Case Report: Treatment of a Severe Puff Adder Snakebite Without Antivenom Administration

Antivenoms are the treatment of choice for managing lethal snakebites. However, antivenoms may not be available in instances where non-native vipers are kept in captivity. We report a case of a puff adder (Bitis arietans) bite treated without antivenom. A 23-year-old man was bitten on his left hand by a puff adder that he illegally kept in his house. The swelling spread rapidly to the upper arm and there was a risk of bleeding, suggesting the need for antivenom administration, but this could not be acquired because of lack of stock. We initiated fluid resuscitation and administered recombinant thrombomodulin (rTM) to prevent venom-induced consumption coagulopathy. In addition, hyperbaric oxygen (HBO) treatment was also performed to reduce local swelling. The patient recovered without complications after the multidisciplinary treatment. Further studies are needed to prove the safety and efficacy of rTM administration and HBO therapy as an adjunct or alternative therapy with antiserum for fatal snakebite.

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Severe form of streptococcal necrotizing fasciitis of the upper limb - diagnostic and therapeutic challenge: A case report

Vojnosanitetski pregled ◽

10.2298/vsp140724069m ◽

2015 ◽

Vol 72 (8) ◽

pp. 745-749 ◽

Cited By ~ 1

Author(s):

Dragan Mikic ◽

Tatjana Takic-Radovanovic ◽

Milan Lukovic ◽

Milomir Kosutic ◽

Srdjan Starcevic ◽

...

Keyword(s):

Case Report ◽

Necrotizing Fasciitis ◽

Upper Limb ◽

Group A Streptococcus ◽

Multidisciplinary Treatment ◽

Severe Form ◽

Limb Amputation ◽

Streptococcus Group ◽

Left Hand ◽

Group A

Introduction. Since delay in recognition and effective treatment of necrotizing fasciitis (NF) caused by invasive group A streptococcus increases the mortality and disability, the early diagnosis and management of this disease are essential for a better outcome. We presented a patient with a severe form of streptococcal NF of the left upper limb in whom amputation was performed as a life saving procedure. Case report. A 65-year-old man, previously healthy, suffered an injury to his left hand by sting on a fish bone. Two days after that the patient got fever, redness, swelling and pain in his left hand. Clinical examination of the patient after admission indicated NF that spread quickly to the entire left upper limb, left armpit, and the left side of the chest and abdomen. Despite the use of aggressive antibiotic and surgical therapy severe destruction of the skin and subcutaneous tissues developed with the development of gangrene of the left upper limb. In this situation, the team of specialists decided that the patient must be operated on submited to amputation of the left arm, at the shoulder. After amputation and aggressive debridement of soft tissue on the left side of the trunk, the patient completely recovered. ?-hemolytic streptococcus group A was isolated from the skin and tissue obtained during the surgery. Conclusion. In the most severe forms of streptococcal NF of the extremities, adequate multidisciplinary treatment, including limb amputation, can save the life of a patient.

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Hemangiomatosis of the greater omentum – a case report

Perspectives in Surgery ◽

10.33699/pis.2019.98.4.178-180 ◽

2019 ◽

Vol 98 (4) ◽

pp. 178-180

Keyword(s):

Case Report ◽

Surgical Treatment ◽

Histological Examination ◽

Case Reports ◽

Greater Omentum ◽

Surgical Removal ◽

Consumption Coagulopathy ◽

Cavernous Hemangiomas ◽

Mesodermal Origin ◽

Benign Tumours

Cavernous hemangiomas are benign tumours of mesodermal origin. Even though various localizations of hemangioma have been described in the literature, its occurrence in the greater omentum is very rare. Only symptomatic hemangiomas are indicated for surgical treatment. There are case reports presenting resection or surgical removal of the greater omentum with hemangioma because of mechanical syndrome, consumption coagulopathy, bleeding, infection or suspicion of a malignancy. This article presents a case report of a patient operated on for a suspicion of carcinomatosis of the greater omentum. Histological examination found hemangiomatosis in the resected greater omentum.

