Post COVID 19- mucormycosis and osteomyelitis of the mandible- A rare case report

Corona virus disease was declared as pandemic in 2020. The second wave of covid 19 in India was completely influenced by the fatal complication of covid 19 called Mucormycosis. It was declared as an epidemic in India after 2 wave. The use of Corticosteroids in the management of covid 19 and uncontrolled diabetes mellitus with other systemic illness has shown tremendous immunosuppression which has ultimately caused Mucormycosis. Mucormycosis is rare in mandible. We are presenting a case report with brief discussion of 9 patients having post covid Mucormycosis along with osteomyelitis of the mandible, the rarest form of the post covid infection, which was managed surgically as well as with adjuvant antibacterial and antifungal drugs followed by post-operative prosthetic rehabilitation. This fatal infection has to be kept in mind in covid 19 active cases as well as in recovered patients, especially in those having comorbidities and judicious use of cortico-steroids should be recommended.

Three-Dimensional Transesophageal Echocardiography in the Diagnosis and Treatment of Mitral Prosthetic Valve Endocarditis—A Narrative Review

Despite advances in diagnosis, imaging methods, and medical and surgical interventions, prosthetic valve endocarditis (PVE) remains an extremely serious and potentially fatal complication of heart valve surgery. Characteristic changes of PVE are more difficult to detect by transthoracic echocardiography (TTE) than those involving the native valve. We reviewed advances in transesophageal echocardiography (TEE) in the diagnosis of PVE. Three-dimensional (3D) TEE is becoming an increasingly available imaging method combined with two-dimensional TEE. It contributes to faster and more accurate diagnosis of PVE, assessment of PVE-related complications, monitoring effectiveness of antibiotic treatment, and determining optimal time for surgery, sometimes even before or without previous TTE. In this article, we present advances in the treatment of patients with mitral PVE due to 3D TEE application.

Clinical and morphological features of SARS-COV-2 associated acute hemorrhagic necrotizing encephalopathy: case report

Background The current case report presents acute hemorrhagic necrotizing encephalopathy (AHNE) as an example of a fatal complication, the etiology of which could be coronavirus disease 2019 (COVID-19) with multiple organ damage along with the existing respiratory tuberculosis. Case presentation A male in his 20s had severe symptoms of central nervous system lesion, which developed against the background of COVID-19 and respiratory tuberculosis, for which he was treated in the intensive care unit. Autopsy confirmed that he died from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) associated AHNE in adults with severe fatal endothelial dysfunction and respiratory tuberculosis. The main morphological signs of brain damage were desquamative endotheliitis, thrombosis, parenchymal hemorrhagic necrosis, encephalitis, severe necrobiotic neuronal damage. Conclusion The defeat of endothelial cells with the development of generalized endotheliitis in COVID-19, especially in conjunction with comorbid pathology, in particular tuberculosis, can lead to a fatal complication that affects the nervous system—AHNE. Therefore, it is worth paying close attention to the appearance of neurological symptoms in patients with a similar combination of diseases.

Bevacizumab-induced esophageal pleural fistula during maintenance therapy without radiation in lung cancer

Background Esophageal pleural fistula (EPF) is a rare but fatal complication associated with bevacizumab use; however, cases reports of EPF caused by bevacizumab have not been previously published. Case presentation A 66-year-old male patient diagnosed with stage IV lung adenocarcinoma on April 24, 2020 received 6 cycles of platinum-containing dual chemotherapy combined with bevacizumab followed by three cycles of bevacizumab monotherapy. Five days before admission, he experienced chest tightness, dyspnea, and right chest pain. Bed-side X-ray examination revealed a massive right hydrothorax, and food was found in the extracted pleural effusion. EPF was further confirmed by upper gastrointestinal radiography after oral administration of iohexol. The patient underwent jejunostomy as the distal esophagus could not be identified on gastroscopy, and eventually died of septic shock on January 16, 2021. Conclusions It is necessary to pay attention to EPF during bevacizumab use in patients with or without risk factors.

Case Report: Simultaneous Ascending Aortic Dissection and Pulmonary Artery Dissection Combined by Aortopulmonary Fistula After Aortic Valve Replacement

Aortopulmonary fistula with/without pulmonary artery dissection is an extremely rare and fatal complication of acute aortic dissection and is often discovered postmortem. We present a case with a simultaneous ascending aortic dissection and pulmonary artery dissection combined by aortopulmonary fistula after aortic valve surgery. However, the patient died of postoperative complications after surgery. Herein, the anatomical basis for this rare entity and its outcome is explored with an emphasis.

