scholarly journals Mask Induction for an Intellectually Disabled Patient With Congenital Infiltrating Lipomatosis of the Face

2020 ◽  
Vol 67 (2) ◽  
pp. 98-102
Author(s):  
Hitoshi Yamanaka ◽  
Masanori Tsukamoto ◽  
Takashi Hitosugi ◽  
Takeshi Yokoyama
Keyword(s):  
Soft Tissues ◽  
Fiber Optic ◽  
Dental Treatment ◽  
Anesthetic Management ◽  
General Anesthetic ◽  
Intellectually Disabled ◽  
Nasopharyngeal Airway ◽  
The Face ◽  
Difficult Airways ◽  
The Right

Airway management for patients with craniofacial disorders poses many challenges. Congenital infiltrating lipomatosis of the face (CILF) is an extremely rare disorder in which mature lipocytes invade adjacent tissues in the head and neck. The manifestations are typically unilateral, often with associated hypertrophy of both the hard and soft tissues of the face. This is a case report regarding the anesthetic management for a 5-year-old intellectually disabled female with CILF involving the right side of her face who underwent a successful intubated general anesthetic for dental treatment. Awake fiber-optic intubations are recommended and routinely used for patients with suspected or confirmed difficult airways. In this case, substantial distortion of the normal facial anatomy was observed clinically with noted hypertrophy of the right maxilla, mandible, and right side of the tongue. Further complicating matters was the patient's inability to fully cooperate because of her intellectual disability, precluding the option of an awake fiber-optic intubation. To secure the airway following mask induction of anesthesia, spontaneous ventilation was carefully maintained using sevoflurane, nitrous oxide, and oxygen combined with the application of a nasopharyngeal airway. Despite compression of the oral cavity and upper pharyngeal space by the hypertrophic tissues due to CILF, the space in and around the glottis was preserved. Intubation was completed easily with the use of a fiber-optic scope without any serious complications.

scholarly journals Anesthetic Management of a Rett Syndrome Patient at High Risk for Respiratory Complications

2021 ◽  
Vol 68 (3) ◽  
pp. 163-167
Author(s):  
Nobuhito Kamekura ◽  
Takayuki Hojo ◽  
Yukie Nitta ◽  
Yuri Hase ◽  
Toshiaki Fujisawa
Keyword(s):  
Rett Syndrome ◽  
Dental Treatment ◽  
Genetic Disorder ◽  
Anesthetic Management ◽  
General Anesthetic ◽  
Respiratory Complications ◽  
Contributing Factors ◽  
Severe Scoliosis ◽  
First Case ◽  
Postural Changes

Rett syndrome (RTT) is a rare genetic disorder that can present challenges in airway management during general anesthesia. This is a case report involving a 23-year-old woman with RTT who received an intubated general anesthetic 3 times for dental treatment. The patient also had severe scoliosis, was bedridden, and had dysphagia. These contributing factors likely led to the development of postoperative respiratory complications including pneumonia after the first case. As a result, several changes were incorporated into the 2 subsequent anesthetic plans in efforts to reduce the risk of such complications. Despite these measures, the patient was suspected of having bronchitis postoperatively after the second anesthetic, although the third occurred uneventfully. Anesthetic management alterations included use of desflurane for anesthetic maintenance and postoperatively delaying oral intake and instituting active postural changes.

The massive nodular cutaneous and soft tissues lesions of the right shoulder and the arm as the extramedullary manifestation of the advanced stage of multiple myeloma

Oncoreview ◽  
2017 ◽  
Vol 7 (4) ◽  
pp. 180-183
Author(s):  
Arkadiusz Drobiecki ◽  
Marcin Pasiarski ◽  
Agnieszka Stelmach-Gołdyś ◽  
Bartosz Garus
Keyword(s):  
Multiple Myeloma ◽  
Soft Tissues ◽  
Advanced Stage ◽  
The Right

Comparison of the efficiency of the indexes of Pont and Korkhause with Kernott technique in patients with narrowing of maxilla

2020 ◽  
Vol 20 (3) ◽  
pp. 199-203
Author(s):  
O. I. Admakin ◽  
I. A. Solop ◽  
A. D. Oksentyuk
Keyword(s):  
Dental Treatment ◽  
Standard Analysis ◽  
Clinical Hospital ◽  
Control Models ◽  
Diagnostic Models ◽  
Left And Right ◽  
The Asymmetry ◽  
The Right ◽  
The University ◽  
Medical University

