IJCR (2019), Volume 3

The use of central neuraxial anaesthesia for lumbar laminectomy is evolving in our centre with its attendant advantages like decrease in intraoperative blood loss, peri-operative cardiac ischemic incidents, postoperative hypoxic episodes, arterial and venous thrombosis, and it provides longer/ adequate postoperative pain control. Nonetheless, blindness a possible complication under general anaesthesia is preventable with regional anaesthesia, this is because patient is awake and there is no restriction in neck movement. This case series helps to provide feasibility of lumbar laminectomy under central neuraxial anaesthesia (spinal, epidural and combined spinal epidural anaesthesia).

Glioblastoma multiforme (GBM) is the most common primary malignant brain tumor. GBM treatment is a combined modality approach involving maximum surgical resection, adjuvant postoperative radiation and adjuvant chemotherapy treatment.There is a greater risk of hematological toxicity in concurrent temozolomide and radiation therapy. We reported that pancytopenia has been developed on a 54-year old female patient with GBM after concurrently used temozolomide and radiotherapy treatment. It should be kept in mind that this side effect may develop because the risk of morbidity and mortality may be elevated. Therefore, supportive therapies should be started immediately in patients where this toxicity developed.

Thromboangiitis obliterans (Buerger’s disease) is a disease of small and medium-sized vasculature, mainly involving the distal upper and lower extremities in male patients under the age of 45. Smoking tobacco is considered to be a predisposing and triggering agent. This presentation discusses the case of JS, a 35-year old male patient who initially presented with a stroke, followed by pain and swelling in the upper extremity, and finally with pain, absent peripheral pulses, and necrosis of the left lower extremity requiring below knee amputation. This case is of interest due to the rarity of this disease in the developed world, the presentation of a stroke in a young patient later diagnosed with thromboangiitis obliterans, and the use of a prostaglandin analog in treatment. This case highlights the difficulty of making the diagnosis of vasculitis and the time consuming, multispecialty approach that is required. The availability of subspecialists, medical record integration, communication between community hospitals, and the drug Iloprost could have positively affected the patient’s outcomes and prognosis.

The term Klinefelters syndrome refers to a group of chromosomal disorders in which the normal male karyotype 46XY has at least one extra X chromosome. The 47XXY aneuploidy is the most common human male sex chromosomal disorder associated with infertility and hypogonadism .It has prevalence of 1 in 500 to 1 in 800 live births independent of race. The aim of this case report is to document the rare case in the literature with the view of raising awareness about its existence in our environment and beyond. The Case: We present a case of a 31 year old black male patient with a 7 years history of progressive bilateral painless breast swelling that has rapidly increased in size over the past 3 years. He has no associated breast discharge. He also complained of associated infertility since he married his wife about 7 years ago despite regular unprotected intercourse within the same period. Hormonal assays done showed elevated gonadotropins( Leuteinising hormone and follicle stimulating hormone) , low levels of testosterone and elevated estradiol. Karyotype done revealed 47XXY karyotype.he was counseled on the need for assisted reproductive therapy, which he accepted. Subsequently, his wife was delivered of a baby boy following a successful assisted reproductive therapy by an obstetrician. Conclusion: Klinefelter syndrome is a rare clinical syndrome but a common chromosomal cause of male infertility. The introduction of assisted reproductive therapy has greatly improved infertility outcomes in terms of achieving pregnancy and live births.

Posterior urethral valve (PUV) is the most common cause of lower urinary tract obstruction in male neonates, with an incidence of one case per 8,000 to 25,000 live births1. The diagnosis is usually made prenatally or at birth, when male newborns are evaluated for prenatal hydronephrosis, or during early childhood, but rarely during adolescence or adulthood. Late presentation of PUV is rare and it has been estimated to account for 10% of cases2. Presentation in adulthood may occur due to the presence of a mild form of the disease devoid of the life threatening complications seen in children with the severe form3. A rare case of PUV which manifested in adulthood with lower urinary symptoms is presented to create awareness of the likelihood of the disease outside the paediatric age group.

In the setting of polytrauma, several foreign bodies could be aspirated, including avulsed teeth. Because a minimally responsive polytrauma patient could be at risk of airway compromise, emergency intubation is performed which can by itself lead to aspirated tooth. A complete dental examination is required to check for any fracture. A CT scan is the most sensitive modality for diagnosis. A rigid or flexible bronchoscopy is indicated for removal of the foreign bodies.

Ortner syndrome is vocal cord paralysis secondary to left recurrent laryngeal nerve palsy from atrial dilation. We present the case of a 28 year old woman with metastatic appendicular cancer to the peritoneum and pleura who experienced chest pain, progressive dyspnea and change in vocal quality secondary to esophageal impingement on the recurrent laryngeal nerve. This novel case of “Pseudo-Ortner Syndrome” further demonstrates the susceptibility of the laryngeal nerve to palsy secondary to mechanical impingement stemming from an unlikely distal non cardiac source.

Introduction: Renal stones are endemic in low income countries among children below 15 years old. This should not be underestimated due to high association with other morbidity and highly recurrence rate when compared with adults. Objective : To explore the Effectiveness of Extracorporeal Shock Wave In Pediatric Renal Stones. Methodology: Study the case of a child girl reported with renal stone, clinical and laboratory data were obtained , Radiological investigations as US and CT were done, The patient underwent dj stent, then patient received one session of Extracorporeal Shock Wave 4000 us guided storz eswl Lithotripsy for urinary Stones then uralyt-u pediatric dose and allpourinol 100 mg once daily then start to passing stones gravels Results: Follow up by CT for the patient after 3 months revealed no stone, renal scan split function from 12 to 18%. Conclusion: Renal stones could be presented even among pediatric group even with negative family history. Ultrasound is the first choice imaging modality for diagnosis of suspected renal stones , CT could be used for follow up. Dihydroxyadenine stones could be missed during routine diagnosis of renal stones so imaging is mandatory and stones analysis should be done.

A 7-month-old girl with congenital cytomegalovirus (CMV) infection underwent an immune assessment in anticipation of Transfer Factor therapy. She had been symptomatic since birth, with jaundice, rhinorrhea, diarrhea, pneumonia, hepatosplenomegaly, chorioretinitis, hydrocephalus (for which she was shunted), motor retardation, and failure to thrive. Her sputum and urine cultures were positive for CMV and her IgM anti-CMV antibody titer was positive at 1:16-1:32 dilutions. Her baseline immune assessment was normal except for a failure of her peripheral blood mononuclear cells to produce migratory inhibitory factor in response to CMV antigen. Treatment with transfer factor prepared from CMV seropositive donors resulted in clinical improvement, clearance of the virus, normal migratory inhibition factor responses to CMV antigen, and subsequent development of normal growth and development parameters.

Pharyngeal perforation is a rare serious finding with fatal outcomes if not diagnosed and managed promptly(1). The main cause is an iatrogenic injury during pharyngeal instrumentation and commonly present with neck pain, swelling, and subcutaneous emphysema. Many predisposing factors played a major role like difficult instrumentation, pharyngeal infection and old age(2). In our case, we present a patient with prostate cancer who underwent radical prostatectomy and was found to have mediastinal and surgical emphysema.