Acase Report Research Articles

Biplanar clavicle extension osteotomy : Acase report of an extension osteotomy due to shortening of a healed clavicle fracture with sagittal split technique and corticocancellous graft

Clavicle fractures healed in shortening or malposition are extremely rare, especially in adolescence. In extreme cases, they can result in massive pain and limitation of movement. Acausal therapeutic approach is lengthening osteotomy using the sagittal split technique with tricortical iliac crest interposition. In the context of the case study of ayoung patient, the procedure, operation as well as documentation of the postoperative results are reported.

MANDIBULAR LATERAL INCISOR PRESENTING BIFURCATED ROOT CANALS: A CASE REPORT

The anatomy of mandibular single-rooted teeth often presents bifurcated root canals, missing one of these leading to failure of endodontic treatment. As the mandibular incisors are smaller in dimensions, proper access cavity preparation is technical, the lingual canal is more difcult to nd because of the angulation. Thorough knowledge and skills are required to negotiate all of the canals for successful treatment and prognosis. Acase report is presented to illustrate non-surgical endodontic management of mandibular lateral incisors with two canals having a common exit. Summary: The mandibular incisors or single rooted teeth of mandible are often thought of having only one canal relating to the anatomy of root. But on the other hand, the morphology of root canal system of mandibular teeth presents multiple variations and multiple canals in single rooted teeth. This case is presented here with mandibular lateral incisor having two canals with common entrance and exit.

Endodontic Management of Four-Rooted Maxillary Second Molar using A Novel Single-File Rotary System : ACase Report

Endodontic Management of Four-Rooted Maxillary Second Molar using A Novel Single-File Rotary System : ACase Report

A New Score to Assess the Perioperative Period: A Retrospective Evaluation of aCase Report by PERIDIA Score

The complexity of cancer patients and the use of advanced and demolitive surgical techniques frequently need post operatory intensive care hospitalization. In order to increase safety and to select the best medical strategies for each single patient, a multidisciplinary team consisting of anesthesiologists, cancer surgeons, pharmacists, psychologists, statisticians and nurses has performed a new peri operatory assessment, arising from evidence-based literature data. The team focused the attention on supramesocolic peridiaphragmatic cancer surgery, such as esophagectomy, lobectomy and pneumonectomy, hepatic metastasectomy, pancreatectomy, gastrectomy and splenectomy. The clinical data concerning patients hospitalized in 2018 in postoperative ICU of the Cancer Institute Giovanni Paolo II of Bari were retrospectively analyzed. The following case report aim sat demonstrating how a perioperative evaluation is necessary to predict complications related to surgical treatment versus nonmultidisciplinary and unstructured assessments. Our first results will be confirmed by an ongoing retrospective study on a large number of patients and by future prospective studies. Keywords: Perioperative period; Patient assessment; Cancer surgery

Percepção dos acadêmicos de enfermagem sobre a aplicabilidade teórico-prática das visitas domiciliares: relato de caso

Objetivo: compreender a percepção dos acadêmicos de enfermagem sobre a aplicabilidade teórico-prática da visita domiciliar, seu impacto na saúde dos usuários e também as mudanças que ocorrem no contexto familiar. Método: Relato de caso desenvolvido pelos discentes da disciplina Enfermagem em Saúde Coletiva II do curso de enfermagem da Universidade Federal de Juiz de Fora - MG, durante o primeiro semestre de 2019. A experiência aconteceu em uma unidade básica de saúde da cidade de Juiz de Fora durante o primeiro semestre de 2019. Resultados: surgiram três tópicos onde podemos constatar que o enfermeiro deve atuar de forma ativa no processo de planejamento, execução e avaliação da visita domiciliar. Conclusão: A pesquisa surge como uma possibilidade de inserção de novos modelos de operação no planejamento, implantação e avaliação de desempenho da visita domiciliar de forma que seja eficiente e atenda aos princípios do sistema nacional de saúde.

