A&A practice
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Case Reports
A Missing Tooth Found in the Nasal Cavity After an Attempt at Insertion of a Nasogastric Tube: A Case Report.
Dental injury is one of the most common complications of tracheal intubation. Although teeth dislodged during tracheal intubation are usually found in the oral cavity, we encountered a case of a missing tooth found in the nasal cavity in an intubated patient. ⋯ A lateral-view radiograph revealed the dislodged tooth in the nasal cavity. The ectopic tooth was removed by an otorhinolaryngologist.
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A 31-year-old primigravid parturient with no pertinent medical history was admitted at 40 weeks and 4 days of gestation for postdate induction of labor. She was subsequently diagnosed with preeclampsia and developed hemolysis, elevated liver enzymes, and a low platelet count. ⋯ The hemorrhage was managed using our institution's massive transfusion protocol. Early transfusions and mobilization of necessary support stipulated in this protocol led to full recovery of the patient, with no significant morbidity.
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Intraoperative evaluation of mitral regurgitation is a complex undertaking. Bileaflet prolapse/flail can result in divergent mitral regurgitation jets with a characteristic "crossed swords sign" appearance. ⋯ The accurate assessment of eccentric mitral regurgitation jets, especially bilateral eccentric mitral regurgitation jets, is challenging before surgical repair. Intraoperative 3-dimensional transesophageal echocardiography with and without color-flow Doppler can significantly improve the localization of the anatomical lesion.
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A 20-year-old man submitted to surgical insertion of a lumboperitoneal drain as a treatment for intracranial hypertension, secondary to venous sinus thrombosis, developed severe headache accompanied by nausea, vomiting, and diplopia 24 hours postoperative. Cerebral spinal fluid low-pressure headache was diagnosed. ⋯ Pain relief was immediate, complete, and sustained for about 24 hours; a second block was performed effectively with pain control, and the patient was discharged. Sphenopalatine ganglion block may be a safe and efficient treatment for the cerebral spinal fluid hypotension headache secondary to lumboperitoneal shunt.
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Regional cerebral tissue saturation monitoring is frequently used in patients on mechanical cardiac assist devices with the intention to promptly detect critical imbalances between cerebral oxygen delivery and oxygen extraction and ultimately circumvent permanent brain injury. We report a case where an intraparenchymal bleed in the supply zone of the middle cerebral artery-followed by severe hemispherical brain edema, leading to life-threatening intracranial hypertension-escaped cerebral oximetry monitoring using near-infrared spectroscopy. Potential explanations for our observation, as well as the specific limitations of these devices, are discussed.