Журнал клинических случаев

Sacral fractures are underdiagnosed and often undertreated. We report the second case of presentation and surgical management of a 56-year-old man with traumatic sacral U-shape fracture secondary to a grand mal epileptic seizure. We then discuss risk factors and mechanism of such fracture in epileptic patients.

Background: The most widely recognized endocrine problem is Polycystic Ovary Syndrome (PCOS) that shows during puberty with menstrual irregularities, acne and hirsutism. The fundamental imperfections in PCOS are still unclear, so insulin resistance and metabolic syndrome are most common in both healthy weight and as well as in obese patients. Numerous treatments are offered for women related to PCOS including weight loss, gonadotropins, metformin, DASH diet, letrozole and laparoscopic ovarian diathermy.

Case presentation: This case report 35-years-old female presented for evaluation of obesity, menstrual irregularity and amenorrhea, and had no received any kind of hormonal treatment. Luteinizing hormone and serum testosterone level were elevated, while follicle stimulating hormone and estradiol level was normal.

Conclusion and Outcome: Metformin and DASH diet was best treatment choice for PCOS patient that requires further examination before to being suggested on a long term basis and successful treatment outcome.

Denosumab is an effective human monoclonal antibody used for postmenopausal women with osteoporosis at high risk for fracture. There are serious adverse effects associated with the use of denosumab, such as hypocalcemia, hypophosphatemia, hypomagnesemia, and increased blood alkaline phosphatase. Hypocalcemia associated with the use of denosumab can lead to central nervous system complications (seizure) in chronic kidney disease patients (CKD 4-5D). The patient, in this case, had osteoporosis and started a denosumab regimen (60 mg subcutaneous injection every 6 months for 2 years) with normal renal function and magnesium and calcium levels but developed reversible convulsion, amnesia, irritability hallucination, marked elevation Gamma-Glutamyl Transferase (GGT), and slight elevations in alkaline phosphatase and Aspartate Aminotransferase (AST). In all previously documented cases, CNS events after the administration of denosumab were associated with hypocalcemia or renal impairment. We hereby report a case of reversible convulsion following denosumab administration for the treatment of osteoporosis in postmenopausal women with normal renal functions, endocrine, and metabolic profiles. The findings of this study suggest careful monitoring of serum levels of calcium, phosphorus, and magnesium and symptoms of CNS events before initiation and during denosumab therapy.

Acute digital ischemia is relatively rare due to collateral blood supply to the hand from ulnar and radial arteries. We present a case of thumb ischemia secondary to embolic occlusion of the princeps pollicis artery, a branch of the radial artery, with concomitant atherosclerotic occlusion of the ipsilateral subclavian artery. This case highlights the importance of thorough investigation for systemic causes of distal upper extremity ischemia.

Background: We report the case of a patient with Cardiogenic Shock (CS) in a course of acute Right Ventricular (RV) Myocardial Infarction (MI) following occlusion of the proximal Right Coronary Artery (RCA). Our case highlights the use of Continuous Veno-Venous Hemofiltration (CVVH) as a novel routine treatment option for Acute Kidney Injury (AKI) in the setting of CS and the use of Rotational Atherectomy (RA) in patients with MI. This finding has important implications for patient treatment plans in the future.

Case summary: The patient was treated with the primary Percutaneous Coronary Intervention (PCI) using three drug-eluting stents in the main RCA and strong right ventricular branch. RA was used to facilitate lesion expansion and stent implantation because of massive calcification. Six hours after the procedure, AKI manifested as anuria, required CVVH for four days until hemodynamic stabilization and restoration of diuresis. Six weeks after MI, the patient underwent coronary artery bypass surgery due to advanced coronary disease in the left coronary artery. There were no peri-or post-procedural complications, and at the end of a cardiac rehabilitation program, the patient was discharged.

Conclusion: RA of calcifications in the infarct-related artery may remain the only option for delivering a stent, and thus maintain patency of the supplied coronary vessel, which is essential for hemodynamically unstable patients. RA can be a safe option if extreme precautions like using small burr sizes and low speeds are used. CVVH may be the first-choice option in patients otherwise treated with RV mechanical circulatory support.