Efficacy of bilateral erector spinae block for post-operative analgesia in liver hydatid surgery

Background: Erector spinae plane (ESP) block is a recently described interfacial block, and since 2016, studies have shown that it is a safe technique related to the lower risk of neurovascular and pleural injury comparing to epidural or paravertebral blockade. The application of ESP block in abdominal surgery is relatively limited to case reports and small population studies, which is why we believe every new case of its application should be a valuable contribution. Case presentation: With this present case, we explored the efficacy of bilateral ESP block as a post-operative analgesia technique for liver hydatid surgery on a 56-year-old patient. Ultrasound-guided bilateral ESP block was applied at T7 level, while the patient was awake before general anaesthesia induction. The local anaesthetic used was 20 mL ropivacaine (0.375%) and 2 mg dexamethasone on each side. After recovery from anaesthesia, she reported mild pain (visual analogue score of 5 on effort). After 12 hours post-operatively, she received only one dose of paracetamol 1 g considered as rescue analgesic. She did not experience nausea and vomiting episodes. We noted a sensory block extending from T4 to T10. Conclusion: To our knowledge, it may be the first adult bilateral single-shot case report for this specific procedure. This technique appears to be safe and effective on post-operative analgesia for this type of surgery; however, prospective studies comparing ESP block to other techniques are needed.

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Effective erector spinae plane block for postoperative analgesia in a pyothorax patient who underwent emergency re-open thoracotomy—a case report

Ain-Shams Journal of Anesthesiology ◽

10.1186/s42077-019-0044-8 ◽

2019 ◽

Vol 11 (1) ◽

Author(s):

Izumi Kawagoe ◽

Daizoh Satoh ◽

Mariko Fukui ◽

Kenji Suzuki ◽

Eiichi Inada

Keyword(s):

Postoperative Analgesia ◽

Transverse Process ◽

Erector Spinae ◽

Open Thoracotomy ◽

Case Presentation ◽

Lung Lobectomy ◽

Erector Spinae Plane Block ◽

Lower Lung ◽

The Right ◽

Vein Stenosis

Abstract Background The appropriate choice of postoperative analgesia for pyothorax surgery is unclear since local infection could contaminate the catheter used for regional blocks and bacteremia can lead to disordered coagulation. We performed erector spinae plane block (ESPB) in a pyothorax patient undergoing emergency re-open thoracotomy. Case presentation An 81-year-old male with internal jugular vein stenosis on aspirin therapy was scheduled for pyothorax drainage and residual middle lobectomy 14 days after he underwent open right lower lung lobectomy for lung cancer. ESPB was performed with injection of 20 ml of 0.375% levobupivacaine at the Th5 transverse process of the right side under ultrasound guidance. Although he needed intravenous pentazocine for pain on postoperative day 0, no more analgesics were required postoperatively. NRS score ranged from 0 to 1 thereafter. Conclusions ESPB provided effective postoperative analgesia following emergency re-open thoracotomy for our pyothorax patient. ESPB might be the appropriate choice for postoperative analgesia following pyothorax surgery.

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Spontaneous haemorrhage of an adrenal angiomyolipoma: case report

African Journal of Urology ◽

10.1186/s12301-019-0006-1 ◽

2019 ◽

Vol 25 (1) ◽

Author(s):

Danielle Whiting ◽

Ian Rudd ◽

Amit Goel ◽

Seshadri Sriprasad ◽

Sanjeev Madaan

Keyword(s):

Case Reports ◽

Case Presentation ◽

Open Adrenalectomy ◽

Large Size ◽

History Of ◽

Loin Pain ◽

Benign Tumours ◽

Spontaneous Haemorrhage ◽

Mesenchymal Tumours

Abstract Background Angiomyolipomas are rare mesenchymal tumours arising from the perivascular epithelioid cells consisting of variable amounts of adipose, thick-walled blood vessels and smooth muscle cells. These benign tumours commonly occur in the kidney with only a few case reports of adrenal angiomyolipomas which have the potential to reach a large size and haemorrhage. Case presentation A 45-year-old lady presented with a 3-week history of right loin pain, nausea and vomiting. A CT scan revealed a right adrenal angiomyolipoma measuring 6.3 × 6.8 cm with associated haemorrhage. The lesion was successfully treated with right open adrenalectomy, and histology confirmed the diagnosis of adrenal angiomyolipoma. The patient remained well with no evidence of recurrence at the 36-month follow-up. Conclusion Adrenal angiomyolipomas are rare benign tumours that have the ability to reach a large size and potential to bleed. Here, we report the second case of spontaneous haemorrhage in an adrenal angiomyolipoma, which was successfully treated with open adrenalectomy.

