A large number of central venous catheters (CVC) are placed each year in the emergency room, operation theatre and critical care units. Although rarely associated with life threatening complications, femoral CVC is known to have the highest incidence of mechanical complications. The femoral veins are frequently preferred when other access sites are exhausted or there is increased risk for complications such as with emergency access, coagulopathy, and in the uncooperative patient .Femoral line placement confirmation is not routine practice. We present our case 59 years old male, Known case of Diabetes ,liver cirrhosis and portal hypertension presented to Accident and Emergency with repeated hematemesis and melena 3 times. On arrival to hospital patient was drowsy and hallucinating. Two large bore venous cannula were inserted and due to his hemodynamic instability requiring vasopressor support, Femoral venous catheter was inserted because of his deranged coagulation profile, with good blood flow and backflow , venous blood gases ( VBG) for placement confirmation was done. Patient was admitted for urgent upper GI endoscopy which revealed esophageal varix where bands were applied and with suspicious of Gut perforation. Urgent Computed Tomography ( CT ) of the abdomen was done . accidental radiological finding that the femoral line appeared to be curled posteriorly on itself. Patient was admitted to ICU where the malpositioned femoral line was removed and new central line was inserted confirmed position by the ultrasound and x-ray. Our conclusion from this case that even with functioning femoral lines confirmation by VBG alone is not enough and we recommend use of ultrasound not even during insertion but after placement for confirmation.
Background: Ovarian fibrosarcoma is a rare malignant tumor that should be distinguished from benign fibrous ovarian tumors and other malignancies, as it has a predilection for early and aggressive metastasis. Case: A 52-year-old woman presented with a large adnexal mass comprised of atypical spindle cells with increased mitotic activity, high Ki-67 index, and positive vimentin staining, consistent with primary ovarian fibrosarcoma. The patient required multiple laparotomies for large volumes of recurrent, rapidly growing disease. She died 15 months after initial surgery. Conclusion: Ovarian fibrosarcoma is an important diagnostic consideration when evaluating adnexal masses. Further study is required to clarify the impact of potential prognostic factors and establish optimal management and treatment.
Use of Internet for medical information by patients & its impact on Consultation time- A Patient Survey
Our patient survey revealed that there is equal number of Internet user and Internet non-user patients visiting our outpatient consultation. This raises an interesting fact about the importance of the need for the present day clinician to keep updated about not only the recent advances in the field but also with the IT skills. Literature has suggested prior Internet awareness amongst patients have resulted in explicitly patient controlled outcomes during consultation (10). Our patient survey did not focus on this aspect. Statistically significant was the increased consultation time of 0.8 minutes among the Internet user group in comparison to the Internet non-user group is still debatable. But does this point to the possible change in the consultation models in the Internet age is still questionable. Poor IT skills among the clinicians may result in defensively asserting an authoritative “expert opinion” when encountered with the Internet user group of patients as studies do suggest (10). Though the internet has revolutionized the world with access and availability of information, health texts needs more regulation as it does seem to start having an impact on the consultation times as seen in our patient survey. Is this the beginning of a change for the physician-patient relationship model in the Internet age?
Anterior Cruciate Ligament (ACL) tears are orthopaedic injury, particularly in athlete and youth populations. ACL is composed of longitudinally oriented bundles of collagen tissue arranged in fascicular subunits within larger functional bands. Ligament is surrounded by synovium, thus making it extra-synovial. Unilateral ACL tear is common & seen by sports medicine orthopaedic surgeons. But bilateral ACL injury is extremely rare and reported only three times in the previous literature. In this case of bilateral ACL tear, which was surgically treated and managed by performing arthroscopic double bundle ACL reconstruction in left knee using quadruplet hamstring graft. This particular surgery is a rare practice adopted by orthopaedic surgeons. We would like to highlight that, performing double bundle grafting not only helped the patient back into his sports field in shorter duration, but also shows that orthopaedic surgeons are espousing newer techniques and accomplishment of such procedure opening new dimension in ACL tear management.
Duodenal duplication cysts are rare congenital anomalies usually found in children, but rare cases have been described in adults. We report the case of a duodenal duplication cyst in a 54-year-old man who presented with a gastrointestinal obstruction inherent to endoluminal hemorrhage. Diagnosis was evocated by endoscopy. It was confirmed by computed tomography, oesogasto duodenal swallowing and magnetic resonance imaging. Partial cystectomy with mucosal stripping was performed via a midline laparotomy. The patient’s recovery was uneventful. The diagnosis was confirmed by histological examination of the operative specimen. In elderly patients with atypical presentation associated to cystic structures neighboring the duodenum, a high index of suspicion is required to diagnose this rare congenital pathology. Complete excision is the optimal treatment, but in some cases, partial cystectomy or endoscopic procedures can be performed.
Lassa fever is highly endemic in Nigeria and other West African countries, it is a disease associated with high case fatality and chronic sequelae in those that survived. Lack of effective vaccine has made the disease difficult to control and it prevention depends on eradications of the multimammate rats and universal precautions by all when a case is identified. We report a case of a 51 years old health worker who had a severe form of Lassa fever complicated by sensorineural deafness at the University College Hospital, Ibadan, South West Nigeria.
Sudden death is common in Africans especially in males in their middle ages. With increasing evidence in reduction of life expectancy among the populace due to several confounding factors there is need to review some of the causes of sudden unexpected death. The study came from the observation of the authors on autopsy requests and reports in Calabar. Two middle aged security officers attached to different private homes were found dead on their duty posts on different days. Autopsy reports on them were similar revealing enlarged heart with evidence of myocardial infarction. Other findings include fatty change, pulmonary oedema and contracted kidneys. Hypertensive heart disease is a common disease condition with resultant high morbidity and mortality if not diagnosed early and well managed.
Homicide from stabbing is the commonest cause of death all over the world and unwholesome activities such as cultism usually result into this in university environment. We present a case of 23 year old undergraduate who was murdered during election within the school premises. He sustained a deep laceration into the chest cavity with injuring to the main vessels resulting in massive internal bleeding, hypovolemic shock and irreversible organ failure and death. All hands must be on deck to prevent unnecessary death on our campuses.
Rhinosinusitis is often under diagnosed and overlooked in children. Fever as the only symptom of rhinosinusitis is rare and largely unreported. A three-year-old boy with a right frontal ventriculo-peritoneal (VP) shunt for congenital hydrocephalus presented with a three-month history of recurrent high grade intermittent fever. He had no other symptoms. A cranial Computed Tomogram for VP shunt evaluation revealed isodense lesions filling the right and left ethmoidal and maxillary sinuses. Bilateral inferior meatal puncture revealed frank pus in both maxillary sinuses. Microbacterial culture yielded Streptococcus pyogenes sensitive to Erythromycin. Following treatment, fever subsided and remained so in subsequent outpatients’ visits.
A patient suffering from stammering since childhood was treated with Tota Vati for six months ,got resque from his suffering and now is acting confidently in play. He can speak fluently now. In Ayurved ,sookshma aushadhi chikitsa is the most popular system of management where we can get better result with processed microfined particals of the same medicine even at very low dose .Ayurved says ,when the medicine is reprocessed with the decoction of same ingredients repeatedly, we get better efficacy with very small quantity of medicine. Tota vati is such type of processed medicine which was prepared by Vaidya .Narhar Bhole Prabhu.These tablets are much more useful in stammering.