Journal of medical case reports
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The phenomenon of autoresuscitation is rare, yet it is known to most emergency physicians. However, the pathophysiology of the delayed return of spontaneous circulation remains enigmatic. Among other causes hyperinflation of the lungs and excessively high positive end-expiratory pressure have been suggested, but reports including cardiopulmonary monitoring during cardiopulmonary resuscitation are scarce to support this hypothesis. ⋯ Understanding the underlying pathophysiology of autoresuscitation is hampered by a lack of reports including extensive cardiopulmonary monitoring during cardiopulmonary resuscitation in a preclinical setting. In this case, continuous capnometry was combined with repetitive ultrasound evaluation, which ruled out most assumed causes of autoresuscitation. Our observation of a rapid decline in end-tidal partial pressure of carbon dioxide supports the hypothesis of increased intrathoracic pressure. Continuous capnometry can be performed easily during cardiopulmonary resuscitation, also in a preclinical setting. Knowledge of the pathophysiologic mechanisms may lead to facile interventions to be incorporated into cardiopulmonary resuscitation algorithms. A drop in end-tidal partial pressure of carbon dioxide, for example, might prompt disconnection of the ventilation to allow left ventricular filling. Further reports and research on this topic are encouraged.
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Spontaneous infectious spondylodiscitis is a rare, but serious disease with the risk of progressive neurological impairment. The surgical approach to spontaneous infectious spondylodiscitis is in most cases an anterior debridement and fusion, often in staged surgeries. Here we report a case of single-stage posterior debridement and posterior instrumented fusion in combination with an injectable calcium sulfate/hydroxyapatite composite eluting gentamicin. ⋯ An injectable calcium sulfate/hydroxyapatite composite releasing a high level of gentamicin can support the surgical treatment of spondylodiscitis in combination with posterior debridement and transpedicular screw-rod instrumentation.
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Case Reports
Esophageal perforation after perioperative transesophageal echocardiography: a case report.
Transesophageal echocardiography is widely used in cardiac surgery. Transesophageal echocardiography probe insertion and manipulation can injure the esophagus. ⋯ Esophageal perforation can occur with transesophageal echocardiography probe insertion, even without difficulty or resistance, in patients with atherosclerotic disease. Appropriate imaging and vigilance for esophageal injury after a transesophageal echocardiography examination in patients with cardiovascular disease are necessary for appropriate diagnosis and treatment.
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Case Reports
Craniopagus parasiticus - a parasitic head protruding from temporal area of cranium: a case report.
Craniopagus parasiticus is rare with an incidence of approximately four to six cases in 10,000,000 births. In our case, the head of the parasitic twin protruded from the temporal area of the normal twin's cranium. The parasitic twin had two deformed lower limbs, of which one was rudimentary, and long bones of the bilateral lower limbs and some pelvic bone. Dissection of the mass of the parasitic twin's body revealed the intestine but no chest organs or abdominal organs. There was a rudimentary labium but no vaginal opening. In resource-limited countries, maternal age or nutritional factors may play a role in craniopagus parasiticus. ⋯ The causes of craniopagus parasiticus are still unknown due to a rarity of cases and a limited number of studies on it. There have been only nine to ten cases of craniopagus parasiticus, of which only three survived past birth and were documented in the literature. Genetic scientists and researchers continue to investigate this case because they might find explanations for the birth defect, and provide answers to improve the prognosis and the life chances of twins with craniopagus parasiticus.
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Case Reports
Anti-N-methyl-D-aspartate receptor encephalitis with an imaging-invisible ovarian teratoma: a case report.
Anti-N-methyl-D-aspartate receptor encephalitis is a recently discovered disease entity of paraneoplastic limbic encephalitis. It largely affects young women and is often associated with an ovarian teratoma. It is a serious yet treatable condition if diagnosed early. Its remedy involves immunotherapy and surgical removal of the teratoma of the ovaries. This case of anti-N-methyl-D-aspartate receptor encephalitis involves an early surgical intervention with bilateral oophorectomy, despite negative imaging evidence of a teratoma. ⋯ Our patient is an example of teratoma-associated anti-N-methyl-D-aspartate receptor encephalitis, in which the teratoma was identified only microscopically. Her case highlights that even with negative imaging evidence of a teratoma, ovarian pathology should still be considered and explored.