An unexpected sudden death due to a choroid plexus papilloma: an autopsy case report

Background Choroid plexus papillomas (CPPs) are histopathologically benign and rare central nervous system tumors. These tumors remain more frequent in children than adults. It is infrequent for these tumors to cause a sudden unexpected death. We aim in this case to discuss the unusual and fatal presentation of choroid plexus papilloma and the mechanism of death. Case presentation we report the case of a 61-year-old man with no medical history, diagnosed at autopsy with a previously unknown CPP. Initial complaints were chronic headache occurring in the last month and acute chest pain for two days. The forensic autopsy including the histopathologic examination showed a tumoral mass of the choroid plexus in the fourth ventricle diagnosed as a psammomatous CPP. The cause of death in this case was attributed to a massive cerebral edema caused by the tumoral mass. Conclusions Through this case report, we stress the importance of an early and a vigorous investigation of every headache and an early detection of this tumor and we highlight as well the role of the post mortem examination to detect such a fatal complication.

Does intestinal peristalsis cause suture failure after instrument suture?

Introduction Gastrectomy with lymphadenectomy is a standard treatment for gastric cancer. Anastomotic leakage remains a potentially fatal complication of gastrectomy. Forceful stapler extraction may cause anastomotic complications. We focused on the duodenal peristalsis, as we hypothesized that it might cause forceful stapler extraction. We then retrospectively investigated duodenal peristalsis. We reviewed videos of Da Vinci system cases to clarify the relationship between peristalsis and anastomotic complications. Methods Forty-nine cases with stored videos of laparoscopic surgery using the Da Vinci system from 2015 to March 2021 were included. Peristalsis was defined by repeated contraction and expansion that was clearly visible three or more times in a row, and that there was no peristalsis in other cases. We investigated the duodenum because it is frequently observed during gastrectomy. We evaluated suture failure in cases with and without peristalsis. Results The study population included 49 patients (male, n=32; female, n=17; median age, 71 [42-82] years). Duodenal peristalsis was observed in 14 (28.6%) cases. Three patients experienced complications. A comparative study of cases with and without complications showed significant peristalsis in cases with complications (p=0.0198). Discussion Anastomotic leakage remains a serious and potentially fatal complication of gastrectomy, and surgeons should make efforts to prevent anastomotic leakage. Various risk factors associated with anastomotic leakage have been reported. This is the first retrospective study to evaluate duodenal peristalsis during gastrectomy for gastric cancer. We hypothesized that duodenal peristalsis would apply extreme tension on the stapler. Peristalsis would twist and increase the pressure on the stapler. In this study, we defined a new scale to evaluate duodenal peristalsis. Anastomotic complications were significantly more frequent in cases with peristalsis (p=0.0198). Our results suggest the utility of manual over-sewing or the use of reinforcement material.

Treatment of Iatrogenic Cervical Esophageal Transection following Thyroidectomy: A Case Report and Review of Literature

Background: iatrogenic cervical esophageal transection after thyroidectomy is an extremely rare condition that requires prompt diagnosis and surgical intervention.Case presentation: we reported a rare case of iatrogenic cervical esophageal transection following thyroidectomy for thyroid carcinoma in a 54-year-old woman. Primary repair was not achievable because of loss of a long segment of the cervical esophagus. A modified diversion was performed by inserting a T-tube into the remnant esophagus, followed by gastrostomy and jejunostomy. The next day, mediastinal abscess was detected on chest computed tomography; therefore, thoracoscopic mediastinotomy was performed, with placement of two drains. After 6 months, thoracoscopic esophagectomy, alimentary reconstruction with gastric pull-up, and cervical esophagogastrostomy anastomosis were performed. The patient was discharged on postoperative day 18, without complications.Conclusions: iatrogenic cervical esophageal transection following thyroidectomy is a rare but fatal complication. It can be successfully managed with a series of treatments, including modified diversion procedure, prompt drainage of mediastinitis, alimentary reconstruction with gastric pull-up, and cervical esophagogastrostomy anastomosis.