Revista de informes de casos clínicos

Fractures of the fifth metatarsal present a unique set of challenges for treatment to the foot and ankle specialist. Understanding the local anatomy, vascular supply, function, and dynamic stresses placed upon the bone, as well as fracture classifications, mechanisms of injury, and expected responses to treatment aid immensely in the decisionmaking processes. This paper provides a critical review of the current literature with the author’s preferred method of treatment of these injuries to provide the orthopaedic surgeon with a basis for treatment of these injuries based on the most recent literature. We tried to link theoretical information with our clinical skills in twenty patients having fracture base of fifth metatarsal in variable ages classification and mechanism of injury.

Achondroplasia is one of the commonest forms of dwarfism. A 26-year-old achondroplasic dwarf with vitamin D deficiency was posted for an elective shaft of femur fixation. Owing to her difficult airway and past history of tuberculosis, it was decided upon to operate her under combined spinal and epidural anaesthesia. This case report highlights on the need for real time ultrasound guidance in locating the epidural space and hence aiding in successful placement of the Quincke’s needle and the epidural catheter. The ultrasound is an effective and reliable tool to ascertain the most feasible inter-vertebral space in cases of a difficult spine anatomy.

An 80-year-old man with severe aortic stenosis, who declined aortic valve replacement several times since 2011 and had recurrent syncope after balloon aortic valvuloplasty, was admitted because of symptomatic aortic stenosis. A percutaneous strategy for his aortic stenosis was decided. Transcatheter aortic valve replacement using a balloon-expandable Edwards Sapien XT valve was performed under rapid ventricular pacing. After valve deployment, an aortic dissection of ascending aorta was noticed. There was no coronary flow compromise, no acute aortic root and ascending aorta dilatation, no pericardial effusion, and paravalvular aortic regurgitation was mild. After consultation with cardiovascular surgeon, interventional radiologist and invasive cardiologist we decided for conservative approach, with very good outcome and no additional disabilities in the follow up of more than two years.

Rhabdomyolysis is a condition in which intracellular components undergo systemic circulation leading to impairment in clinical and laboratory findings due to striated muscle destruction due to traumatic or traumatic causes. The most common clinical symptoms of rhabdomyolysis are muscle weakness, muscle pain and dark urinary tract. The most important complication is acute renal failure.

A 32-year-old female patient was brought in by an immediate family member with complaints of fatigue, muscle aches, and wandering in the morning. The patient had a history of psychosis and the use of antipsychotic medication. In the patient’s anamnesis, it was learned that she jumped about six meters in height 10 days ago for suicide but was able to walk completely independently and without support. There was flask paralysis in the lower extremity on the neurological examination performed. She was begun to be followed by Guillain barre syndrome (GBS] by preliminary diagnosis. In the biochemical analysis results, creatine kinase 50,902 U/L (24-190), AST 871 U/L (10-40) and lactate dehydrogenase 1617 U/L (220-450) were detected. According to the clinical and laboratory results, acute renal insufficiency (ARI] developed in the patient despite diagnosis of rhabdomyolysis and intensive hydration therapy. ARI was completely improved with appropriate treatment. Patient was mobilized and discharged.

In this article, a case is presented in which GBS was considered with the initial examination findings in the emergency department and clinical and laboratory findings and rhabdomyolysis were detected in follow-up. It was emphasized the importance of seeing rhabdomyolysis, which is among the neuromusculer aciller, in mind for the rare occurrence. The presence of flask paralysis in our case clinic and the development of rhabdomyolysis after falling from the top have the feature of being first.

Behçet‘s disease is a chronic vasculitis with heterogeneous manifestation. Cardiovascular involvement, although rare, is described and of extreme severity. We report the observation of a 33-year-old man diagnosed with Behçet‘s disease complicated with a thrombosed aneurysm of the right coronary responsible of a myocardial infarction and an aneurysm of the lower LV wall admitted for management of a life threatening ventricular tachycardia with an indication of an implantable cardioverter-defibrillator (ICD) implantation.

Pleural-effusion is a general symptom in cardiac insufficiency even after VAD implantation. Draining of pleuraleffusions improves symptoms without complications. In VAD-patients repeated thoracentesis is associated with higher risk of bleeding, the operative management showed very safe results with more privileges towards video assisted-thoracic-surgery. Nonetheless, operative treatment isn’t always feasible. In such cases another approach is required. We found that implantation of indwelling-pleural-catheter is an effective treatment for non-operablepatients as in our Case a spontaneous remission of the pleural-effusion was achieved after 6 months. However, a case of chronic pleural-effusion with indwelling-pleural-catheter and left ventricular-assist-device support has not been previously reported.

We report a twin pregnancy with a selective feticide of the first foetus with a Niemann Pick disease type C and a delayed interval delivery. The presented case confirmed that a delayed interval delivery is possible and successful. However, a close monitoring of the mother and the retained child after the birth of the first child is essential. A delayed delivery seems to be save for the mother, but the success for the neonatal outcome cannot be predicted.

