Suppurative Flexor Tenosynovitis of the hand is a rapid spreading condition with significant morbidity effect on hand function. The avascular nature of the tendon sheath has its disadvantage of limiting the host immune system response towards bacterial invasion and proliferation. Immunosuppression from conditions like diabetes predisposes the occurrence of the condition. A 39 year old housewife presented with signs and symptoms of left middle finger flexor tenosynovitis with distal wet gangrene. Extensive drainage and amputation of the gangrenous digit was done, with subsequent healing albeit minimal residual functional impairment. The case highlights the importance of early detection and appropriate referral of flexor tenosynovitis cases so that early aggressive intravenous antibiotics and surgical debridement and irrigation can be performed to avoid the preventable complication of digital necrosis and subsequently amputation. Literature review was done to explain the pathophysiology, determine the poor prognostic factors and outcome of this condition.
Introduction: Klippel Trenaunay is a Neurocutaneous syndrome Mesodermal abnormality syndrome characterized by clinical trial of (1) portwine stain due to capillary malformation, (2) bone and soft tissue hypertrophy; and (3) varicose veins.
Presentation of Case: 57 years old male presented to our hospital in outpatient department with history of asymptomatic port wine stain over right ear, right upper extremity, right side of thorax anteriorly and posteriorly, over both sclera and both legs present since birth with history of varicose veins over left leg and hypertrophy of limbs. We report a rare case of bilateral multi-extremity Klippel Trenaunay syndrome.
Discussion: Klippel Trenaunay Syndrome is a sporadic non-heriditary rare mesodermal abnormality that usually affects a single lower limb. It is characterized by a triad of varicose veins, port wine stain, bony and soft tissue hypertrophy of the affected limb. Klippel and Trenaunay described the association of the three findings in 1900. In minority of patients an upper extremity is affected. Infrequently patients have involvement of both limbs on one side and rarely all 4 extremities will be affected.
Conclusion: Patients with Klippel-Trenaunay syndrome (KTS) should be monitored at least annually and more often if clinically indicated. Stable disease can be followed clinically. KTS is not always a static disease process. Our patient had all the three features of the syndrome and the involvement was bilateral involving multiple extremities, which is rarely seen.
The development of the internal carotid artery (ICA) begins at the 3-4 mm embryonic stage and acquires its mature shape by the end of the fourth week. Complex reconstruction of the terminal segment of the dorsal aorta and the third aortic arch underlies the formation of primordial ICA. Failure of this process leads to agenesis of the ICA in one of its seven segments with the following absence of the distal part of the vessel.
Due to the plasticity of the cerebral circulation, the majority of people with agenesis of the ICA manage to stay asymptomatic. However, some geometric patterns of the compensatory blood flow are predisposed to failure, resulting in susceptibility to the development of aneurysms, ischemic attacks, and accidental arterial dissections.
The wide-spread use of modern visualizing techniques allowed registration of quite a number of such cases, allowing systematic analysis and clinical evaluation of settled types of the collateral cerebral circulation and clinical tendencies in patients with agenesis of the ICA. Here, we report a case of unilateral agenesis of the ICA and additionally expose the results of systematic clinical analysis of 45 similar patients reported since 2000.
Introduction: Traumatic Brain Injuries (TBI) is random and unpredictable complication of deployment, and its presentations vary depending on the etiological factors and perhaps frequency of exposure to such factors. Organic psychosis is a well recognized presentation of Chronic Traumatic Encephalopathy (CTE) and symptoms include mood and behavioral disturbances, progressive decline of memory and executive functioning, cognitive deficits and sometimes dementia, if early intervention is not instituted. The rationale for this report is perhaps to highlight the need for early involvement of a psychiatrist in behavioral disorders with highly suspected organic etiologies as this may significantly reduce cases of missed diagnosis.
Case Presentation: 45 year old private soldier, who returned from Operation Lafia Dole, in Maiduguri, which is code name for the counter insurgency operations against Boko Haram insurgents, referred from the 2 Brigade Medical Reception Service with complains of abnormal behavior, low mood, weepy spells, sleeplessness, with poor response to psychotropic medications. CT-SCAN revealed Subdural Hematoma with hypodense lesions. Was subsequently referred to the University of Port Harcourt Teaching Hospital (UPTH) for Burr hole draining, which was done with good outcome.
Conclusions: Psychiatric symptoms like depression, psychosis and apathy, are common in neurological disorders that affect the brain and this contributes to the suffering and disability of the patients. Diagnostic puzzle can occur which can be resolved with Neuro-imaging.
Aims: The use of levetiracetam, a second-generation anti-epileptic drug, is increasing due to its favorable side effect profile and lack of drug interactions. Limited data exist to guide dosing during continuous venovenous hemofiltration (CVVH). Therefore, we present a case in which the pharmacokinetic characteristics of levetiracetam were evaluated in a patient with acute kidney injury on CVVH.
Presentation of Case: A 72 year old male in status epilepticus was started on levetiracetam 1000 mg intravenously once followed by 500 mg every 12 hours. Pre-filter-replacement CVVH was performed with a blood flow of 250 ml/min and a fluid replacement rate of 1.5-2 L/hr. Levetiracetam maximum and minimum concentrations were collected in both the serum and CVVH effluent with the first dose and third dose. CVVH clearance (CLCVVH) accounted for 50.8% of total clearance (TC) (0.23-0.3 and 0.59-0.62 ml/min/kg, respectively).
Discussion: This is the first study to measure levetiracetam concentrations in effluent fluid, which allow for a more detailed pharmacokinetic analysis, including the CLCVVH and its contribution to TC. Even though our patient was on pre-filter-replacement CVVH with fluid replacement rates of 1.5-2 L/hr (equivalent to a creatinine clearance (CrCl of approximately 23-29 ml/min)), TC was more consistent with that seen in a patient with mild kidney disease, or a CrCl of 50-80 ml/min.
Conclusion: This case demonstrates that levetiracetam is efficiently removed by CVVH and suggests that patients may require higher doses than what the estimated creatinine clearance based on CVVH flow rate would otherwise predict.