse
Affiliation(s)
- Sudhagar Eswaran
- ENT, Head and Neck Surgery, Sri Ramachandra Medical College and Research Institute, Chennai, India
| | - Anupriya Ayyaswamy
- ENT, Head and Neck Surgery, Sri Ramachandra Medical College and Research Institute, Chennai, India
| | - Prasanna Kumar Saravanam
- ENT, Head and Neck Surgery, Sri Ramachandra Medical College and Research Institute, Chennai, India
| |
Collapse
|
41
|
Xiao Hong C, Abd Wahab S, Azman M. Retained haemodialysis-catheter guidewire in the head and neck: a multidisciplinary team approach. BMJ Case Rep 2020; 13:13/10/e236484. [PMID: 33109696 DOI: 10.1136/bcr-2020-236484] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Penetrating foreign body in the head and neck can be catastrophic from injury to the constellation of vascular and neural structures in the neck. Early recognition and prompt surgical intervention is imperative to save lives. Herein, we present an unusual case of iatrogenic foreign body-a coiled guidewire embedded in the deep neck space. The complications, radiological investigation and multidisciplinary surgical management are further discussed.
Collapse
Affiliation(s)
- Chow Xiao Hong
- Department of Otorhinolaryngology, Universiti Kebangsaan Malaysia Fakulti Perubatan, Kuala Lumpur, Malaysia .,Department of Otorhinolaryngology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Syafazaima Abd Wahab
- Department of Otorhinolaryngology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Mawaddah Azman
- Department of Otorhinolaryngology, Universiti Kebangsaan Malaysia Fakulti Perubatan, Kuala Lumpur, Malaysia
| |
Collapse
|
42
|
Ahmed T, Lodhi SH, Kapadia S, Shah GV. Community and healthcare system-related factors feeding the phenomenon of evading medical attention for time-dependent emergencies during COVID-19 crisis. BMJ Case Rep 2020; 13:13/8/e237817. [PMID: 32843473 PMCID: PMC7449484 DOI: 10.1136/bcr-2020-237817] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
The current COVID-19 crisis has significantly impacted healthcare systems worldwide. There has been a palpable increase in public avoidance of hospitals, which has interfered in timely care of critical cardiovascular conditions. Complications from late presentation of myocardial infarction, which had become a rarity, resurfaced during the pandemic. We present two such encounters that occurred due to delay in seeking medical care following myocardial infarction due to the fear of contracting COVID-19 in the hospital. Moreover, a comprehensive review of literature is performed to illustrate the potential factors delaying and decreasing timely presentations and interventions for time-dependent medical emergencies like ST-segment elevation myocardial infarction (STEMI). We emphasise that clinicians should remain vigilant of encountering rare and catastrophic complications of STEMI during this current era of COVID-19 pandemic.
Collapse
Affiliation(s)
- Taha Ahmed
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Samra Haroon Lodhi
- Department of Internal Medicine, King Edward Medical University, Lahore, Pakistan
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Gautam V Shah
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| |
Collapse
|
43
|
Abstract
A 17-year-old man with osteosarcoma of the proximal humerus was planned for possible limb salvage surgery after standard neoadjuvant chemotherapy. However, during the surgical phase of treatment, the COVID-19 or SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) outbreak occurred changing the healthcare landscape due to uncertainty regarding the virus, risk of COVID-19 infection and complications, and implementation of an enhanced community quarantine restricting movement of people within cities. Instead of limb salvage surgery, the patient underwent a forequarter amputation. Exposure to the virus in a high-risk hospital setting was minimised with patient discharge after a short hospital stay and home convalescence monitored by video conferencing. Multidisciplinary sarcoma team meetings with family members and a sarcoma navigator nurse were crucial in managing expectations and deciding on appropriate treatment in the setting of a novel infectious disease causing a pandemic.