Relevance. The narrowing of the maxilla is one of the most common pathologies in orthodontics. Recent studies show that the narrowing is always asymmetric which is connected to the rotation of the maxilla. To choose the treatment correctly one need a calculation that reveals the asymmetry, which is impossible with using standard indexes.Purpose – to compare efficiency of indexes of Pont and Korkhause with the Kernott's method in patients with narrowing of the maxilla.Materials and methods. The study involved 35 children aged from 8 to 12 years old undergoing dental treatment in the University Children's Clinical Hospital of the First Moscow State Medical University with no comorbidities. For every patient a gypsum model was prepared and after that to carry out the biometrical calculation. In this study two indexes were used: Pont's index and Korkhause's; using this standard analysis the narrowing of the maxilla was revealed. After using Pont's Index and Korkhaus analysis all the models were calculated by the method of Kernott with Kernott's dynamic pentagon.Results. As a result of the analysis of the control diagnostic models a narrowing of the maxilla in 69% of cases (n = 24) was revealed in all cases, the deviation of the size of the dentition was asymmetric. Thus, 65% of the surveyed models showed a narrowing on the right. This narrowing was of a different severity and averaged 15 control models.Conclusions. This shows that for the biometrics of diagnostic models it is necessary to use methods that allow to estimate the width of the dentition rows on the left and on the right separately. To correct the asymmetric narrowing of the dentition, it is preferable to use non-classical expanding devices that act equally on the left and right sides separetly.

scholarly journals General anesthesia with remimazolam in a patient with mitochondrial encephalomyopathy: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Yuji Suzuki ◽  
Matsuyuki Doi ◽  
Yoshiki Nakajima
Keyword(s):  
Lactic Acidosis ◽  
General Anesthesia ◽  
Mitochondrial Disease ◽  
Muscle Relaxation ◽  
Anesthetic Management ◽  
Perioperative Period ◽  
Mitochondrial Encephalomyopathy ◽  
Anesthesia Induction ◽  
General Anesthetic ◽  
Anesthetic Agents

Abstract Background Systemic anesthetic management of patients with mitochondrial disease requires careful preoperative preparation to administer adequate anesthesia and address potential disease-related complications. The appropriate general anesthetic agents to use in these patients remain controversial. Case presentation A 54-year-old woman (height, 145 cm; weight, 43 kg) diagnosed with mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes underwent elective cochlear implantation. Infusions of intravenous remimazolam and remifentanil guided by patient state index monitoring were used for anesthesia induction and maintenance. Neither lactic acidosis nor prolonged muscle relaxation occurred in the perioperative period. At the end of surgery, flumazenil was administered to antagonize sedation, which rapidly resulted in consciousness. Conclusions Remimazolam administration and reversal with flumazenil were successfully used for general anesthesia in a patient with mitochondrial disease.

scholarly journals Ovarian epithelioid angiosarcoma complicating pregnancy: a case report and review of the literature

2021 ◽  
Vol 49 (5) ◽  
pp. 030006052110196
Author(s):  
Xiaotong Peng ◽  
Zhi Duan ◽  
Hongling Yin ◽  
Furong Dai ◽  
Huining Liu
Keyword(s):  
Adverse Events ◽  
Soft Tissues ◽  
Malignant Tumors ◽  
Cystic Teratoma ◽  
Abdominal Distension ◽  
Epithelioid Angiosarcoma ◽  
History Of ◽  
New Ideas ◽  
The Right ◽  
Clinical Awareness

Epithelioid angiosarcoma is a rare and highly aggressive soft tissue angiosarcoma most commonly arising in the deep soft tissues. Given that abundant vascular cavities anastomose with each other, most angiosarcomas prone to metastasis recur quickly, and the overall prognosis is poor. We report a 25-year-old woman at 24 weeks’ gestation who presented with a 1-month history of abdominal distension. Ultrasonography suggested a mass in the right adnexa, and she underwent two operations owing to uncontrolled intraperitoneal bleeding with progressive anemia. The right ovarian tumor and right adnexa were removed successively. Biopsy yielded a diagnosis of primary epithelioid angiosarcoma with mature cystic teratoma. The patient died from uncontrolled progressive bleeding 1 week after the second operation. This case revealed that epithelial angiosarcoma is a highly malignant endothelial cell tumor. The results of surgery and chemoradiotherapy tend to be poor, and the recurrence rate is high. The purpose of this study is to raise clinical awareness of epithelial angiosarcoma and its adverse events and to provide new ideas for the treatment of these adverse events. Immunohistochemical staining of pathological specimens can facilitate diagnosis. Pregnancy with malignant tumors may lead to rapid disease progression, extensive lesions, and a poor prognosis.

