Entering the fractured tracheotomy tube into the left bronchus, a case report

Background and Purpose: Tracheostomy is a second selective approach to management the upper respiratory tract obstructions after intubation and used in patients who require long-term ventilation. This article reports a rare complication, entering the fractured tracheostomy tube into the left bronchus

The Patient: A 74-year-old man with a large hematoma in the right frontal lobe, Craniotomy surgery and evacuated of hematoma was done. A Patient's metal tracheostomy tube fractured and entered into the left bronchus that is a rare complication. The ICU staff immediately recognized and ENT specialist removed the fractured tube with rigid bronchoscopy

Conclusion: Fracturing of the Tracheostomy tube is one of the rare complications that need careful examination before the tubes used and applying the standard tracheostomy tube Should be considered

Report of a rare case of unprescribed long-term use of dexamethasone injection for 20 years

Background and Purpose: Most corticosteroids are dose- and duration-dependent. Dexamethasoe has been the highly used drug in the country in the last years, and can produce a pseudokushing syndrome if use in the long run. In the present paper, we will report a case of dexamethasone use for twenty years

The Patient: The patient is 52-year old man, married but has no child; he has started injecting dexamethasone 30 years ago; he keeps cattle and has a farm too. The patient was hospitalized first with a diagnosis of drug-resisitant brucellosis in Jovein, Iran. Laboratory tests indiated anemia, leukocytosis, hypocalemia, hypocalcemia and hyponathremia; he was discharged from the hospital four days later. Two days later, he was referred to neurocerebral surgeon due to backache, lower and upper limbs numbness, and walking disorder with a diagnosis of spastic quadriparesia and babinsky. Sixteen days after that, he underwent a total laminectomy surgery of C3-C6 with the diagnosis of cervical myelopathy. He had already been hospitalized in Mashad, Iran for a fever of unknown causes two years before that, and cataract surgery of both eyes

Conclusion: Long-term use of dexamthasone has caused six hospitalizations, diagnostic measures, medical interventions and surgical procedures for the patient reported here

report of a very rare case: situs inversus totalis in a 14-year-old boy

Situs inversus or situs transversus is a rare congenital condition where abdominal organs are positioned in a transverse manner, as in front of a mirror. Its prevalence is less than one in 10,000. This paper is intended to report one such case. A fourteen-year-old boy referred to the clinic with complaints of leftward abdominal pain beneath the navel, nausea and vomiting. Early diagnosis of acute appendicitis was made after clinical examinations, laboratory tests and sonography. Radiography reports revealed the shift of heart to the right of chest, confirming the diagnosis of Dextrocardia. Gastric bubble and spleen were observed on the right and liver and cholecyst on the left with sonography. Pancreas was also positioned on the opposite side. LLQ results indicated acute appendicitis on the left. Clinical findings and paraclinic measures rendered the certain diagnosis of situs inversus totalis. The patient finally underwent left appendectomy. Normally, situs inversus is accompanied with dextrocardia and major vessels dislocation and its prognosis is good. This condition with levocardia is less common and amounts to one in 22,000, with a likelihood of increasing congenital cardiac diseases. In the reported case, no particular problem came up after surgery. Inverted anatomical condition and the atypical history of situs inversus make the early diagnosis difficult in these patients. Accurate history and clinical examinations and reliance on imaging techniques in traumatic cases can reduce and minimize medical errors in treating such rare cases