Журнал клинических случаев

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A 59-year-old man with Benign Symmetrical Lipomatosis (BSL) who underwent the neck and chest lipomas resection under general anesthesia is described. Benign Symmetrical Lipomatosis (BSL) is a rare fat metabolism disorder characterized by the most common symptom of nonencapsulated axial lipomas symmetrically diffused around the neck. The airway was secured by video laryngoscopy intubation in this case. Sober local anesthesia or topical anesthesia may provide a simple and safe available method to retain spontaneous breathing for patients with BSL under general anesthesia. 

Objective: To find out the incidence of iatrogenic bile duct injury following open and laparoscopic cholecystectomy and their postoperative outcome.

Material and methods: Twenty patients with iatrogenic bile duct injuries were admitted through the OPD and emergency department of PMC Hospital Nawabshah. Apart from baseline investigations, MRCP and ERCP were performed in selected cases. Postoperatively patients were monitored in the surgical ward and sent home after removing their drains. Patients were followed up in the OPD for 6 months. Data was collected and analyzed on SPSS Version 10.

Results: Out of 20 cases, 8 (40%) sustained injuries in our unit while 12 (60%) were referred from peripheral hospitals. The mean age was 40± 3 years and the male to female ratio was 1:4. Presenting complaints were jaundice, abdominal pain and persistent bile discharge. Procedure performed included Roux en Y (65%), choledochoduodenostomy (25%) and primary repair over T-tube (10%). Post-operative complications were bile leak (10%), wound infection (15%) and recurrent cholangitis (5%). Mortality was zero. The average hospital stay was 10-15 days.

Conclusion: Roux en Y choledochojejunostomy is the preferred surgical procedure for iatrogenic bile duct injuries with minimal postoperative complications.

A 29-year-old woman with an 8-year history of retinitis pigmentosa presented with decreased visual acuity in both eyes. We collected her examinations and diagnosed her with retinitis pigmentosa, macular schisis and lamellar macular holes in both eyes. We proposed the poor condition of retina, caused by retinal pigmentosa, resulted in macular schisis and lamellar macular holes. 

The ingestion of a foreign body is a frequent cause of gastrointestinal emergency in pediatric population. Toothbrush swallowing is a rare event. Foreign bodies greater than 6-10 cm length are unable to negotiate the curvature of the duodenum with its fixed retroperitoneal attachment. Therefore, spontaneous passage of a toothbrush is unlikely and its removal via endoscopy is highly recommended. When the ingested object is a toothbrush, eating disorders as bulimia or other psychiatric disorders should be suspected. We present a case of a 15-year-old girl who swallowed accidentally a toothbrush that was removed via laparoscopy after unsuccessful endoscopy.

Tongue piercing has a long history of being associated with religious and cultural symbolism. In recent years it has grown popular among teenagers and young adults. Several complications may be associated with this practice. Infection of the piercing site is a common complication, which can result in abscess formation or formation of granuloma over the period of time. The management of this complication is always removal of the tongue stud and surgical debridement of the infected site. We present the case report of a patient with chronic infection of the tongue which resulted due to a tongue stud which got embedded submucosally within the tongue.

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The restoration of a fractured anterior tooth by fragment reattachment is biological, conservative, and the most currently acceptable treatment option. In addition, the advancements in adhesive dentistry, tooth fragment reattachment procedure has become simpler and clinically reliable. This article presents management of two cases of complicated crown fracture of maxillary incisors by reattachment of the fractured tooth segment.