Case Reports in Clinical Practice
Volume:6 Issue: 3, May-Jun 2021

Traumatic Diaphragmatic Rupture (TDR) is a rare type of trauma. Small intestine injuries are the third most common type of injury resulting from blunt trauma to abdominal organs. The immediate diagnosis of TDR and bowel injuries is a daunting task. We reported a 53-year-old male patient who was transferred to the hospital by EMS because of a car accident. The chest X-ray showed the left diaphragm elevation. Also, a computed tomography scan revealed that the greater omentum, a portion of the colon, spleen, and stomach were transposed in the hemithorax through a diaphragm rupture. The patient underwent laparotomy and the incidental findings in laparotomy showed bowel injuries. This case was a common cause of traumatic left-sided diaphragmatic rupture and intestinal injury. The suspicion of diaphragmatic rupture and intestinal injury in a patient with multiple traumas contributes to early diagnosis. Surgical repair remains the only treatment for diaphragmatic rupture. The severe injury in a part of the intestine may result in the resection of that part.

A 9-year-old girl with signs and symptoms of acute toxic myocarditis and cardiogenic shock with elevated cardiac enzymes was admitted to the Critical Care Unit (CCU) of our hospital with an ejection fraction of 25%. The patient was managed with supportive care and the administration of polyvalent antivenom and inotropes, and after 8 days, she was discharged without any complication with normal ejection fraction. Toxic myocarditis can be a result of scorpion envenomation. After two months of follow-up, the patient recovered completely and medications were discontinued.

Acquired Hemophilia (AHA) is a relatively rare disease that occurs in patients with no previous family history of hemophilia. The spontaneous development of autoantibodies (IgG1 and IgG4) against factor VIII has been reported as the most probable cause of AHA. AHA has been reported in association with other conditions, including some autoimmune bullous skin diseases, such as bullous pemphigoid, pemphigus vulgaris, and pemphigus foliaceous. To the best of our knowledge, only 21 cases of AHA with skin autoimmune bullous diseases have been reported so far. Herein, we report a 63-year-old male with a previous history of pemphigus vulgaris who developed large ecchymotic areas on his lower abdomen and forearms after the second infusion of rituximab. Based on coagulation factors evaluation, he was diagnosed with AHA. Treatment with factor VII led to the improvement in his coagulation status, but unfortunately, he passed away because of inferior wall myocardial infarction four days later.

Sulfasalazine, a non-antibiotic sulfonamide, is associated with severe hypersensitivity reactions, including Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome. We report a case of sulfasalazine-induced DRESS syndrome that relapsed following the administration of visipaque® (iodixanol). Macular rashes, pruritus, and an acute exacerbation of dyspnea were immediately observed after the administration of contrast media. It seems that patients suffering from DRESS syndrome are sensitive to the administration of other new medications with a high possibility of hypersensitive reactions. It can be concluded that iodinated contrast media should be used cautiously in patients with DRESS syndrome.

Schwannoma is one of the most common benign intracranial tumors, which originates from the Schwann cells of neural structures in the upper part of the vestibular branch of the eighth cranial nerve. This report describes a 64-year-old woman with headache and vertigo who had a past surgical history of acoustic schwannoma about 10 years ago. The patient underwent excisional surgery. Histological examinations revealed schwannoma with extensive xanthomatous changes. Immunohistochemistry staining confirmed the diagnosis. Base on the diagnosis, the patient received no more treatment. After 6 months of close follow-up examinations, no recurrence and complication were observed. Schwannoma could be seen with a vast variety of histologic changes. Recurrence of Schownnoma is uncommon in patients without neurofibromatosis, but it should be considered in a proper clinical context.

Puerperal uterine inversion is a rare obstetric emergency that may cause maternal mortality. We describe a multiparous women with total uterine inversion after a normal vaginal delivery.

