Both Bone Forearm Fracture with Complex DRUJ Dislocation: What Are the Odds?

Background Distal radioulnar joint (DRUJ) dislocation can occur as an isolated injury or in association with fracture radius (Galeazzi fracture-dislocation), Essex–Lopresti lesion or, rarely, with fracture of both radius and ulna (termed “Galeazzi type fracture”). DRUJ dislocations can be simple or complex. While simple DRUJ dislocation can be reduced by closed methods once the associated fractures are fixed anatomically, complex dislocation does not reduce by closed means. A complex DRUJ dislocation occurring in a both bone forearm fracture is an extremely unusual pattern of injury. Case Description We describe the clinical presentation, intraop findings, management, and follow-up of two such cases of both bone forearm fracture with complex DRUJ dislocation. In both the cases, the ulnar head was found to be buttonholed through extensor retinaculum between the extensor tendons. Open reduction had to be done via dorsal approach. Timely intervention allowed good results in both the patients. Literature Review Several authors have reported simple DRUJ dislocations in both bone forearm fractures; however, we could come across only three cases of complex DRUJ dislocation in a both bone forearm fracture. A summary of various series and reports on these injuries is presented. Case Relevance Through this case report, we want to highlight this unusual association and emphasize on sequence of fixation, so that this perilous injury pattern is not missed, and favorable outcomes could be obtained through appropriate and timely intervention.

Unusual association between Ornithonyssus bursa (Berlese 1888) (Mesostigmata: Macronyssidae) and Parabuteo unicinctus (Temminck, 1824) (Accipitriformes: Accipitridae) in Paraíba State, Brazil

Ornithonyssus bursa (Berlese, 1888), known as the tropical fowl mite, is a hematophagous mite of domestic and wild birds. This mite can bite humans accidentally, causing “gamasoidosis,” “avian-mite dermatitis,” or “bird-mite dermatitis” in tropical and subtropical regions of the world. In Brazil, O. bursa was previously recorded parasitizing birds of the orders Charadriiformes Huxley, 1867, Columbiformes Latham, 1790, Galliformes Temminck, 1820, Passeriformes Linnaeus, 1758, Strigiformes Wagler, 1830, and Tinamiformes Huxley, 1872. Here, we provide a new association of O. bursa with Harris’s hawk, Parabuteo unicinctus (Temminck, 1824) (Accipitriformes: Accipitridae) and the first record of this mite species in the Paraíba State, Brazil.

DOUBLE J STENTING IN A DELAYED URETER INJURY DUE TO THERMAL NECROSIS FOLLOWING LAPAROSCOPIC-ASSISTED VAGINAL HYSTERECTOMY

The presenting symptom to a gynecologist for postoperative vaginal discharge, which may or may not be related to the gynecologic diagnosis. A 40-year-old woman with abnormal uterine bleeding came to ObGyn Opd. The diagnosis was simple endometrial hyperplasia for which laparoscopic assisted vaginal hysterectomy with bilateral salphingo oophorectomy was done. Post-Operative Day 18 patient developed vaginal discharge suggestive of urinary leakage. The postoperative delayed ureter injury is an unusual association with laparoscopic assisted vaginal hysterectomy. The management was ureter stent insertion. This case report could be guidance to surgeons about the postoperative management of ureter injury. Gynecologists should consider the presenting symptom of vaginal discharge in formulating their differential diagnosis.

“Type C appendicular duplication with patent vitello-intestinal duct—an unforeseen association”—a case report

Background Gastrointestinal duplications are uncommon occurring in 1 in 5000 live births. Small intestine is commonly involved, while appendicular duplications are extremely rare. Vitelline duct anomalies arise due to failure of involution of the omphalomesenteric duct. Their spectrum ranges from a simple umbilical sinus to completely patent omphalomesenteric fistulae. We report here a rare association of complete appendico-cecal duplication with patent vitello-intestinal duct (PVID). Case presentation A 14-year-old girl who presented with complaints of scant, foul smelling, and feculent discharge from umbilicus intermittently since birth was evaluated and diagnosed to have a patent vitello-intestinal duct. At laparotomy, a patent vitello-intestinal tract opening unusually at the ileo-cecal junction was noted. In addition, an appendico-cecal duplication cyst bearing an appendix on the mesenteric side and a 4-cm long orthotopic appendix on the native cecum was found with the duplex cecum sharing a common wall and blood supply. The terminal ileum with the duplication and patent vitello-intestinal duct were excised in toto, and an end-to-end ileo-ascending anastomosis was done. The child is well at 1 year follow-up. Conclusion A complete appendico-cecal (Type C) duplication with ectopically inserted patent vitello-intestinal duct is reported here as an unusual association, discussing its management and the probable disarray in the embryological development.

An unusual association of disseminated staphylococcal infection in dengue fever

Dengue fever is an important mosquito-borne disease with a highly variable clinical spectrum, ranging from self-limiting mild illness to expanded dengue syndrome (EDS). While the immune-pathogenesis of dengue virus (DENV) infection had been studied thoroughly, the exact mechanism remains elusive. The transient suppression of host innate immunity by DENV might be the likely reason for dengue-associated co-infections and/or superinfections. In addition, the dual infection can worsen the clinical outcome of Dengue fever. We are reporting a case of disseminated staphylococcal infection in a 31-year-old healthy male with a recent dengue infection. Blood culture showed methicillin-sensitive Staphylococcus aureus. Selective IgM deficiency has been proved in this patient, which might explain, the occurrence of disseminated staphylococcal septicemia. This case report highlights the importance of early detection of atypical features and the emerging entity called EDS

Unusual association of cirrhosis and sickle cell anemia revealed by hemolytic anemia: A case report

Hepatobiliary complications of sickle cell disease are rare, cirrhosis remains very exceptional, especially in heterozygous forms of the disease. We report the case of a 19-year-old patient whose etiologic investigation of hemolytic anemia revealed heterozygous sickle cell disease complicated by hepatic cirrhosis. The diagnosis of cirrhosis was made due to the presence of signs of hepato-cellular insufficiency, portal hypertension syndrome and hepatic dysmorphia on imaging. The etiological assessment was negative. The liver biopsy was not performed due to the risk of bleeding. The interest of this observation is to evoke hepato-biliary complications (in particular cirrhosis) in patients with sickle cell anemia, in order to avoid a pejorative evolution burdened with serious complications.