pISSN: 2538-2683
eISSN: 2538-2691
Editor-in-Chief:
Shahin Akhondzadeh
Editor-in-charge:
Seyed Farshad Allameh
Vol 8 No 4 (2023): July-August
Case Report(s)
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This study introduces the anterior wall of the maxillary sinus as a viable and accessible graft site for small to moderate bone defects in the maxilla that pose challenges for implantation. A healthy 40-year-old woman was referred by a prosthodontist due to malpositioned implants. Following a comprehensive assessment, the decision was made to remove the implants. Upon executing this treatment plan, a medium-sized defect was revealed. The flap was elevated to expose the anterior wall of the maxillary antrum, from which an osseous graft was obtained. This graft was then fixed as a buccal wall of the defect and supported by a membrane. After a healing period of 6 months, two implants were successfully inserted. The anterior wall of the maxillary sinus can serve as a beneficial graft source. However, more extensive studies with appropriate design are required to reach a definitive conclusion.
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NAC reconstruction represents the final stage of breast reconstruction. This can be accomplished thr ough non-surgical and surgical procedures, each with its own set of advantages and disadvantages. The majority of surgeons employ the Skate flap. The following is a de monstration of a modific ation to this flap.A woman, 56 years of age, who had previously undergone breast reconstruction using a TRAM flap, was admitted for nipple reconstruction. During the design of the star flap, a modification was executed, which involved reciprocally changing the orientation of the lateral flaps. Both flaps were properly positioned in their prepared locations during the flap inset and skin closure. The final outcome was satisfactory and aesthetically pleasing.The modification in the design of the Skate flap alters the orientation of the transferred flaps, making the final inse t feasible with less dis figurement.
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Immune thrombocytopenic purpura (ITP) is a condition that can occur either spontaneously or as a secondary complication of preexisting disorders, often associated with viral infections. In the context of COVID-19, hematological manifestations, including thrombocytopenia, have been observed and linked to increased mortality rates among severely infected patients.Presented here is a case study of a 70-year-old man who recovered from COVID-19 but subsequently developed ITP. The severity of his thrombocytopenia exceeded what is typically observed during COVID-19 infections, leading to a diagnosis of ITP. Treatment with steroids and intravenous immunoglobulin (IVIG) was initiated based on specialist recommendations, resulting in an adequate response.
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The prevalence of renal stones with concomitant UPJO is about 20-30%. Its treatment method is controversial. In this study, a 29-year-old man with UPJO and simultaneous ipsilateral renal stone is presented, who was treated with PCNL following Hellström laparoscopic pyeloplasty.
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Meckel’s diverticulum (MD) is a congenital outpouching or bulge in the lower part of the small intestine. It is the most common congenital defect of the gastrointestinal tract. MD is usually asymptomatic but when symptomatic, typically presents in childhood. A case is presented of a 33-year-old Caucasian man who presented with multiple episodes of bright red blood per rectum prior to hospital admission, with associated weakness and nausea. The patient denied abdominal discomfort, fevers, or vomiting. Eventually, it was found that the patient had a Meckel’s diverticulum with an associated focus of active extravasation from a dilated mesenteric vein. The feeding artery was successfully embolized with cessation of flow to the draining vein. Colonoscopy and computed tomography (CT) scan were inconclusive, and the patient ultimately underwent diagnostic laparoscopy and small bowel resection of the Meckel’s diverticulum to prevent further bleeding by removing aberrant tissue
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Gestational trophoblastic neoplasia (GTN) is a rare neoplasm and is a spectrum of proliferative disorders of placenta. Invasive mole is a subtype of GTN that almost always arises after molar pregnancy. This report presents a 35-year-old woman with an atypical presentation of invasive mole after a normal pregnancy. The patient presented with a complaint of vaginal bleeding after normal vaginal delivery. Invasive mole was diagnosed based on findings of imaging and elevated beta human chorionic gonadotropin (ß-hCG) levels. Hysterectomy was finally decided upon due to severe vaginal bleeding and the patient’s request. Although GTN occurs after normal delivery, the patient recovered without receiving chemotherapy. It is important to consider all subtypes of GTN as a differential diagnosis of patients with abnormal postpartum bleeding and elevated ß-hCG levels even after a normal pregnancy.
