Журнал клинических случаев

A 32-year-old woman with cystic fibrosis pregnant with twins presented at 28 weeks with an acute rib injury sustained during a vigorous coughing episode. Two paravertebral catheters were placed to manage the severe pain associated with her four times daily vest treatments. She received a continuous ropivacaine infusion with twice daily boluses which resulted in a significant decrease in daily opioid use. The catheters remained in place for 32 days until she spontaneously went into labor, upon which they were removed and she had an uneventful cesarean section.

During childhood and adolescence, Obsessive-Compulsive Disorder (OCD) is a debilitating condition that is characterized by a particular collection of troubling symptoms. These symptoms include persistent and intrusive thoughts (known as obsessions) as well as time-consuming and distressing rituals (known as compulsions). This study presents a case study of a 15-year-old male with OCD with also diagnosis of Autism Spectrum Disorder (ASD), the patient was treated with Acceptance and Commitment Therapy (ACT), specifically using the Matrix protocol. During treatment, the patient displayed a notable psychological change, as his previously compulsive behavior shifted from being driven by aversive verbal contexts to being driven by positive verbal contexts. The study suggests that third-generation psychotherapy techniques and a focus on values can improve the quality of life and relationships in individuals with autism spectrum disorders and may inform best practices for clinicians.

Actinomyces meyeri is a rare cause of lung infection. In general, actinomycosis is rare and more frequent in men than in women, exception for pelvic infection. The diagnosis is challenging as actinomycosis can clinically and radiologically mimic other infections and malignancies. Nowadays, thanks to antibiotics availability, the prognosis has improved, so death and deformity occur very rarely. Here is reported the case of a young male presented with a lung mass that was highly suspicious for cancer, so that he was hospitalized in Oncologic Medicine department of Modena University Hospital, Italy. A biopsy of the lesion was performed to obtain a diagnosis. The culture from mass biopsy resulted positive for Actinomyces meyeri, so a specific antibiotic therapy was started and prolonged for six weeks, with patient’s clinical and radiological remission. His relevant clinical data are reported here, together with radiological and microbiological examinations. Patient’s general conditions were good during all the hospitalization period. The aim of this case report is to focus attention on a rare form of infection, with a difficult differential diagnosis with lung cancer. The two diseases have a really different treatment and prognosis. From the anamnesis, it is possible to suspect lung actinomycosis if the patient has an history of alcoholism or bad dental hygiene. The case will be discussed, with references to available literature.

Epidermolysis Bullosa (EB) poses challenges to anesthesiologists due to difficulty maintaining skin integrity with interventions contacting the skin. Complications during all types of anesthesia are created by needs for monitoring and securing access, potentially creating blisters and bullae from friction and shearing forces. Also, due to EB patients having a higher opioid tolerance from prolonged use and being in a hypermetabolic state, adequate pain control is more difficult to achieve. This case report details the decision process and management of a pediatric patient who received bilateral infraclavicular catheters for bilateral syndactyly procedure. Epidermolysis Bullosa poses unique challenges for anesthesia care due to interventions that test skin integrity and management of chronic pain commonly controlled by opioids. Cather placement for perioperative pain has been infrequently documented as a solution to pain control due to concerns of causing blister and bullae formation. Bilateral infraclavicular catheters used for postoperative pain management were successfully utilized in a pediatric patient with Epidermolysis Bullosa.

In late December 2020, vaccination for the Coronavirus Disease 2019 (COVID-19) started among the personnel of the United States Forces Korea and related units, including the medical team. Because its usage was approved based on emergency circumstances, sufficient research on the possible side effects has not been conducted yet. We experienced an unusual neurologic side effect after injection of the SARS-CoV-2 mRNA-1273 vaccine. A 32-year-old U.S Army male soldier with headache, blurred vision, and cramping chest pain after second-dose injection visited the emergency room. Subsequently, left-sided weakness developed during the observation. Imaging of the cervical lesion for the diagnosis of acute intracranial disease was performed but revealed no definite disease. While under close observation, the patient’s symptoms progressed to nearly hemiplegic but then improved gradually in an ascending and peripheral-to-center manner with only supportive care. We report this case as the first unilateral neurologic side effect of the SARS-CoV-2 mRNA-1273 vaccine.

Introduction: Skin and Soft Tissue Infections (SPI) occur very frequently in hospital services and complicated cases require hospitalization or immediate interventions in hospitalized patients. However, there are few studies in our setting that describe new treatments for these infections.