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Clozapine-induced stuttering in the absence of known risk factors: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-02803-8 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Florence Jaguga

Keyword(s):

Risk Factors ◽

Family History ◽

Side Effect ◽

Case Reports ◽

Extrapyramidal Symptoms ◽

Prior History ◽

Case Presentation ◽

Rare Side Effect ◽

History Of ◽

Electrophysiological Findings

Abstract Background Stuttering is a rare side effect of clozapine. It has been shown to occur in the presence of one or more factors such as abnormal electrophysiological findings and seizures, extrapyramidal symptoms, brain pathology, and a family history of stuttering. Few case reports have documented the occurrence of clozapine-induced stuttering in the absence of these risk factors. Case presentation A 29-year-old African male on clozapine for treatment-resistant schizophrenia presented with stuttering at a dosage of 400 mg/day that resolved with dose reduction. Electroencephalogram findings were normal, and there was no clinical evidence of seizures. The patient had no prior history or family history of stuttering, had a normal neurological examination, and showed no signs of extrapyramidal symptoms. Conclusion Clinicians ought to be aware of stuttering as a side effect of clozapine, even in the absence of known risk factors. Further research should investigate the pathophysiology of clozapine-induced stuttering.

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Fibromuscular dysplasia with recurrence after “long-term” following percutaneous transcatheter renal angioplasty: two case reports with a review of 26 patients

BMC Nephrology ◽

10.1186/s12882-021-02342-w ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Shuntaro Oribe ◽

Takafumi Toyohara ◽

Eikan Mishima ◽

Takehiro Suzuki ◽

Koichi Kikuchi ◽

...

Keyword(s):

Fibromuscular Dysplasia ◽

Age Of Onset ◽

Case Reports ◽

Case Presentation ◽

Renal Angioplasty ◽

Long Term Follow Up ◽

Percutaneous Transluminal Renal Angioplasty ◽

The Difference

Abstract Background Fibromuscular dysplasia (FMD) often causes renal artery stenosis with renovascular hypertension. Recent clinical outcomes encourage percutaneous transluminal renal angioplasty (PTRA) to treat FMD; however, the necessary follow-up period remains unclear. Moreover, previous studies have not revealed the difference in the period until recurrence between two major types of FMD—multifocal and focal. Case presentation We describe two patients with multifocal FMD who developed hypertension during their teenage years and had recurrence of FMD > 10 years after PTRA. We further examined the types of FMD and age of onset in 26 patients who underwent PTRA. The period until recurrence of multifocal FMD was longer than that of focal FMD. Moreover, patients with early-onset multifocal FMD are likely to have a delayed recurrence after PTRA compared to other types. Conclusions Our report suggests that patients with multifocal FMD, especially those with onset at an early age, may need long-term follow-up for at least ≥ 10 years.

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Familial hemiplegic migraine type 2 due to a novel missense mutation in ATP1A2

The Journal of Headache and Pain ◽

10.1186/s10194-021-01221-x ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Fabio Antonaci ◽

Sabrina Ravaglia ◽

Gaetano S. Grieco ◽

Stella Gagliardi ◽

Cristina Cereda ◽

...

