Unprecedented emergencies during radiofrequency ablation procedure: a case series

Radiofrequency ablation (RFA) of nerves is an upcoming intervention for relieving chronic musculoskeletal pain. However, being relatively new not much publications are available on emergencies during the procedure. 66 years old male, a case of Osteoarthritis knee, underwent RFA genicular nerve of right knee. Conventional RFA of Superolateral, Inferomedial, Superomedial genicular nerves were done under C- arm guidance. Thirty minutes after the procedure, we found a boggy swelling developing over his right knee. It was a hematoma developing on the superomedial aspect of the right kneecap most likely due to injury to Superomedial genicular vessels accompanying the nerve. 67 years old female planned for RFA genicular nerves of both knees under C arm guidance. During the intervention, she complained of numbness around face, and suddenly went into disoriented state with muscle twitching and bluish discoloration of lips. Medicine consultation diagnosed the incident as LA associated systemic toxicity. 57 years old female with chief complaints of pain in left hemiplegic shoulder pain for 6 months duration admitted for suprascapular nerve block. During the procedure patient goes into hypotensive bradycardic episode. 65 years old female admitted for Medial calcaneal block for right heel pain. 24 hours after the procedure she has aggravated pain of foot. RFA is considered as a non-invasive, OPD based procedure for effective pain relief but it is also important to understand such unprecedented emergencies that can happen.

A case report on gingival depigmentation by scraping method by scalpel

Smile is the most wonderful gesture of the human being. A Person who is genuinally happy shows his or her pleasure in the form of smile. A beautiful smile for sure enhances individual self confidence. A beautiful smile lies in a harmonial balance between competent lips, size, color, and proper alighnment of teeth and the color of gingival tissues. The normal color of gingival is coral pink as in accordance to British population, and pale pink as in accordance to Indian population. However this gingival pigmentation varies among each and every individual in accordance with the color of the skin, various pigments present in human body like melanin, haemoglobin, carotene. However this melanin when secreted in excess, can lead to brownish, blackish, or bluish discoloration of gingiva, and this discoloration is denoted by the term hyperpigmentation, and the procedure to overcome this hyperpigmentation is called as depigmentation. Present case report is on a 21 years old female whose chief complaint was visual blackish display of gums while smiling. So the procedure depigmentation was done by surgical scalpel by scraping method, and the patient showed better results following two weeks after procedure. Esthetic dentistry is a recently emerging branch. People now a days are much more concern about the gingival esthetics and smile design, as they want their smile to be beautiful in order to boost up their confidence. . One of the gingival esthetic for which the people are concerned are the hyperpigmented gingiva. Gingival depigmentation is the process to remove this abnormal pigmented gingiva. The clinician must have a knowledge as for which condition, which type of gingival depigmentation technique can be applie so as in order to make the treatment successful.

Diagnostic dilemma of primary neonatal iliopsoas abscess

Background Primary iliopsoas abscess is extremely rare in neonates and overlooked easily. It is potentially curable with surgical drainage and broad-spectrum antibiotics if diagnosed early. Case presentation A 13-day-old neonate was presented with a swelling and bluish discoloration on the left thigh and groin. There was a restriction of movement of the left lower limb, and he developed high grade fever later on, during hospital stay. In spite of a great dilemma, we could finally reach the diagnosis of primary iliopsoas abscess, performed surgical drainage, and controlled ongoing sepsis. At 3 months follow-up, the patient was doing well and there was no asymmetry in appearance of movements. Conclusion High index of suspicion, vigilant clinical examinations, and targeted laboratory investigations with imaging studies are of paramount importance in establishing its diagnosis. This case highlights the diagnostic difficulties and re-evaluates the representative features of neonatal iliopsoas abscess and its management.