Material and methods: Prospective descriptive observational study of patients with episodes diagnosed with post-traumatic, diabetic, mixed (diabetic/traumatic) ulcers delayed wound healing and burns in postoperative patients in the plastic surgery unit of the Reina Catalina Clinic in Barranquilla, Colombia from July 2022 to November 2022.

Results: Fifteen (15) cases of hospitalized patients with picture of post-traumatic, diabetic, mixed (diabetic/traumatic) ulcers, delayed wound healing and burns with the presence of skin and soft tissue infections (IPPB). The most frequently diagnosed entity was cellulitis/erysipelas (60%); the origin of the IPPB was hospital and the majority of patients did not present comorbidities. None of the patients evaluated presented any vascular disease that could alter the results. The most frequently isolated microorganism was P. aeruginosa (40%), P. mirabilis (20%), E. coli (20%) and E. cloacae (20%), all of nosocomial origin. During the treatment, no patient died and all of them completely healed from their IPPB.

Conclusion: The most frequently treated IPPB in patients hospitalized at the Reina Catalina clinic in Barranquilla are mainly ulcers associated with cellulitis/erysipelas, most of them acquired by nosocomial route. The use of new and old antibiotics have not had the expected success, especially due to the presence of biofilms that favor the aggravation of infections. Chlorine dioxide solubilized in water at 3000 ppm topical, had a result of complete resolution of nosocomial infections in the area of plastic surgery, which makes it a promising substance in the resolution of infections in postoperative, traumatic and ulcer wounds. diabetes and burns in particular in the treatment of the biggest problem associated with these infections: The biofilm.

Anomalies of pelvic vasculature are very dangerous as they can cause torrential bleeding during pelvic surgery, especially oncological surgery. A thorough knowledge of possible variations is necessary to ensure preparedness and ability to manage the complications that may arise. We present a case of duplication of the external iliac artery in a case of carcinoma ovary, detected intra-operatively.

Introduction: Lipoma can grow on any part of the body but it is often found on the neck, shoulders, upper limbs, as well as on the thigh. Lipoma is considered a benign growth or tumor of the adipose tissue. It does not have a known cause however it is likely related to a genetical issue in people with multiple lipomas.

Materials and methods: We have chosen to detail the rare case of a 57 year-old man from personal case records. He presented for consultation with a large tumor formation located on the right arm posteriorly that progressively increased in size to an apparent diameter of about 30 cm over a period of 5 years.The local examination revealed a large lipoma of approximately 32-30-26 cm with uncertain clinical features of malignancy.

Results: Local anaesthesia proved to be enough for the surgery to be successful. We have arranged follow-up for the patient at 3, 6 and 12 months.

Discussion points: In the case of large tumors it is necessary to have a multidisciplinary approach, involving teams from surgery, histopathology and potentially oncology. The Golden Standard indication for these cases is the surgical excision of the tumor within safe margins to decrease the risk of recurring malignancy.

Conclusion: Surgical excision needs to be wide enough to ensure safe margins are achieved even for a benign-looking tumor and it is mandatory for pieces to be sent to histopathology laboratory for examination. pectively to ensure the wound was healing well and monitor for reappearance.

Subdural hematoma (SDH) occurs from interruption of bridging or superficial cerebral veins, most commonly from head trauma. Rupture of an intracranial aneurysm may rarely lead to SDH with or without subarachnoid or intraventricular bleed. We report a rare case of ruptured dissecting aneurysm of an extradural posterior inferior cerebellar artery (PICA) leading to spontaneous subdural hematoma and explain possible mechanisms.

Background: Blunt abdominal injury is a known, but very rare cause of portal vein thrombosis. In most cases, full anticoagulant therapy is sufficient. Surgical thrombectomy is an extremely rare procedure in the treatment of acute portal thrombosis.
Materials and Methods: We present a case of a young patient with portal vein thrombosis and its branches after a blunt abdominal injury resulting from the sport. Due to severe infarction of the intestinal loops, we chose surgical thrombectomy as the only causal treatment option. This procedure is generally rarely reported in the scientific literature. However, it has not yet been described with a blunt abdominal injury. The patient was subsequently shown to have a Leiden mutation in a heterozygous form. The interplay of all factors including blunt abdominal injury, Leiden mutation, and intestinal malrotation could lead to acute thrombosis of the portal vein and its branches.
Conclusions: We successfully used direct surgical thrombectomy from portal vein and its branches for the patient with portal vein thrombosis and severe small intestine infarction after a blunt abdominal trauma as the only available treatment option, because other treatment options were not suitable in this patient. In our case, early diagnosis, right decision to choose surgical treatment, and direct surgical trombectomy resulted in success and the patient has fully returned to normal life.