Bilateral globe luxation with multiple facial fractures: what next?

Luxation of the globe is a rare, vision-threatening event that can presently spontaneously or following trauma. A 35-year-old man presented with bilaterally luxated globe, postroad traffic accident. On imaging, bilateral LeFort fracture type 1, 2 and 3 with palatal split along with nasal bone and orbital floor fracture. Both condyles and left parasymphysis of mandible were fractured. There was no evidence of intracranial injury. There was pneumothorax on the right side for which intercostal drainage (ICD) tube was placed. On exploring, bilateral optic nerve avulsion was present. Both the globes were repositioned and a temporary tarsorrhaphy was placed for cosmetic rehabilitation. On follow-up visits after 6 months, both eyes were in their sockets with minimal exodeviation. It is important to reposition the globes, even with extensive periorbital fracture at the earliest. The longer the globe and orbital structures are prolapsed, the poorer are the structural and cosmetic prognosis owing to ocular ischaemia.

Download Full-text

Early and Late Endograft Limb Proximal Migration with Resulting Type 1b Endoleak following an EVAR for Ruptured AAA

Case Reports in Vascular Medicine ◽

10.1155/2017/4931282 ◽

2017 ◽

Vol 2017 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Patrick T. Jasinski ◽

Demetri Adrahtas ◽

Spyridon Monastiriotis ◽

Apostolos K. Tassiopoulos

Keyword(s):

Aortic Rupture ◽

Endovascular Techniques ◽

Case Presentation ◽

Iliac Arteries ◽

Proximal Migration ◽

Abdominal Aortic ◽

Potential Risk Factors ◽

The Right

Introduction. Seal zone failure after EVAR leads to type 1 endoleaks and increases the risk of delayed aortic rupture. Type 1b endoleaks, although rare, represent a true risk to the repair. Case Presentation. We report the case of a 65-year-old female who underwent emergent endovascular repair for a ruptured infrarenal abdominal aortic aneurysm and developed bilateral type 1b endoleaks following proximal migration of both endograft limbs. The right-side failure was diagnosed within 48 hours from the initial repair and the left side at the 1-year follow-up. Both sides were successfully treated with endovascular techniques. A review of the literature with an analysis of potential risk factors is also reported. Conclusion. For patients undergoing EVAR for ruptured AAA and with noncalcified iliac arteries, more aggressive oversizing of the iliac limbs is recommended to prevents distal seal zone failures.

Download Full-text

Bilateral Congenital Pseudarthrosis of the Tibia with Neurofibromatosis Type 1: Case Report and Literature Review

Journal of the Pakistan Medical Association ◽

10.47391/jpma.504 ◽

2021 ◽

pp. 1-9

Author(s):

Bunyamin Ari ◽

Sabit Numan Kuyubasi ◽

Admin

Keyword(s):

Neurofibromatosis Type 1 ◽

Neurofibromatosis Type ◽

Correction Osteotomy ◽

Pathological Fractures ◽

Café Au Lait Spots ◽

The Right ◽

Fibular Grafting ◽

Gene Mutation Analysis

Congenital pseudoarthrosis of the tibia (CTP) is a pathology characterized by dysplasia and pathological fractures in the tibia which fail to heal on its own. Its relationship with neurofibromatosis type 1 is already known. A very rare case; an 13 year old child diagnosed with NF1, accompanying bilateral CTP was presented in this article. She also had occasional blood pressure attacks and café au lait spots. She was diagnosed with NF, by gene mutation analysis and the BT results reported that pseudoarthrosis affected both tibiae. The patient was successfully treated by performing fibular grafting and external fixation operation of the tibia with internal and Ilizarov technique. Correction osteotomy was performed and grafted with 20 cc synthetic bone graft on the part of the right tibia where the bowing deformity was observed; the left tibia was not osteotomized as the bowing deformity was slighter. As a result of the 13-month follow-up,

Download Full-text

Delayed deterioration following the evacuation of posterior fossa extradural hematoma

Romanian Neurosurgery ◽

10.1515/romneu-2015-0016 ◽

2015 ◽

Vol 22 (1) ◽

pp. 121-124

Author(s):

Amit Agrawal ◽

S. Satish Kumar ◽

Umamaheswara Reddy V.