Case Report: 

A 28 years old, gravid3 pregnant women was admitted to the hospital in the first stage of labor. She had a Past medical history of curettage due to abnormal vaginal bleeding following her second vaginal delivery and the present pregnancy proceeded without complications. After the delivery of the fetal  due to the history of placental adhesion, umbilical cord traction was avoided and after 20 minutes, the patient was asked to push hard. During a Valsalva maneuver, the uterus and the placenta were suddenly expelled from the vagina. The placenta was completely adherent to the decidua and the patient displayed no signs of shock. Then manual repositioning of the uterus was performed by a closed fist. and subtotal abdominal hysterectomy was performed. Pathological examination revealed placenta inccreta and The placenta was found completely adherent at the fundus.

Conclusion :

Uterine inversion usually occurs unexpectedly and is unpreventable in some cases. Assessment of the possible risk factors before delivery may help predict its occurrence. Therefore, in women with a positive history, special measures should be taken in third stage of labor to manage the possibility of inversion.

We report a rare case of bilateral corneal ghost vessels in a 6–year-old child with an unremarkable past ocular and past medical history. This study was a single observational case report. A 6-year-old girl was referred to our clinic for further evaluation, due to suboptimal visual acuity in both eyes. Her past medical and ocular history revealed no systemic, inflammatory, infectious, or degenerative disorders. Slit-lamp examination revealed regressed blood vessels (“ghost vessels”) in the anterior and mid-corneal stroma as the only pathologic finding. Confocal scanning microscopy of both corneas demonstrated scattered branching railroad-shaped ghost vessels at the level of the middle and anterior stroma. Complete systemic workup was performed for the patient. No identifiable risk factor for the development of corneal vascularization was found. According to our findings, we assume that in our patient, vasculogenesis occurred due to angioblast invasion to the presumptive cornea due to disequilibrium in mechanisms involved in vascular patterning during embryonic development.

This is a new case, affecting a twin that both with Hirschsprung’s disease, one was suffering from long-segment Hirschsprung’s disease with skip segmented. Our surgeon suspected the absence of abnormal vessel tortuosity in the transitional zone; thus, the appendix was sent for permanent pathology. There were ganglion cells in the colostomy site but no ganglion was found in the appendix. Complete biopsies from different parts of the intestine demonstrated positive ganglion cells in the transverse colon, ascending colon, and the distal ileum, jejunum, and duodenum, and negative ganglion cells in the rectum, sigmoid, descending colon, appendix, and 5 cm far from the ileocecal valve were observed. Therefore, the Kimura procedure was done. The most important key in such cases is the surgeons’ observation during operation.

This study aimed to assess the effects of cognitive-behavioral play therapy on anxiety and aggression in children with attention-deficit hyperactivity disorder (ADHD) by reporting a 7-year-old boy with ADHD inattentive type diagnosed by a psychiatrist. According to the interview, it was observed that the child was physically abused by the father. The chief complaint of the patient’s family was the symptoms of aggression, anxiety disorder, and urinary incontinence. We used the trauma system therapy model, which is used for children and adolescents who have had traumatic experiences and problems with emotional and behavioral modifications. The intervention was provided in 8 sessions for 2 days a week and lasted 45 minutes each. The child was evaluated using the Aggression Scale for Preschoolers and Preschool Anxiety Scale. The results of this study showed that cognitive behavior play therapy can reduce anxiety and aggression in ADHD children who are physically abused.

Idiopathic intracranial hypertension is characterized by an increase in intracranial pressure with no significant structural cause. The diagnostic criteria include general signs and symptoms of generalized increased intracranial pressure or papilledema, increased Cerebrospinal Fluid (CSF) pressure (>250 mm H2O), and normal brain imaging. It usually occurs in adults but rarely can be seen in children. We report a 7-year-old child with a manifestation of increased intracranial tension after the measles vaccine, associated with bilateral sixth nerve palsy and bilateral facial palsy with lower motor neuron features. Normal magnetic resonance imaging and CSF results were normal, except for an increase in CSF pressure. The symptoms began to be resolved after lumbar puncture with the complete resolution of symptoms after one and half months. We add also acetazolamide at the proper dose to reduce intracranial pressure from the first day of diagnosis.