Collapse
Affiliation(s)
- Czar Louie Lopez Gaston
- Department of Orthopedics, Quirino Memorial Medical Center, Quezon City, Philippines
- Department of Orthopedics, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | | | - Emilleo Dacanay
- Department of Orthopedics, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Albert Jerome Quintos
- Department of Orthopedics, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| |
Collapse
|
44
|
Apthorp C, Sharma S, Barrak Aldeerawi H. Uncommonly sited rare tumour causing nasal obstruction. BMJ Case Rep 2020; 13:13/6/e233486. [PMID: 32522720 DOI: 10.1136/bcr-2019-233486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
: The study aims to discuss a case of an uncommonly sited rare tumour causing nasal obstruction and a literature review of angioleiomyomas in the nose. A 64-year-old woman presented with blockage of the right nostril, associated with a visible swelling on the undersurface of the alar cartilage, in the lateral wall of the nasal cavity. Anterior rhinoscopy highlighted a 1 cm cystic lesion, with areas of firmness, present at the mucocutaneous junction with a broad base. It was not attached to the underlying cartilage. There was no ulceration or bleeding on palpation. Nasal endoscopy did not show any extension further and the rest of the nasal cavity was clear. Endonasal resection of the tumour using a two-handed technique. This paper highlights not only the importance of considering angioleiomyomas within a differential diagnosis of nasal obstructions but also the uncommon site. .
Collapse
Affiliation(s)
- Christina Apthorp
- ENT, South Warwickshire General Hospitals NHS Trust, Warwick, UK .,North Manchester General Hospital, Manchester, UK
| | - Shweta Sharma
- ENT, South Warwickshire General Hospitals NHS Trust, Warwick, UK
| | | |
Collapse
|
45
|
van der Linden MC, van den Wijngaard IR, van der Linden S, van der Linden N. Night-time confusion in an elderly woman post-stroke. BMJ Case Rep 2020; 13:13/5/e230693. [PMID: 32444438 DOI: 10.1136/bcr-2019-230693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
For patients with acute ischaemic stroke, faster recanalisation improves the chances of a disability-free life and a quick discharge from the hospital. Hospital discharge, certainly after suffering a major life-changing event such as a stroke, is a complex and vulnerable phase in the patient's journey. Elderly are particularly vulnerable to the stressors caused by hospitalisation. Recently hospitalised patients are not only recovering from their acute illness; they also experience a period of generalised risk for a range of adverse events. At the same time, elderly generally prefer living in their own homes and should be discharged from the hospital and return home as quickly as possible. Both premature and delayed discharge are potential threats to patient well-being. We present a 90-year-old patient who underwent successful thrombectomy but suffered from night-time confusion at the hospital and discuss the transition process from hospital to home.
Collapse
Affiliation(s)
| | | | | | - Naomi van der Linden
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
46
|
Goncalves R, Marques M, Cartaxo T, Santos V. Hard routes of mental health in Portugal: what can we offer to an adolescent with serious mental illness and multiple social risk factors? BMJ Case Rep 2020; 13:13/4/e229120. [PMID: 32321729 DOI: 10.1136/bcr-2018-229120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Worldwide, millions of children and adolescents are suffering due to a lack of efficient mental healthcare. Although some progress has been made to address the mental health problems in this age group, currently, even developed countries fail in providing psychiatric patients with the best practice care. We present a case of a Portuguese adolescent with a first episode of psychosis in whom multiple social and environmental risk factors were identified as triggers to his clinical presentation, as well as fundamental determinants of prognosis in the short and long term. In this case, we demonstrate how social determinants, including poverty, family dysfunction and difficulties in accessing appropriate mental healthcare, strongly influence the development, maintenance and prognosis in early psychosis during adolescence. Furthermore, we consider the implications of an absence of community-based mental healthcare and rehabilitation services and reasons for why this may complicate the management and limit opportunities to this patient population.
Collapse
Affiliation(s)
- Rita Goncalves
- Child and Adolescent Psychiatry Department, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Mafalda Marques
- Child and Adolescent Psychiatry Department, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Teresa Cartaxo
- Child and Adolescent Psychiatry Department, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Vera Santos
- Child and Adolescent Psychiatry Department, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| |
Collapse
|
47
|
Villa EK, Villa D, Bundoc RC. Narcotrend-guided intraoperative care of a Trisomy 21 paediatric patient who underwent occipitocervical fusion. BMJ Case Rep 2020; 13:13/2/e231276. [PMID: 32051155 DOI: 10.1136/bcr-2019-231276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
A 9-year-old female with Trisomy 21 with complex craniovertebral instability causing severe cervicomedullary compression underwent occipitocervical fusion. This paper will discuss the anaesthetic management and highlight the use of the Narcotrend monitor not only as a depth of consciousness monitor but more importantly as a tool to detect surgery-induced cerebral hypoperfusion by monitoring the right and left cerebral hemispheres independently and simultaneously.