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Safety and efficacy of ketamine infusion in treatment-resistant depression with metabolic syndrome and morbid obesity: a case report

10.26226/morressier.59d4913ad462b8029238a2d8 ◽

2017 ◽

Author(s):

Carolina Nakahira

Keyword(s):

Metabolic Syndrome ◽

Morbid Obesity ◽

Case Report ◽

Treatment Resistant Depression ◽

Treatment Resistant ◽

Safety And Efficacy ◽

Ketamine Infusion ◽

Resistant Depression

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Duplication in the formation of median nerve - a case report

National Journal of Clinical Anatomy ◽

10.1055/s-0039-3401543 ◽

2015 ◽

Vol 04 (01) ◽

pp. 043-045

Author(s):

Gyata Mehta ◽

Varsha Mokhasi

Keyword(s):

Case Report ◽

Median Nerve ◽

Lateral Root ◽

Axillary Artery ◽

Anatomical Variations ◽

Upper Arm ◽

Present Case Report ◽

Lateral Cord ◽

Two Stages ◽

Different Levels

AbstractThe median nerve is formed in the axilla by fusion of the two roots from the lateral and medial cords. The present case report describes an anomalous presentation of double formation of median nerve and its relation with axillary and brachial arteries. The median nerve was formed in two stages at different levels, first in the axilla and then in the upper arm by receiving double contribution from the lateral root of the lateral cord, which fuse with the medial root of the medial cord to form the median nerve. The formation took place medial to the axillary artery in the axilla and antero-medial to the brachial artery in the arm. Such anatomical variations and their relation with the arteries are important for the surgeons and anesthesiologists and of great academic interest to the anatomists.

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Long-term survival with multiple metastasectomies for pulmonary osteosarcoma: a case report

Surgical Case Reports ◽

10.1186/s40792-020-01106-2 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Satoshi Takamori ◽

Hiroyuki Oizumi ◽

Jun Suzuki ◽

Katsuyuki Suzuki

Keyword(s):

Case Report ◽

Pulmonary Metastases ◽

Multidisciplinary Treatment ◽

Underlying Disease ◽

Pulmonary Metastasectomy ◽

Extensive Resection ◽

Term Survival ◽

Long Term Survival ◽

Primary Surgery

Abstract Background Repeat pulmonary metastasectomy (PM) considerably improves the prognosis of patients with pulmonary metastases of osteosarcoma. Reports have demonstrated a significantly improved prognosis in patients who have undergone repeat metastasectomy for osteosarcoma; however, there have been no reports with more than six metastasectomies. Herein, we describe the long-term survival of a patient following resection of multiple tumors and other treatments for metastatic osteosarcoma. Case presentation A 28-year-old woman underwent extensive resection and postoperative adjuvant chemotherapy for right tibial sarcoma. Over the years, she developed repeated pulmonary metastases. First, 116 metastases were removed from the bilateral lungs. After that, multiple PMs of approximately 250 tumors and other treatments for deep metastatic lesions were performed. The patient died of the underlying disease 24 years after the primary surgery. Conclusions This case report demonstrates the long-term survival benefit of a multidisciplinary treatment centered on multiple metastasectomies.

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Ketamine: Safe and Effective Treatment for Severe Depression

Journal of the American Psychiatric Nurses Association ◽

10.1177/10783903211033023 ◽

2021 ◽

pp. 107839032110330

Author(s):

Thomas Bradley Koss

Keyword(s):

Low Dose ◽

Alternative Therapy ◽

Severe Depression ◽

Infusion Therapy ◽

Depression Treatment ◽

Educational Video ◽

Treatment Resistant Depression ◽

Treatment Resistant ◽

Safety And Efficacy ◽

Resistant Depression

OBJECTIVE Depression resistant to standard treatment is devastating to an individual’s quality of life. Ketamine offers a safe and effective alternative to standard depression treatment, but many patients and providers are often unaware of this option. The American Association of Nurse Anesthetists and the American Psychiatric Nurses Association partnered in developing a collaborative approach to providing ketamine infusion therapy for psychiatric disorders. The purpose of this project was to disseminate information through an educational video about the safety and efficacy of outpatient low-dose ketamine infusions as an alternative therapy for treatment-resistant depression. METHODS A thorough literature review was conducted in PubMed, PsychINFO, CINAHL, and Google Scholar for articles describing the safety and efficacy of ketamine use in treatment-resistant depression. Based on the current research, an educational video reporting the benefits and safety of ketamine was developed and launched on two social media platforms—YouTube and Facebook—for individuals to view. The effectiveness of the video was evaluated through the number of views, likes, shares, and comments recorded. RESULTS At 9 months, 156 views, 60 likes, 8 shares, and 4 comments were recorded in both platforms. Comments indicated that viewers found the video informative and encouraging. CONCLUSIONS A short evidence-based educational video provides individuals with information regarding the safety and efficacy of low-dose ketamine infusions as an option for depression treatment. Ketamine outpatient clinics support and treat depressed patients who do not benefit from conventional pharmacologic medications.