Transplacentally transmitted organophosphorous compound poisoning in a newborn : Acase report and narrative review of literature

Organophosphorous compound (OPC) poisoning in the newborn is a medical emergency but completely treatable condition. Early recognition and treatment is of paramount importance in preventing fatality. A newbornmale of severe perinatal asphyxia was admitted in our neonatal intensive care unit (NICU) with a history of maternal OPC poisoning 31 hours before delivery. We treated the case on urgent basis, had stormy neonatal course and finally baby went home safely. OPC poisoning in newborn is a rare occurrence in the tropics. We report a rare case of transplacentally transmission of OPC poisoning innewborn and it is going to be 3rd and latest such reported case across the world upon literature search.
 Bangladesh Crit Care J September 2020; 8(2): 120-123

Laboratory Diagnostic Approach and Interpretation in Gram-Negative Bacterial Infection: A-Case Report of Sepsis in Secondary Hospital Settings

Gram-Negative Bacteria (GNB) have been widely reported to cause worldwide infections and life-threatening. The high prevalence of drug-resistant GNB causes the treatment of GNB to become difficult. This case report describes a stepwise laboratory approach and interpretation for Gram-negative bacteria infection in sepsis patients. An 84-year-old female patient with a history of congestive heart failure, after three weeks of hospitalization, GNB was proven as the cause of sepsis. Laboratory approach for inflammation (C-reactive protein, procalcitonin) was made and confirmed with a positive culture of several specimens (sputum, urine, and blood). The identification of bacterial-culture revealed as Carbapenem-resistance Klebsiella pneumoniae and Extended-spectrum Beta-lactamases Escherichia coli. This case highlights GNB as a potential agent to worsen the infection (sepsis) and also a useful approach for the detection of multidrug-resistant bacteria, particularly in secondary hospital settings. The application and interpretation of integrated clinical and laboratory criteria may bring out better and effective patient management.

Incarcerated lumbar hernia in the Petit´s triangle as a cause of large bowel obstruction

Petitshernia is arare defect in the abdominal wall located in the lower lumbar triangle. The herniation in the Petiti trigonum is complicated by bowel incarceration in about 9% of cases, most often of the large bowel. We present acase report of a73-year-old patient with clinical manifestations of large bowel obstrution. The patient was admitted and indicated for urgent surgery. Incarcerated left lumbar hernia in the Petitstriangle with herniation of sigmoid colon that showed no signs of ischemia was found. Reposition of the sigmoid colon and hernioplasty of the lumbar hernia was performed. There were no postoperative complications and the patient was discharged on postoperative day 9. The presented case report shows that the lumbar hernia (Petit) may result in bowel obstruction and thus may cause alife-threatening condition that requires urgent surgical intervention.

Challenges in Diagnosis of ChronicOsteomyelitis : ACase Report from Sri Lanka

The prevalence of osteomyelitis has been continuously decreasing in children with improvement of health care services and introduction of Hemophilus and Pneumococcal vaccines. Despite this, diagnosis and management of osteomyelitis are often a challenge to pediatricians as well as orthopedic surgeons. We report a 13-year old boy who had been treated as for rheumatic fever over 2 years with Benzathene penicillin, but ultimately turned out to have chronic osteomyelitis of right tibia. Evidence of chronic osteomyelitis was radiologically confirmed by X-ray and Computerized tomogram (CT) of right tibia and pus cultures grew staphylococcus aureus. Clinical features and biochemical markers completely resolved upon debridement of pus and intravenous antibiotics. He is currently on follow up at the orthopedic and pediatric clinics in the local hospital.International Journal of Human and Health Sciences Vol. 05 No. 01 January’21 Page: 118-121

En Bloc Capsulectomy with Implant Explantation in a High-Risk Patient with Breast Implant Illness: A Case Report

En bloc resection with capsulectomy in breast implant surgery may be problematic and challenging, with limited indications aside from Breast Implant Associated Anaplastic Large Cell Lymphoma [1, 2]. This is a case report highlighting the technique and tools utilized intraoperatively in higher risk circumstances with a 35-year-old female patient and her medical team requesting explantation with total capsulectomy as a compassionate measure for a perceived contribution towards the patient’s uncontrolled hypertension of unknown etiology [3].