Breast cancer is the most common malignancy in women and the main cause of cancer death in China. Breast cancer metastatic to the gastrointestinal tract is rare. The metastatic patterns of invasive lobular carcinoma (ILC) and invasive ductal carcinoma (IDC) have been shown to differ considerably. Liver, lung and brain metastases are more common in IDC. Here We present a 60-year old woman who was diagnosed with metastatic carcinoma of the stomach.

Post-vaccination neutropenia is not uncommon. The risk of thrombocytopenia following MMR vaccination is 1 in 30,000 to 1 in 40,000 vaccinated children. The clinical course of these cases is usually transient and benign.

In this report, we describe a white man with symptomatic hypoglycemia whose medical work-up revealed an excessively elevated serum insulin level (867 mIU/l). The need to measure IAA in patients with extraordinarily high measured levels of total insulin is essential because of the possible artifactual elevation (in a conventional insulin immunoassay) caused by IAA. In the present case, the elevated IAA level (>50 kIU/l) confirmed the diagnosis of autoimmune hypoglycemia and allowed to avoid unnecessary surgical intervention.

Cleidocranial dysplasia (CCD) represents a rare genetic disease characterized by disturbances in osseous structures, face dysmorphia, hypoplasia or aplasia of clavicles and numerous supranumerary teeth causing permanent teeth impaction. The study aimed at presenting a case of 12-year-old girl with CCD at the phase of active orthodontic treatment, involving successive extraction of multiple supranumerary teeth and repositioning of additional teeth using elastic traction. The patient was also subjected to a complex auditory examination which detected a hearing loss. Patients with CCD from their youngest years should be covered by a broad diagnosis and therapy, involving a comprehensive collaboration of multiple specialities.

Background: Cervical adenocarcinoma has rarely been documented with literature reports focusing primarily on squamous cell carcinoma.

Case report: In this report, we present a case of a 66-year-old woman who presented with an abnormal Pap test with atypical squamous cells which cannot exclude high grade lesion (ASC-H). Pelvic MRI was performed and led to the diagnosis of stage IB1 endocervical adenocarcinoma. Subsequent radical hysterectomy, bilateral salpingo oophorectomy, bilateral pelvic lymph node cleaning operation and Lymph nodes by abdominal aorta dissection were performed. The definitive diagnosed was stage IIB1 well differentiated endocervical adenocarcinoma confirmed by histologic and immunohistochemical analysis. The patient received no adjuvant therapy and has remained without evidence of disease.

Conclusion: Cervical adenocarcinoma is easy to be missed and we should be vigilant.

Background: The clinical symptoms of inguinal lipoma (IL) are similar to those of inguinal hernia (IH). As for IH, the treatment for symptomatic IL includes surgery. This study aimed to evaluate the outcomes of laparoscopic excision of IL with suture repair of the deep inguinal ring.

Methods: The cohort of this retrospective study included 46 adult patients with IL who visited Damsoyu hospital from September 2012 to December 2016. During the same period, 1,100 patients with inguinal hernia were treated. IL was completely excised, and the deep inguinal ring was repaired with intracorporeal sutures.

Results: IL without IH was observed in 35 males and 11 females and symptoms of inguinal bulging with pain in 26 (74.3%) males and 10 (90.9%) females. IL was located in the indirect inguinal canal in 32 (91.4%) males and 7 (63.6%) females. It was separated from the preperitoneal fat in 21 (60%) males and 6 (54.5%) females.

Conclusion: When treating a groin mass in the absence of IH, IL should be suspected. Laparoscopic excision of IL and the suturing of the deep inguinal ring as posterior wall repair had a shorter surgical duration and acceptable recurrence and complication rates.

A 28-year-old man suffered intentional dermal exposure to potassium hydroxide inside a psychiatric hospital bathroom during inpatient treatment for schizophrenia. He received initial treatment at a local emergency department (ED) and was transferred to our burn unit. On arrival at 18 hours after the injury, he was diagnosed as having 60% total body surface area (TBSA) chemical burns; third-degree: 24%, second-degree: 36%. At the outside ED, his serum potassium level peaked at 8.2 mEq/L (normal range: 3.5 to 5.0 mEq/L) and decreased to 6.9 mEq/L after he received intravenous glucose and insulin therapy. At our facility his potassium had increased to 7.3 mEq/L. The patient’s urine output was maintained at >100 mL/h, but his serum potassium level rose to 8.1 mEq/L and continuous hemodiafiltration was initiated within 5 h of admission. Early debridement was performed due to extensive thirddegree burns, risk of deep-tissue alkali injury, and persistent (chemical-induced) hyperkalemia. At 40 h after the injury, fascial resection of the lower leg was performed, involving 20% TBSA third-degree burn, and his serum potassium normalized. After five operations he was able to ambulate with assistance, and on hospital day 72 he was transferred to a rehabilitation hospital without major complications.