Keyword(s):

Cerebral Edema ◽

Traffic Accident ◽

Road Traffic ◽

Neuronal Damage ◽

Mass Effect ◽

Extradural Hematoma ◽

Secondary Brain Damage ◽

The Road ◽

The Right

Abstract A missed or delayed detection of intracranial injuries can lead to progressive neuronal damage and secondary brain damage. We present a case of 45 year female presented 8 after the road traffic accident and had a large posterior extradural hematoma on left side with mass effect. In addition there was a small speck of right frontal contusion with localized cerebral edema. The patient initially improved after evacuation of the hematoma. However on 3rd post-operative day she was complaining of headache and became progressively drowsy. A follow up CT scan showed increase in peri-lesional edema around the right frontal contusion with squashing of the lateral ventricles suggestive of diffuse cerebral edema. The patient was shifted back to intensive care unit and responded well to further conservative management. In our patient the events could be collaborated well with existing evidence (presence of contrecoup contusion and on clinical deterioration at day 3).

Download Full-text

Brugada ECG Sign & Chest Pain Mimicking ST Elevation Myocardial Infarction

International Journal of Medical Students ◽

10.5195/ijms.2013.210 ◽

2013 ◽

Vol 1 (2) ◽

pp. 86-90

Author(s):

Omar Mousa ◽

Haroonur Rashid

Keyword(s):

Chest Pain ◽

Previous History ◽

Wave Inversion ◽

History Of ◽

Future Events ◽

St Elevation ◽

The Right ◽

Brugada Pattern

Background: Management of patients with the brugada ECG sign who have no previous history of syncope is still negotiable. We present a case of a 57 year-old Caucasian lady who presented to the emergency department with substernal chest pain. Results: Her past medical history showed that she had two previous episodes of lightheadedness, but no syncope. She had a family history of sudden death secondary to unknown cause in her aunt at the age of 61. Physical exam was unremarkable except for diaphoresis. Electrocardiography (ECG) showed ST elevation in the right precordial leads (V1-V2) with T inversion, mimicking a STEMI. Emergent cardiac catheterization revealed normal coronary arteries. Echocardiogram was normal. Again, interpretation of ECG revealed a Brugada type 1 pattern, characterized by coved-type, gradually descending ST-T segment, elevated J point of more than 2 mm and T wave inversion. Electrophysiological (EPS) testing with a Sodium channel blocker challenge showed a persistent Brugada type 1 pattern with non-inducible ventricular tachycardia. This patient had Brugada type 1 ECG pattern with no previous history of syncope (asymptomatic). Thus she was considered at low risk of developing a serious arrhythmogenic event in the future. Conclusion: A history of syncope remains the best available predictor for arrhythmogenic events. EPS testing in such patients, to stratify the risk and predict for any future events, is still controversial. It is still unjustified to place an implantable cardioverter-defibrillator in asymptomatic non-inducible individuals with the Brugada pattern. These patients should follow up closely with a cardiologist and be aware of the risk of possible triggers of ventricular arrhythmias.

Download Full-text

What Is the Important Point Related to Follow-Up Sonographic Evaluation for the Developmental Dysplasia of the Hip?

Journal of Child Science ◽

10.1055/s-0037-1606611 ◽

2017 ◽

Vol 07 (01) ◽

pp. e123-e126

Author(s):

M. Donma ◽

M. Dogru ◽

M. Demirkol ◽

O. Ozcaglayan ◽

B. Topcu ◽

...

Keyword(s):

Physical Examination ◽

Developmental Dysplasia ◽

Childhood Disability ◽

Sonographic Examination ◽

Sonographic Screening ◽

Left And Right ◽

The Right ◽

Dysplasia Of The Hip

AbstractDevelopmental dysplasia of the hip (DDH) is an important cause of childhood disability. Subluxation or dislocation can be diagnosed through pediatric physical examination; nevertheless, the ultrasonographic examination is necessary in diagnosing certain borderline cases. It has been evaluated routine sonographic examination of 2,444 hips of 1,222 babies to determine differences in both, developmental dysplasia and types of hips, and evaluated their development on the 3-month follow-up. Evaluating the pathologic “α” angles under 59, there was no statistically significant differences between girls and boys in both right (55.57 ± 3.73) (56.20 ± 4.01), (p = 0.480), and left (55.79 ± 3.96) (57.00 ± 3.84), (p = 0.160) hips on the 45th day of life. Routine sonographic examinations on the 45th day of life revealed that 51 of (66.2%) 77 type 2a right hips were girls and 26 (33.8%) were boys. The number of the right hips that develop into type 1 was 38 (74.5%) for girls and 26 (100%) for boys on the 90th day of life (p = 0.005). A total of 87 type 2a left hips included 64 girls (73.6%) and 23 boys (26.4%). In the 90th day control, 49 right hip of girls (76.6%) and 21 right hip of boys (91.3%) developed into type 1 (p = 0.126). In the assessment of both left and right hips, girls showed a significantly higher frequency in latency and boys showed significantly higher development in the control sonography. A total of 31 girls (2.5%) and 11 boys (0.9%) accounted for a total of 42 (3.4%) cases who showed bilateral type 2a hips in 1,222 infants. On the 90th day control, 26 girls (83.9%) and all 11 boys (100%) developed into type 1 (p = 0.156). The study emphasizes the importance of the sonographic examination on the 90th day of life. Results of the investigation include the data of sonographic screening of DDH on the 45th day, and also stress the importance of the 90th-day control sonography after a close follow-up with physical examination between 45th and 90th days of life.