Surgical Anatomy for Extended Facelift Techniques

2020 ◽  
Vol 36 (03) ◽  
pp. 309-316
Author(s):  
Ozcan Cakmak ◽  
Ismet Emrah Emre
Keyword(s):  
Facial Nerve ◽  
Soft Tissues ◽  
Extended Techniques ◽  
Surgical Anatomy ◽  
Superficial Musculoaponeurotic System ◽  
Increased Risk ◽  
The Face ◽  
Facial Soft Tissues ◽  
Relationship Of ◽  
The Relationship

AbstractPreservation of the facial nerve is crucial in any type of facial procedure. This is even more important when performing plastic surgery on the face. An intricate knowledge of the course of the facial nerve is a requisite prior to performing facelifts, regardless of the technique used. The complex relationship of the ligaments and the facial nerve may put the nerve at an increased risk of damage, especially if its anatomy is not fully understood. There are several danger zones during dissection where the nerve is more likely to be injured. These include the areas where the nerve branches become more superficial in the dissection plane, and where they traverse between the retaining ligaments of the face. Addressing these ligaments is crucial, as they prevent the transmission of traction during facelifts. Without sufficient release, a satisfying pull on the soft tissues may be limited. Traditional superficial musculoaponeurotic system techniques such as plication or imbrication do not include surgical release of these attachments. Extended facelift techniques include additional dissection to release the retaining ligaments to obtain a more balanced and healthier look. However, these techniques are often the subject of much debate due to the extended dissection that carries a higher risk of nerve complications. In this article we aim to present the relationship of both the nerve and ligaments with an emphasis on the exact location of these structures, both in regard to one another and to their locations within the facial soft tissues, to perform extended techniques safely.

scholarly journals Primitive Neuroectodermal Tumor of the Liver: A Case Report

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Eduardo Cambruzzi ◽  
Enilde Eloena Guerra ◽  
Hamilton Cardoso Hilgert ◽  
Herbert Jorge Schmitz ◽  
Vinícius Lopes Silva ◽  
...  
Keyword(s):  
Primitive Neuroectodermal Tumor ◽  
Soft Tissues ◽  
Young Patients ◽  
Neuroectodermal Tumor ◽  
Solid Mass ◽  
Resected Liver ◽  
The Central Nervous System ◽  
Right Lobe ◽  
Upper Abdominal ◽  
The Right

Primary liver sarcomas represent a rare group of neoplasias, with angiosarcoma being the most common histological type. Primitive neuroectodermal tumor (PNET) represents a high malignant neoplasia that usually affects the central nervous system and soft tissues. An 18-year-old male patient was admitted with clinical complains of pain in the right upper abdominal quadrant. The clinical evaluation revealed a solid mass in the right hepatic lobe. On the gross examination of the resected liver specimen, the right lobe of the liver was replaced by a yellow-red solid mass measuring 21 cm in its largest dimension. On the histopathology, a tumor composed of small round blue cells with little cytoplasm and round nuclei was identified. The lesion revealed positive immunoexpression for vimentin and CD99 and negative immunostaining for desmin, CD45, cytokeratin, and neuroblastoma protein, suggesting, then, the diagnosis of PNET. Although it is an unusual tumor, it should be considered in the differential diagnosis of liver masses, especially in young patients.

scholarly journals Chronic (Rasmussen’s) Encephalitis in an Adult

2003 ◽  
Vol 30 (3) ◽  
pp. 263-265 ◽  
Author(s):  
Richard Wennberg ◽  
Sukriti Nag ◽  
Mary-Pat McAndrews ◽  
Andres M. Lozano ◽  
Richard Farb ◽  
...  
Keyword(s):  
Visual Field ◽  
Right Visual Field ◽  
Loss Of Consciousness ◽  
Mild Head Injury ◽  
Partial Seizures ◽  
Complex Partial Seizures ◽  
The Past ◽  
Rasmussen’S Encephalitis ◽  
The Face ◽  
The Right