Chemical peritonitis resulting from spontaneous rupture of amature ovarian cystic teratoma: acase report.

Mature cystic teratomas (dermoid cysts) are themost common germ cell tumours with 10-25% incidence of adult and 50% of paediatric ovarian tumours. Theaetiology of dermoid cysts is still unclear, although currently theparthenogenic theory is most widely accepted. Thetumour is slow-growing and in themajority of cases it is an accidental finding. Presenting symptoms are vague and nonspecific. Themain complication of adermoid cyst is cyst torsion (15%); other reported complications include malignant transformation (1-2%), infection (1%), and rupture (0.3-2%). Prolonged pressure during pregnancy, torsion with infarction, or adirect trauma are themain risk factors for a spontaneous dermoid rupture that can lead to acute or chronic peritonitis. Thediagnosis of mature cystic teratoma is often made in retrospect after surgical resection of an ovarian cyst, because such imaging modalities as ultrasound, computer tomography, or magnetic resonance imaging cannot yet accurately and reliably distinguish between benign and malignant pathology. We present areport of aclinical case of a35-years-old female, who was referred to thehospital due to abdominal pain spreading to her feet for three successive days. She had ahistory of anormal vaginal delivery one month before. Abdominal examination revealed mild tenderness in the lower abdomen; no obvious muscle rigidity was noted. Transvaginal ultrasound showed amultiloculated cystic mass measuring 16×10cm in thepelvis. In theabsence of urgency, planned surgical treatment was recommended. Thenext day thepatient was referred to thehospital again, with acomplaint of stronger abdominal pain (7/10), nausea, and vomiting. This time abdominal examination revealed symptoms of acute peritonitis. Theultrasound scan differed from theprevious one. This time, thetransvaginal ultrasound scan revealed abnormally changed ovaries bilaterally. There was alarge amount of free fluid in theabdominal cavity. Thepatient was operated on-left laparoscopic cystectomy and right adnexectomy were performed. Postoperative antibacterial treatment, infusion of fluids, painkillers, prophylaxis of thethromboembolism were administered. Thepatient was discharged from thehospital on theseventh postoperative day and was sent for outpatient observation. Ultrasound is theimaging modality of choice for adermoid cyst because it is safe, non-invasive, and quick to perform. Leakage or spillage of dermoid cyst contents can cause chemical peritonitis, which is an aseptic inflammatory peritoneal reaction. Once arupture of an ovarian cystic teratoma is diagnosed, immediate surgical intervention with prompt removal of thespontaneously ruptured ovarian cyst and thorough peritoneal lavage are required.

Epidural analgesia for a vaginal birth after caesarean section: Acase report

The use of epidural for vagina birth after caesarean section is contentious even in established Labour and Delivery Units because of concerns regarding maternal and fetal wellbeing following the occurrence of a uterine rupture as epidural analgesia may obscure the pain following such. Epidural analgesia has remained the major option for the management of pain in labour. Recently, there has been anecdotal evidence of increase in the use of epidural in labour and consequently brought to the fore a wide variety of case-mix on the floor. We report a case of labour epidural analgesia for vaginal birth after caesarean section (VBAC). The Parturient was a 28 year old booked G2P1+0, gestational age 37weeks in latent phase of labour. She had a previous caesarean section done for fetal distress and a lower uterine incision was used for the delivery of the fetus.Epidural analgesia was requested by the parturient and this was established in the sitting position using a size 18g Tuohy needle observing unit protocol. It was then activated with 8ml of 0.125% plain bupivacaine and then 5ml after 2 minutes. We ensured safety by ensuring close monitoring of the fetus using a cardiotocography and also of the parturient using a multiparameter monitor. At 4hours 40 minutes after admission, she had an unassisted vaginal delivery of a live 2.75kg male neonate with an Apgar score of 8 in 1 minute and 9 in 5. Baby was healthy and normal and the third stage of labour was managed using 10 international units of intravenous oxytocin and 20IU oxytocin in intravenous fluid 5% dextrose water.Conclusion: Women for VBAC should not be denied epidural labour analgesia. Monitoring gadgets and recruiting more manpower should be advocated especially in emerging Labour and Delivery Units and engender resource-constrained environment.