Collapse
Affiliation(s)
- Evangeline Ko Villa
- Department of Anesthesiology Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Dominic Villa
- Department of Anesthesiology Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Rafael C Bundoc
- Department of Orthopedics Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| |
Collapse
|
48
|
Radcliffe K, Akhtar S, Wilson A. Bilateral hypoglossal nerve damage due to the use of the harmonic focus scalpel. BMJ Case Rep 2020; 13:e231573. [PMID: 31988056 PMCID: PMC7021158 DOI: 10.1136/bcr-2019-231573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2020] [Indexed: 11/03/2022] Open
Abstract
We describe the case of a 68-year-old man who presented with an anterior floor of mouth squamous cell carcinoma and underwent bilateral neck dissection. Subsequently, the patient developed permanent bilateral hypoglossal palsies, causing significant dysphagia, dysarthria and breathing difficulties. Hypoglossal nerve damage from surgical causes is uncommon, occurring in only 0.42% of functional neck dissections. However, it is the bilateral and permanent features of this case which make it unique. This injury may have been caused by incorrect use of the Harmonic Focus scalpel. Therefore, we discuss the literature demonstrating that the Harmonic Focus scalpel causes more lateral thermal damage than alternative tools, and the widely accepted 3 mm safety limit is not enough to protect important surrounding structures. This case report aims to highlight the need for proper training and specific identification of the hypoglossal nerve to prevent this rare and debilitating complication occurring in future patients.
Collapse
Affiliation(s)
- Katherine Radcliffe
- Maxillofacial Surgery, Royal Preston Hospital, Preston, UK
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Shakeel Akhtar
- Maxillofacial Surgery, Royal Preston Hospital, Preston, UK
| | - Ajay Wilson
- Maxillofacial Surgery, City Hospitals Sunderland NHS Foundation Trust, Sunderland, UK
| |
Collapse
|
49
|
Hori A, Takebayashi Y, Tsubokura M, Kim Y. Efficacy of prolonged exposure therapy for a patient with late-onset PTSD affected by evacuation due to the Fukushima nuclear power plant accident. BMJ Case Rep 2019; 12:12/12/e231960. [PMID: 31888897 PMCID: PMC6936524 DOI: 10.1136/bcr-2019-231960] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Trauma-focused cognitive–behavioural therapy (TF-CBT), such as prolonged exposure therapy, is a first-line treatment for post-traumatic stress disorder (PTSD). However, adapting TF-CBT as an intervention in situations with limited resources, such as in disaster settings, is problematic. This case report concerns a Japanese man in his 30s who was diagnosed with late-onset PTSD 5 years after the 2011 Great East Japan Earthquake. The onset and progression of his symptoms were heavily affected by changes in his life after evacuation due to the postearthquake nuclear power plant accident. We were able to successfully implement structured CBT and help the patient better cope with his symptoms in a disaster-stricken location. CBT for PTSD includes exposure to traumatic memories, which may lead to worsening of PTSD symptoms, but we were able to administer the therapy successfully with clinical support through the use of modern information and communication technology.
Collapse
Affiliation(s)
- Arinobu Hori
- Department of Psychiatry, Hori Mental Clinic, Minami-Soma, Fukushima, Japan
| | - Yoshitake Takebayashi
- Department of Health Risk Communication, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Masaharu Tsubokura
- Department of Public Health, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yoshiharu Kim
- National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| |
Collapse
|
50
|
Abstract
Unindicated hysterectomy is a disturbing problem in India. Women are counselled into the procedure by the fear of cancer, and by reinforcing their notion that unrelated somatic problems are solved by the removal of the uterus. This is a case of a woman from the state of Bihar, India, who was referred to us after an unindicated hysterectomy at the age of 24, performed as a first-line treatment for lower abdominal pain. This highlights the problem of rising hysterectomy in India and the lack of integrated treatment for women with the debilitating condition of chronic pelvic pain. Pelvic pain and vaginal discharge are often not indicative of pelvic inflammatory disease, and need a more considerate and broad-minded approach. Public health initiatives should take more account of women's lack of knowledge of reproductive health and make efforts to disseminate such information by the use of television, radio and newspapers in local languages.
Collapse
Affiliation(s)
- Amenda Ann Davis
- Resident, Obstetrics and Gynaecology, All India Institute of Medical Sciences, Delhi, India
| |
Collapse
|