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Colorectal cancer affects the rectum or large bowel, including the appendix. This type of cancer develops from the colorectal mucosa, with adenocarcinoma being the most common form, accounting for over 95% of cases. It typically affects individuals aged 50 years or older. However, this report highlights a case of colorectal adenocarcinoma that occurred at a young age, despite no family history. Unfortunately, the cancer was initially missed during check-ups because of the unlikely age group, resulting in a delayed diagnosis. The patient, who presented with an obstruction, underwent surgical interventions. Upon further examination, the histopathological tests revealed that the patient had well-differentiated type I colorectal adenocarcinoma.
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Small bowel obstruction (SBO) is a common surgical emergency, accounting for almost 50% of all emergency laparotomies with significant in-hospital morbidity. History of previous intra-abdominal surgery is very common in SBO patients, which can include up to 80% of these patients. However, there are cases of SBO with no prior abdominal surgery caused by omental bands, which are very rare and have a high probability of misdiagnosis, referred to as a virgin abdomen. In this article, a rare case of adhesion band small bowel obstruction in a virgin abdomen is presented. Although the factors related to SBO in a virgin abdomen and its underlying causes are not yet fully understood. In this case, the most possible explanation is considering the patient’s age and congenital condition because of the absence of previous abdominal surgeries or inflammation history.
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Trichobezoar is a rare form of bezoar characterized by the accumulation of swallowed hair in the stomach. An unusual form of bezoar, in which the bezoar spreads from the stomach to the small intestine or beyond, is called Rapunzel syndrome. This syndrome is mainly seen in females and is often associated with psychiatric disorders. Trichobezoar usually presents with abdominal pain, early satiety, and nausea. However, it may also present as an asymptomatic abdominal mass or obstruction and pe rforation of the gastrointestinal tract.This diagnosis should be considered in young women with abdominal pain, an epigastric mass, and malnutrition, especially in patients with a history of trichophagy or psychiatric disorder.The case of a 13-year-old girl with Rapunzel syndrome is described. She presented to the emergency ward with a history of abdominal pain, non-bilious vomiting after meal and fluid intake, halitosis, decreased appetite, and weight loss. The patient was treated successfully by laparotomy.
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Accidental esophageal intubation is a preventable human error that complicates airway management and continues to occur despite advances in medical devices. Perforation of the stomach has been associated with esophageal intubation in several case reports.This report presents a case of an elderly woman suspected of having COVID-19-related pneumonia. She was intubated due to respiratory dysfunction. In the initial few minutes, the patient became desaturated, leading to a second intubation. An hour later, the patient’s abdomen was distended, and the chest computed tomography (CT) showed a massive pneumoperitoneum. During laparotomy, a 6 cm long rupture was found in the lesser curvature, which was attributed to accidental esophageal intubation. To avoid such a fatal condition, it is imperative for physicians to ensure the correct positioning of the endotracheal tube. To achieve this goal, further investigation into readily available and highl y sensitive techniques is recommended.
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Pheochromocytoma is a rare catecholamine-secreting tumours of chromaffin tissues that cause a constellation of symptoms. It is closely associated with endocrine hypertension that can be masked, sustained or paroxysmal leading to hypertensive crisis, resulting in vascular and non-vascular complications and rarely cerebral ischaemia and stroke.A healthy 22 year old male reported with acute Right upper limb(RUL) monoplegia and Motor aphasia for five days with raised blood pressure levels. hypertonia was present, deep tendon reflexes were exaggerated in RUL and Right Plantar was extensor. General and systemic findings were nonsignificant . Routine investigations showed thrombocytosis and M.R.I. Brain was suggestive of acute infarction of Left Parieto-Temporal region. Renal doppler, Carotid Intima Media Thickness, Cerebral Angiogram, 2D-E.C.H.O. and Fundoscopy were normal. AntinuclearAntibody was negative. Contrast CT of abdomen revealed right adrenal mass suggestive of isolated Pheochromocytoma. Vanyl-Mandelic Acid was positive. Patient was stabilised and managed conservatively for 4 weeks followed by adrenalectomy and appropriate medical therapy. Patient is on regular followup and does not seem to require any antihypertensives or any other intervention.Pheochromocytoma is a notorious tumor and a great masquerader specially in young adults. A keen eye, routine checkups and evaluation is the key to detecting and preventing its associated morbidity and mortality.