A 24-year-old woman was referred because of incompletely-controlled complex partial seizures. Her seizures had started at age 21, after a mild head injury with brief loss of consciousness incurred in a biking accident, and were characterized by a sensation of bright flashing lights in the right visual field, followed by numbness and tingling in the right foot, spreading up the leg and to the arm, ultimately involving the entire right side, including the face. Occasionally they spread further to involve right facial twitching with jerking of the right arm and leg, loss of awareness and, at the onset of her epilepsy, rare secondarily generalized convulsions. Seizure frequency averaged three to four per month. She was initially treated with phenytoin and clobazam and subsequently changed to carbamazepine 800 milligrams per day. She also complained that her right side was no longer as strong as her left and that it was also numb, especially the leg, but felt that this weakness had stabilized or improved slightly over the past two years.

The Essence of Christianity and the Cross of Christ

1914 ◽  
Vol 7 (4) ◽  
pp. 538-594
Author(s):  
Benjamin B. Warfield
Keyword(s):  
New Haven ◽  
Liberal Theology ◽  
Religious System ◽  
The World ◽  
Cross Of Christ ◽  
The Face ◽  
Divinity School ◽  
The Common ◽  
The Cross ◽  
The Right

In a recent number of The Harvard Theological Review, Professor Douglas Clyde Macintosh of the Yale Divinity School outlines in a very interesting manner the religious system to which he gives his adherence. For “substance of doctrine” (to use a form of speech formerly quite familiar at New Haven) this religious system does not differ markedly from what is usually taught in the circles of the so-called “Liberal Theology.” Professor Macintosh has, however, his own way of construing and phrasing the common “Liberal” teaching; and his own way of construing and phrasing it presents a number of features which invite comment. It is tempting to turn aside to enumerate some of these, and perhaps to offer some remarks upon them. As we must make a selection, however, it seems best to confine ourselves to what appears on the face of it to be the most remarkable thing in Professor Macintosh's representations. This is his disposition to retain for his religious system the historical name of Christianity, although it utterly repudiates the cross of Christ, and in fact feels itself (in case of need) quite able to get along without even the person of Christ. A “new Christianity,” he is willing, to be sure, to allow that it is—a “new Christianity for which the world is waiting”; and as such he is perhaps something more than willing to separate it from what he varyingly speaks of as “the older Christianity,” “actual Christianity,” “historic Christianity,” “actual, historical Christianity.” He strenuously claims for it, nevertheless, the right to call itself by the name of “Christianity.”

NECROTISING SOFT TISSUE INFECTION OF BILATERAL UPPER LIMB CAUSED BY THE INJECTION OF ORAL BACTERIA: A CASE REPORT

Hand Surgery ◽  
2013 ◽  
Vol 18 (02) ◽  
pp. 243-246 ◽  
Author(s):  
Yuichi Yoshii ◽  
Tomoo Ishii ◽  
Shinsuke Sakai
Keyword(s):  
Soft Tissue ◽  
Upper Limb ◽  
Soft Tissue Infection ◽  
Soft Tissues ◽  
Biceps Brachii ◽  
Subcutaneous Tissue ◽  
Oral Bacteria ◽  
Tissue Infection ◽  
Left Elbow ◽  
The Right

Necrotising soft tissue infection is a rare and rapid process with devastating consequence. We report one case of necrotising soft tissue infection in a bilateral upper limb with uncommon oral bacteria. Radiological imaging revealed the presence of gas in upper limb soft tissues, and an MRI showed the localised signal changes in the biceps muscle of the right upper arm, and the subcutaneous tissue of the left elbow. The patient was treated with surgical resection of the infected muscle and wide debridement of the subcutaneous tissue. Antibiotics were initiated. The patient recovered immediately without functional deficit. The unique features of this patient were possible to observe in the progression of the necrotising soft tissue infection in the bilateral upper limb with intentional injection of oral bacteria, and the effect of biceps brachii resection in a prime age worker.

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