Giant osteoma of the occipital bone: Acase report

Osteomas are benign, slow-growing osteogenic tumors commonly occurring in the craniofacial bones. They are usually asymptomatic and can be discovered in routine clinical and radiographic examination. In this paper, we present a large solitary osteoma located in the occipital region causing aesthetic deformity and headache in a 22-year-old woman. Patient underwent radiographic examination with computed tomography followed by surgical excision and histopathological analysis.

Changes in concentrations of antiepileptic drugs in pregnant women – acase report

Changes in concentrations of antiepileptic drugs in pregnant women – acase report

First Trimester Rupture of Scarred Uterus After Use of Mifepristone, Misoprostol A-Case Report.

Uterine rupture is a disastrous obstetric complication, occurring mostly in second and third trimesters. The risk of uterine rupture markedly increases with previous uterine surgeries. Termination of early pregnancy failure by misoprostol is common. However, its use in women with scarred uterus is speculative and usually puts the obstetricians in a stressful condition. Here we present a case of rupture of a scared uterus in the first trimester after using mifepristone and misoprostol. A 25 years old parous lady presented with uterine rupture after taking mifepristone and misoprostol by herself to induce abortion for unwanted pregnancy. Immediate laparotomy was done and the defect was repaired. Termination of pregnancy in a woman with scarred uterus by mifepristone and misoprostol can lead to uterine rupture. It should be used cautiously under close supervision or other routes (vaginal or oral).
 KYAMC Journal Vol. 10, No.-1, April 2019, Page 57-59

Plasmablastic lymphoma in the oral cavity of a hiv negative male: acase report

Background: Plasmablastic lymphoma (PBL) is a rare aggressive subtype of non-Hodgkin Lymphoma, which is characterized by a diffuse propagation of large neoplastic cells resembling B cells. PBL is most frequently associated with Human Immunodeficiency Virus (HIV)-positive patients and primarily affects the oral cavity. Trends have shown an increase of reported PBL cases in immunocompetent patients. The clinical presentation of PBL may mimic other dental pathologies thus delaying diagnosis and worsening prognosis.

LATE DRUG ELUTING STENT THROMBOSIS: MORE THAN MEETS THE EYE?

Under expanded stents are in consequence of a non-dilatable fibrocalcificlesion. These are not uncommon, pose a technical challenge and areassociated with adverse procedural and long-term clinical outcomes.Excimer coronary laser atherectomy has well-established role in treatingunder expanded stents to achieve successful diltatation. We describe acase report in which a patient with an under expanded stent presented withan acute stent thrombosis resulting in a large thrombus burden. Weutilized excimer coronary laser atherectomy in successfully treating boththe under expanded stent to achieve maximal dilatation as well as theassociated large thrombus burden. Intra coronary imaging in the form ofoptical coherence tomography was undertaken throughout the case.

New Definition of Irreversibility in Neurological Side Effects of Lithium Intoxication: ACase Report

New Definition of Irreversibility in Neurological Side Effects of Lithium Intoxication: ACase Report

Repeated radiotherapy in apatient with avaginal recurrence – acase report

Repeated radiotherapy in apatient with avaginal recurrence – acase report

Epidural Anaesthesia a Safe Option for Caesarean Section in Parturient with Severe Pulmonary Hypertension - ACase Report

Epidural Anaesthesia a Safe Option for Caesarean Section in Parturient with Severe Pulmonary Hypertension - ACase Report