Keyword(s):

Case Reports ◽

3D Structure ◽

Familial Hemiplegic Migraine ◽

Transmembrane Helices ◽

Hemiplegic Migraine ◽

Case Presentation ◽

Italian Family ◽

Protein Prediction ◽

Functional Consequences

Abstract Background The mechanisms of genotype-phenotype interaction in Familiar Hemiplegic migraine type 2 (FHM2) are still far from clear. Different ATP1A2 mutations have been described, with a spectrum of phenotypes ranging from mild to severe. No genotype-phenotype correlations have been attempted. Case presentation We describe an Italian family with FHM and a missense ATP1A2 variant (L425H) not previously described. The clinical picture was mild in all the affected members. Conclusions Co-segregation of the variant with the aura phenotype was complete in this family, suggesting a 100% penetrance. In silico protein prediction softwares indicate that this variant may change the 3D structure of ATPA1A2 at the cytoplasmic loop between the two central transmembrane helices. Milder FHM phenotypes are rarely reported in literature, likely because case reports are biased towards the most severe phenotypes, with milder forms possibly misdiagnosed as sporadic migraine with aura forms (MAs), even with complex auras. Further studies taking into account intra-familiar variability and functional consequences on the channel protein may help clarify genotype-phenotype correlations.

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Severe pneumonia caused by Parvimonas micra: a case report

BMC Infectious Diseases ◽

10.1186/s12879-021-06058-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Qing Yu ◽

Lingling Sun ◽

Zuqing Xu ◽

Lumei Fan ◽

Yunbo Du

Keyword(s):

Bronchoalveolar Lavage Fluid ◽

Case Reports ◽

Severe Pneumonia ◽

Lavage Fluid ◽

Due Date ◽

Case Presentation ◽

Abdominal Abscesses ◽

Parvimonas Micra ◽

Next Generation Sequencing Ngs ◽

Generation Sequencing

Abstract Background Parvimonas micra (P. micra) is a gram-positive anaerobic coccus that is detected widely on the skin, in the oral mucosa and in the gastrointestinal tract. In certain circumstances, P. micra can cause abdominal abscesses, bacteraemia and other infections. To the best of our knowledge, there have been no case reports describing the biological characteristics of P. micra-related pneumonia. These bacteria do not always multiply in an aerobic organ, such as the lung, and they could be easily overlooked because of the clinical mindset. Case presentation A 35-year-old pregnant woman was admitted to the emergency department 4 weeks prior to her due date who was exhibiting 5 points on the Glasgow coma scale. A computed tomography (CT) scan showed a massive haemorrhage in her left basal ganglia. She underwent a caesarean section and brain surgery before being admitted to the ICU. She soon developed severe pneumonia and hypoxemia. Given that multiple sputum cultures were negative, the patient’s bronchoalveolar lavage fluid was submitted for next-generation sequencing (NGS) to determine the pathogen responsible for the pneumonia; as a result, P. micra was determined to be the causative pathogen. Accordingly the antibiotic therapy was altered and the pneumonia improved. Conclusion In this case, we demonstrated severe pneumonia caused by the anaerobic organism P. micra, and the patient benefited from receiving the correct antibiotic. NGS was used as a method of quick diagnosis when sputum culture failed to distinguish the pathogen.

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Identification of a De Novoc.1000delA ANK1 mutation associated to hereditary spherocytosis in a neonate with Coombs-negative hemolytic jaundice-case reports and review of the literature

BMC Medical Genomics ◽

10.1186/s12920-021-00912-3 ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Lichun Xie ◽

Zhihao Xing ◽

Changgang Li ◽

Si-xi Liu ◽

Fei-qiu Wen

Keyword(s):

De Novo ◽

Hereditary Spherocytosis ◽

Case Reports ◽

De Novo Mutation ◽

Case Presentation ◽

Important Means ◽

Genetic Detection ◽

Membrane Defects ◽

Severe Jaundice ◽

Neonates And Infants

Abstract Background To strengthen the understanding of Hereditary Spherocytosis (HS) and determine the disease-causing mutation present with neonatal jaundice. HS is a hemolytic condition resulting from various erythrocyte membrane defects. Many different mutations result in HS, including mutations in ANK1. Case presentation A term neonate presented at ten hours with severe jaundice requiring exchange transfusion. At two months he was hospitalized due to repeated pallor and anemia requiring blood transfusions. Using next-generation sequencing, we discovered the responsible mutation in the proband but not in his parents; a heterozygous nucleotide variation of c.1000delA (p.1334Sfs*6) in ANK1. Thus hereditary spherocytosis was diagnosed. Conclusions Genetic detection is an important means of discovering the cause of hemolytic anemia in neonates and infants where routine diagnostic tests are unrevealing. We found a novel de novo mutation, c.1000delA (p.1334Sfs*6) in ANK1 that might account for other cases of HS in the Chinese population.