Delayed Presentation of a Penile Fracture: A Case Report

Penile fracture is a urological emergency caused by blunt trauma to an erect penis. We report a case of a 40-year-old male who presented with a complaint of a painful swelling of the penis for 4 days. On examination, a flaccid swollen tender penis with bluish discoloration over the shaft and scrotum was noted. A clinical diagnosis of delayed penile fracture was made which was managed immediately surgically under spinal anesthesia. Ourreport emphasizes that penile fracture is diagnosed solely on a reliable history and clinical examination. It has outstanding outcome despite delayed presentation if treated promptly.

Nicolau Syndrome Following Intralesional Sclerotherapy: A Dreaded Complication of a Simple Office Procedure

Introduction: Nicolau syndrome is an iatrogenic dreaded adverse skin reaction leading to ischemic necrosis of skin and underlying tissue after parenteral drug injection. The etiopathogenesis is poorly understood. However, inflammation, reflex vasospasm, and thrombo-embolic occlusion of blood vessels, including arterioles and arteries, are suggested as the cause of ischemia. Case Presentation: We report a 12-year-old girl who developed Nicolau syndrome after a simple office procedure of intralesional sclera therapy with sodium tetradecyl sulfate for a apyogenic granuloma on her right index finger. Three days later, she reported complaints of excruciatingly painful swelling with bluish discoloration of the right hand involving the palm, entire index, middle, and ring fingers, and distal part of the little finger. Nicolau syndrome was documented after intramuscular injections of drugs. Nevertheless, there are very few reports of Nicolau syndrome following post intralesional sclerotherapy. Conclusions: Sclerotherapy is a simple office procedure routinely performed by health care professionals (e.g., dermatologists and surgeons), and awareness about its dreaded entity is key. Stringent precautions and prompt management can prevent unfavorable complications. Additionally, prudent patient selection and detailed counseling with explicit informed consent regarding Nicolau syndrome are imperative while planning any parenteral drug injection or intralesional sclerotherapy to avoid litigation.

Unexpected nasal foreign body

Foreign body in the nose is a common complaint in the paediatric age group and the most prevalent site of foreign body insertion compared to the ear and throat. Typical presentation involves foul-smelling unilateral nasal discharge. However, some cases are asymptomatic with no witnesses, and only discovered by medical practitioners during routine examinations. The diagnosis in this scenario becomes more challenging when another nasal pathology is present. We describe the case of a 6-year-old girl with underlying extensive infantile haemangioma of the face, tongue, neck and chest, who came for a routine follow-up, without any nasal complaints. However, the examination revealed right nasal crusting with bluish discoloration and hypertrophy of the right inferior turbinate, which was initially thought of as extension of the patient’s haemangioma. A foreign body in the right nasal cavity was noted by the girl’s parent on the next day after nasal douching, and was successfully removed in the clinical setting.

A rare case report of neonatal iliopsoas abscess presenting as swelling of left hip

We report the case of a 12 days old baby boy who presented with swelling and bluish discoloration on his left hip at Pakistan Institute of Medical Sciences in November 2018. Ultrasound (USS) was useful in making the diagnosis of a neonatal psoas abscess. He was treated with extraperitoneal drainage and with systemic antibiotics. The clinical presentation and diagnosis, treatment of this rare condition and brief literature review is given in this case report. Key Words: Abscess, Iliopsoas, Neonate, Staphylococcus aureus, Extraperitoneal Drainage. Continuous....

Cardiac CT in criss-cross heart

A criss-cross heart is an uncommon congenital rotational anomaly. It accounts for less than 0.1% of all congenital heart defects. The anomaly is characterized by crossing of the atrioventricular connections caused by rotation of the heart about its long axis. It is commonly associated with diverse cardiac defects. Cardiac CT imaging of criss-cross heart is sparse. We present a case of 1-year-old child with chief complaints of bluish discoloration of the body and fast breathing. Cardiac CT revealed atrial situs solitus, criss-cross-atrioventricular connections, atrioventricular discordance, double outlet right ventricle and dextro-malposed great arteries (Van Praagh S,D,D).