Журнал клинических случаев

Trabeculectomy with Mitomycin-C (MMC) and glaucoma drainage device implantation remain the most commonly performed surgical procedures for the treatment of Open Angle Glaucoma (OAG). Numerous studies have shown good efficacy for these surgical procedures [1-3]; however, a high rate of complications [4] has prompted the glaucoma community to search for alternative surgeries to treat OAG.

The advent of Transcatheter Aortic Valve Implantation (TAVI) has influenced the management of patients with severe aortic stenosis with high or prohibitive risk for standard surgical management. Procedure associated risks with TAVI are substantially different from those related to surgical aortic valve replacement. .

Objectives: Current breast cancer treatment involves both standard (e.g., surgery, chemotherapy radiation therapy, and hormone therapy) and new immune therapy methods. Standard treatments are effective at early stages but their effectiveness drops with advanced stages. Recent studies suggest that bacterial and viral infection could be implicated in breast cancer pathogenesis. Therefore, pathogenic inhibition could be a feasible treatment approach. A 54-year-old woman presented with an inflammatory-edematous form of breast cancer (T4N1M1 stage). Due to the inflammatory edematous form tumor was fully metastasized and inoperable. Patients with similar condition usually have a very short life span. Methods: This patient underwent a combinatorial therapy consisting of immunocorrective and metabolism regulating therapy, as well as antimicrobial and standard chemotherapy. Results: This treatment was shown to extend patient’s life for almost two additional years. This case report demonstrates extent and possibility of using a systemic approach to treat inoperable breast cancer.

Laryngeal trauma is a rare but life threatening injury. In cut throat, laryngeal injury should be suspected and investigated. The first priority in management is to secure airway. Associated injuries should be searched for. Treatment may be conservative or surgical depending upon the site, magnitude of injury and stability of laryngeal framework. Here we present a rare form of penetrating laryngeal injury with complete disruption between cricoid and thyroid cartilages

The estimated prevalence of secondary and tertiary (central) adrenal insufficiency is 150-280 per million [1]. A lot of processes that involves the hypothalamus and which interferes with CorticotrophinReleasing Hormone (CRH) secretionare hypothalamic tumors, surgery, irradiation and autoimmune hypothalamic disease will result in central adrenal failure.

Introduction: Hyponatremia is a known side effect of antidepressant medications.Usually management of hyponatremia in patients receiving antidepressants involves stopping of antidepressant and restriction of fluid intake. However, information is not clear with respect to use of antidepressant in patients with persistent hyponatremia. Objective: To describe a patient detected to have hyponatremia prior to starting of antidepressant. The hyponatremia was corrected with the use of fludrocortisone, but introduction of sertraline led to reemergence of hyponatremia. Later patient tolerated milnacipran along with fludrocortisone, without recurrence of hyponatremia. Conclusion: Fludrocortisone can be used for prevention and management of hyponatremia in patients at high risk of developing the same. Further, milnacipran may be considered as a viable option in patients who develop hyponatremia with SSRIs

We present a case of Nonalcoholic Steatohepatitis (NASH) occurring in combination with sleep apnea syndrome (SAS) in a 35-year-old man whose liver function improved on introduction of continuous positive airway pressure (CPAP). The patient had been steadily gaining body weight since the age of 20, and liver dysfunction had been frequently highlighted during regular health checks. He had a history of snoring, nasal obstruction, and lethargy and was admitted to our hospital for evaluation and diagnosis of these symptoms. Following Polysomnography (PSG), he was diagnosed with SAS on the basis of an apnea and hypopnea index (AHI) score of 34.7/hour. Following CPAP treatment, his symptoms gradually improved and his AHI score reduced to 3.8/hour. However, despite CPAP contributed to the improvement of Alanine Aminotransferase (ALT) and aspartate aminotransferase (AST) these levels remained elevated, and he showed sustained liver dysfunction. Therefore, we were consulted for evaluation and diagnosis of the sustained liver dysfunction. On admission, his body mass index (BMI) was 34.5 kg/m2 and abdominal Ultrasonography (US) and Computed Tomography (CT) indicated the presence of severe fatty liver. A liver biopsy was performed and the patient was diagnosed with NASH, grade 1/stage 2 and steatosis grade 3.

Lipomas of the pancreas are very rare. There are fewer than 25 reported cases of lipoma originating from the pancreas. We present a case of pancreatic lipoma in a 60-year-old woman who present with pain abdomen. Diagnosed incidentally on Computed tomography. CT Guided FNAC revealed lipoma, We will discuss the radiological findings distinguishing a pancreatic lipoma from other fatty lesions of the pancreas and provide a brief review of literature.