Revista de informes de casos clínicos

Placenta accreta is an obstetrical complication that can result in life threatening hemorrhage if not managed with adequate care and cause high maternal morbidity. Caesarean hysterectomy is an effective method to control intra-operative bleeding; however, we present a case of placenta accreta that was diagnosed intra-operatively in our secondary set-up hospital. Owing to the lack of multidisciplinary team, bleeding was temporarily controlled by tying a tourniquet using a Foley’s catheter around the lower uterine segment with the tourniquet left in-situ and patient was shifted to a tertiary care hospital. This novel tourniquet technique bought time to transport the patient, arrange for a multidisciplinary team needed for this patient’s management, and reduce hemorrhage which directly determined maternal outcome.

Background: Accessory Hepatic Lobe (AHL) is a rare congenital anomaly that consists of the presence of a supernumerary lobe of hepatic parenchyma. The incidence of AHL is less than 1%, with only 27 cases having been reported in the paediatric population to date.

Aim: To identify studies in the literature on accessory hepatic lobe and present our experience with this condition.

Material and methods: We report the case of a patient who underwent surgery for intestinal occlusion and was found to have an accessory liver lobe with an embedded gallbladder. We reviewed published articles on accessory hepatic lobes accessed via PubMed, Google Scholar, Science Direct and Web of Science. Keywords included accessory hepatic lobe, ectopic liver tissue, ectopic liver lobe, accessory liver lobe. The search included articles published before August 2021 in English.

Results: We identified 27 published cases of paediatric accessory hepatic lobe. Of these 27, 14 were female and 13 were male, and the age range was 1 day to 19 years. We report the case of a female patient with intestinal occlusion found to have an accessory hepatic lobe with an embedded gallbladder. Of the 28 published cases, including ours, 11 are associated with abdominal wall defects including Umbilical Hernia, Omphalocele, Cloacal Exstrophy and Beckwith Wiedemann syndrome.

Conclusion: Accessory hepatic lobe is a rare entity usually detected incidentally. A total of 28 cases were reported, including our own. Paediatric surgeons should be aware of this condition in children with a history of abdominal wall defects.

Streptomycin associated nephrotoxicity can manifest either as nonoliguric acute kidney injury, tubular dysfunction or electrolyte abnormalities including Fanconi-like syndrome or Bartter syndrome. We report a case of Streptomycin-induced renal electrolyte wasting mimicking Bartter’s syndrome.

Purpose: Individuals diagnosed with End-Stage Kidney Disease (ESKD) have multiple comorbidities and require many medications. Alterations in renal function, coupled with pharmacokinetic and pharmacodynamic changes in individuals with increasing age, can result in adverse drug effects. The purpose of this case is to demonstrate how interventions recommended by a clinical pharmacist improved medication safety for a patient with ESKD.

Case: A 55-year-old male with a past medical history of ESKD, peripheral artery disease, chronic heart failure, cirrhosis, and major depressive disorder had a clinical pharmacist-led medication review. During the review, the clinical pharmacist identified several medications (i.e., bumetanide, metolazone, spironolactone, rivaroxaban) that should be discontinued since the patient had no urinary flow output and was on dialysis. Before the recommendations were addressed, the patient experienced retinal hemorrhaging, which may have been a rivaroxaban-associated adverse drug reaction. After addressing the retinal hemorrhaging, the physician discontinued the rivaroxaban and initiated clopidogrel. Additionally, both bumetanide and metolazone were discontinued.

Conclusion: This case demonstrates that clinical pharmacists can have a significant role in medication therapy management and medication safety, especially in patients with ESKD. Healthcare providers with patients with ESKD on dialysis can greatly benefit from consulting with a clinical pharmacist who can evaluate all medications for safety and efficacy.

Transverse myelitis is an uncommon neurological condition characterized by the inflammation of the spinal cord causing destruction to the myelin sheath. Acquired immunodeficiency syndrome can be a risk factor for this unusual disease. In later stages of AIDS, HIV myelopathy can be presented with diminished CD4 counts. We report the case of a 47-year-old male patient with H/O HIV and Hypertension presented with the complaints of asymmetrical limb weakness, followed by involuntary bowel and bladder habits, decreased bladder sensation, and intermittent fever. At the time of admission, the patient was found to have features of myelopathy and after various modalities of evaluation the patient was initiated on the treatment for the same. Being a rare case, this case report has great importance. Also, treatment of multiple diseases with multiple drug therapy remains a major challenge for physicians.

Antecedentes: Las alucinaciones visuales son alteraciones de la percepción presentes en diversas patologías. La alucinosis peduncular es una alucinación visual compleja que involucra animales o, a menudo, personas aterradoras que ocurren después de lesiones pontinas. En este informe de caso presentamos la historia clínica de un hombre de mediana edad que refirió alucinación peduncular debido a lesiones isquémicas leves pero numerosas en la región pontina. Esta es una condición peculiar ya que la literatura reporta HP para lesiones mucho más graves. Presentación del caso: Un hombre caucásico de 55 años con hipertensión, dislipidemia, ateromatosis carotídea y un diagnóstico previo de trastorno bipolar fue ingresado en el servicio de psiquiatría del Hospital Sant'Andrea debido a la aparición de un estado de ánimo mixto con agitación psicomotora, aceleración ideica, angustia, alucinaciones auditivas, ansiedad severa, ataques de pánico, insomnio total, alteraciones de la concentración e ideación suicida. Durante la hospitalización, tuvo alucinaciones visuales complejas. En la resonancia magnética del cerebro, había numerosas áreas isquémicas en la región ventral paramediana pontina. En el examen audiométrico se encontró hipoacusia neurosensorial bilateral. El paciente fue dado de alta con Ácido Valproico 1000 mg/día, Quetiapina 200 mg/día. Luego del alta se realizó evaluación neuropsicológica que evidenció deterioro cognitivo. Conclusión: Existen diversos casos en la literatura de isquemias pontinas que han dado lugar a alucinaciones visuales simples y complejas, aterradoras y bellas. Los pacientes generalmente tenían un estado de conciencia normal, no tenían delirios y presentaban alteraciones del sueño. Las lesiones de la protuberancia que comprometen el núcleo del rafe dorsal resultan en la pérdida de la inhibición ascendente de serotonina al núcleo geniculado lateral dorsal. En consecuencia, un geniculado sobreexcitado puede generar alucinaciones visuales a nivel cortical. Estas isquemias en la región pontina ventral paramediana pueden haber dañado el núcleo del nervio acústico causando una hipoacusia neurosensorial bilateral y los núcleos de la formación lenticular que, a través de la desregulación serotoninérgica y dopaminérgica, dieron lugar a alucinaciones visuales. Estas alucinaciones visuales pueden considerarse HP. Teniendo en cuenta el deterioro cognitivo, evaluado mediante evaluación neuropsicológica, y los factores de riesgo cardiometabólicos, también podemos afirmar que el diagnóstico psiquiátrico previo de trastorno bipolar podría haber retrasado las investigaciones diagnósticas neurológicas.