Download Full-text

Implication of osteoplastic flap for frontal sinus surgery in the endoscopic era

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20194958 ◽

2019 ◽

Vol 5 (6) ◽

pp. 1717

Author(s):

Aishwarya Raj Pillai Devaraj ◽

Kothegala Chandrashekariah Prasad ◽

Abhilasha Karunasagar ◽

Manna Jose Pappanacherry ◽

Harshitha Naganna Gowda ◽

...

Keyword(s):

Frontal Sinus ◽

Traffic Accident ◽

Road Traffic ◽

Nasal Bone ◽

Case Series ◽

Anterior Wall ◽

Sinus Surgery ◽

Sinus Disease ◽

Good Cosmesis

<p class="abstract">In the present era where functional endoscopic sinus surgery is the mainstay of management for any frontal sinus disease, we present a case series comprising six cases of various frontal sinus pathology that were managed with an external approach using a bicoronal osteoplastic flap technique of which three cases were of inverted papilloma, one case of allergic fungal rhinosinusitis, one case of frontal mucocele and a case of road traffic accident with frontal bone and nasal bone fracture. The cases had a mean follow-up period of 6 months. There was no recurrence of disease and no significant postoperative complications have been reported during the follow-up period so far. Osteoplastic anterior wall approach to the frontal sinus has proved to be one of the most effective, simple, and reliable procedures with excellent success rate and good cosmesis.</p>

Download Full-text

Gene-Replacement Therapy (GRT) in Spinal Muscular Atrophy Type 1 (SMA1): Long-Term Follow-Up From the Onasemnogene Abeparvovec Phase 1/2 Clinical Trial

10.1055/s-0039-1698259 ◽

2019 ◽

Cited By ~ 1

Author(s):

Jerry R. Mendell ◽

Richard Shell ◽

Kelly J. Lehman ◽

Markus McColly ◽

Linda P. Lowes ◽

...

Keyword(s):

Clinical Trial ◽

Muscular Atrophy ◽

Phase 1 ◽

Gene Replacement ◽

Spinal Muscular Atrophy Type ◽

Gene Replacement Therapy ◽

Long Term Follow Up

Download Full-text

CASE REPORT: SURGICAL MANAGEMENT OF LUMBAR COMPRESSION FRACTURE

Neurologico Spinale Medico Chirurgico ◽

10.15562/nsmc.v1i4.131 ◽

2019 ◽

Vol 1 (4) ◽

Author(s):

Yustinus Robby Budiman Gondowardojo ◽

Tjokorda Gde Bagus Mahadewa

Keyword(s):

Spinal Cord ◽

Left Lung ◽

Lumbar Vertebrae ◽

Compression Fracture ◽

High Mobility ◽

Early Mobilization ◽

Cord Injury ◽

Cardiothoracic Surgeon ◽

The Right

The lumbar vertebrae are the most common site for fracture incident because of its high mobility. The spinal cord injury usually happened as a result of a direct traumatic blow to the spine causing fractured and compressed spinal cord. A 38-year-old man presented with lumbar spine’s compression fracture at L2 level. In this patient, decompression laminectomy, stabilization, and fusion were done by posterior approach. The operation was successful, according to the X-Ray and patient’s early mobilization. Pneumothorax of the right lung and pleural effusion of the left lung occurred in this patient, so consultation was made to a cardiothoracic surgeon. Chest tube and WSD insertion were performed to treat the comorbidities. Although the patient had multiple trauma that threat a patient’s life, the management was done quickly, so the problems could be solved thus saving the patient’s life. After two months follow up, the patient could already walk and do daily activities independently.

Download Full-text