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Chilaiditi Syndrome: A Case Report Highlighting the Intermittent Nature of the Disease

Case Reports in Medicine ◽

10.1155/2018/3515370 ◽

2018 ◽

Vol 2018 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

Esha M. Kapania ◽

Christina Link ◽

Joshua M. Eberhardt

Keyword(s):

Case Report ◽

Complete Resolution ◽

Clinical Symptoms ◽

Case Reports ◽

Delayed Diagnosis ◽

Spontaneous Resolution ◽

Radiographic Evidence ◽

Case Presentation ◽

Chilaiditi Syndrome

Background. Chilaiditi syndrome is a phenomenon where there is an interposition of the colon between the liver and the abdominal wall leading to clinical symptoms. This is distinct from Chilaiditi sign for which there is radiographic evidence of the interposition, but is asymptomatic. Case Presentation. Here, we present the case of a patient who, despite having clinical symptoms for a decade, had a delayed diagnosis presumably due to the interposition being intermittent and episodic. Conclusions. This case highlights the fact that Chilaiditi syndrome may be intermittent and episodic in nature. This raises an interesting question of whether previous case reports, which describe complete resolution of the syndrome after nonsurgical intervention, are perhaps just capturing periods of resolution that may have occurred spontaneously. Because the syndrome may be intermittent with spontaneous resolution and then recurrence, patients should have episodic follow-up after nonsurgical intervention.

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Acute celiac artery occlusion secondary to blunt trauma: Two case reports

10.21203/rs.3.rs-36070/v1 ◽

2020 ◽

Author(s):

Hui Li ◽

Yu Zhao ◽

Yan-an Xu ◽

Tao Li ◽

Jun Yang ◽

...

Keyword(s):

Motor Vehicle ◽

Case Reports ◽

Celiac Artery ◽

Artery Occlusion ◽

Severe Liver ◽

Case Presentation ◽

Artery Injury ◽

Vehicle Collision ◽

Fall From Height ◽

The Right

Abstract Background Blunt celiac artery injury is extremely rare, but it is easy to ignore. The clinical manifestation of celiac artery injuries is usually atypical, so it is easy to fail to diagnose them. Case presentation: We report two cases of celiac artery occlusion after multiple trauma admitted, its mechanisms were motor vehicle collision and fall from height, respectively. The first patient was combined with severe liver injury, and the right hepatic arterial was embolized with coil assisted by the operation through the superior mesenteric artery. Both patients were managed with non-operation treatment, and no complications occurred during hospitalization. Conclusions For patients with celiac artery injury, conservative treatment is an important choice, but successful treatment still needs to be individualized based on the patient's condition.

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Case Reports On The Multimodal Management of Refractory Chronic Oncological Pain of The Chest Wall: The Use of The Spinal Erector Plane Neurolysis

10.21203/rs.3.rs-847803/v1 ◽

2021 ◽

Author(s):

John Cardenas ◽

Juan Felipe Vargas-Silva ◽

Alejandro Ramirez

Keyword(s):

Pain Management ◽

Chest Wall ◽

Case Reports ◽

Management Strategies ◽

Erector Spinae ◽

Opioid Rotation ◽

Interventional Pain Management ◽

Multimodal Management ◽

Advanced Stage Cancer

Abstract Chronic pain of oncological origin is one of the most frequent complications and is difficult to control, that results in a decrease in the quality of life and disability among patients suffering from this pathology. Primary or metastatic tumors originating from lung, colonic, or breast neoplasms can invade the chest wall, causing progressive respiratory pain and symptoms that require multiple interventions to achieve adequate control. Many of these cases presenting with advanced-stage cancer are often incurable; thus, pain management and palliative care are primary objectives. Multimodal management is the strategy of choice in these cases through the participation of a multidisciplinary team. Analgesic therapy covers the use of potent opioids, opioid rotation, adjuvant analgesics, and interventional pain management strategies. We report two cases of chronic oncological pain of the chest wall refractory to pharmacological analgesic management. The optimization of multimodal management and the performance of neurolysis by phenolization of the erector spinae plane achieved an adequate response.

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