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Safety and Efficacy of Vortioxetine in the Treatment of Post-partum Depression: a Case Report

European Psychiatry ◽

10.1016/s0924-9338(15)32135-0 ◽

2015 ◽

Vol 30 ◽

pp. 1933

Author(s):

K. Pavlovs ◽

L. Berze ◽

E. Rancans ◽

P. Andzans

Keyword(s):

Case Report ◽

Post Partum ◽

Safety And Efficacy ◽

Post Partum Depression

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Solitary Skeletal Muscle Metastasis as First Site of Recurrence of Cervical Cancer: A Case Report

Case Reports in Oncology ◽

10.1159/000478976 ◽

2017 ◽

Vol 10 (2) ◽

pp. 694-698 ◽

Cited By ~ 4

Author(s):

Indumathy Varadarajan ◽

Aparna Basu ◽

Sherri Besmer ◽

Jaganmohan Poli ◽

Scott Richard ◽

...

Keyword(s):

Skeletal Muscle ◽

Cervical Cancer ◽

Case Report ◽

African American Woman ◽

American Woman ◽

Extensive Literature ◽

Upper Arm ◽

Skeletal Muscle Metastasis ◽

Muscle Metastasis

Cervical cancer is the fourth most common cancer in women worldwide, with a large majority of prevalence (85%) in developing countries. As of 2012, it accounts for 7.5% of all female cancer deaths. Despite its high prevalence, skeletal muscle metastasis from cervical cancer is extremely uncommon. In our extensive literature search, we were able to find only 8 cases where skeletal muscle metastasis was the only site of recurrence. We report a case of a 52-year-old African-American woman with a past medical history of cervical cancer (stage IIIB) who presented with pain and swelling in her left upper arm over the preceding 2 months. MRI of the left upper arm showed a solid well-circumscribed mass measuring 7.0 × 2.8 × 2.5 cm, deep to the biceps. Biopsy of the mass revealed a metastatic squamous cell carcinoma that was p16-positive. PET scan showed that the lesion was the sole site of metastasis. She received local radiation with concurrent chemotherapy. Follow-up MRI 6 months after the completion of therapy showed resolution of the mass. She has remained disease-free for the last 24 months as evidenced by a PET/CT scan in May 2016. In this case report, we discuss the role of imaging and pathology in the diagnosis of a solitary metastatic lesion. This case also emphasizes the importance of a close follow-up which aids in early intervention, increasing overall survival.

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Abstract 1122‐000097: Recurrent Carotid Cavernous Fistula Requiring Complex Repair of Ruptured Cavernous Carotid Aneurysm: A Case Report

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.01.suppl_1.000097 ◽

2021 ◽

Vol 1 (S1) ◽

Author(s):

Rami Z. Morsi ◽

Faten El Ammar ◽

Sonam Thind ◽

Scott J. Mendelson ◽

Cedric McKoy ◽

...

Keyword(s):

Visual Acuity ◽

Case Report ◽

Large Scale ◽

Mechanical Valve ◽

Covered Stent ◽

Stent Grafts ◽

Cerebral Angiogram ◽

Safety And Efficacy ◽

Third Nerve Palsy ◽

History Of

Introduction : There are no studies investigating the safety and efficacy of covered stent grafts, particularly the newly developed stents such as the PK Papyrus stent, for endovascular treatment of direct carotid cavernous fistulas (CCFs). Methods : We present a case of a 75‐year‐old female who presented to the hospital with a three‐week history of worsening left eye vision, chemosis, proptosis, and partial third nerve palsy. Patient was found to have left direct Type A CCF secondary to ruptured cavernous segment carotid aneurysm. Results : The CCF was treated with coil embolization and pipeline Shield stent embolization devices with immediate stagnation and improvement of symptoms. Patient had history of an aortic mechanical valve and thus was started on warfarin and ASA. After achieving INR level of 2.5‐3.5, patient started to have recurrent swelling of the left eye associated and decreased visual acuity. Repeated diagnostic cerebral angiogram revealed residual CCF. Onyx liquid embolization and a Surpass Evolve Flow Diverter were attempted to slow the fistulization with no success. Multiple attempts for direct percutaneous superior ophthalmic vein cannulation were also unsuccessful. At this point, two coronary graft‐covered PK Papyrus stents were implanted across the fistula pouch, which resulted in immediate resolution of the CCF with evidence of persistent normal flow within left ophthalmic artery. Patient’s visual acuity and left eye movement improved. Conclusions : This case report highlights the effectiveness and safety of covered stent grafts, particularly more flexible stents such as the PK Papyrus stent, in navigating the carotid vasculature and closing direct CCFs and may be used as a first‐line technique. More large‐scale studies are warranted to investigate the safety and efficacy of using such stent grafts to treat direct CCFs in the setting of antithrombotic agents and anticoagulation.

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