RESUMO
Sirenomelia is a rare congenital anomaly characterized by the presence of a median single lower appendage. The affected fetus is popularly referred to as a “Mermaid baby,” due to the uncanny resemblance to the fictious fable character. The manifestation is a result of the merger of the lower limbs with variable fusion or complete absence of bones. Sirenomelia is universally fatal due to the associated lethal anomalies involving the internal organs, which are usually part of the VACTER or VACTERL complex. However, this sirenomelia-afflicted fetus is unique in being associated with VACTERL as well as congenital hydrocephalus.
RESUMO
Duodenal gangliocytic paragangliomas are rare neoplasms often arising in the duodenum in close proximity to the ampulla of Vater. These neoplasms are considered to have a benign behavior with lymph node metastases being a rare phenomenon and distant metastases even more so. Although a standardized treatment has not been determined, a margin-free tumor resection seems to be the best treatment modality. We report herein the case of a 36-year-old female who presented with abdominal pain and was found to have a polyp in the second part of duodenum which was excised endoscopically. Histopathology and immunohistochemistry revealed characteristic features of this rare tumor.
RESUMO
Background: Alpha-2 agonists are added to local anesthetic agents to extend the duration of peripheral nerve blocks. Objective: We evaluated the effect of combining dexmedetomidine with levobupivacine with respect to duration of motor and sensory block and duration of analgesia. Material and Methods: Sixty patients of ASA grade I or II aged between 18-60 years, posted for elective upper limb surgeries were enrolled for a prospective, randomized, double-blind study. Patients were divided into two groups, the control group B and the study group BD. In group B (n = 30), 30 ml of 0.325% levobupivacaine + normal saline; and in group BD (n = 30), 30 ml of 0.325%levobupivacaine + 1μg/kg dexmedetomidine were given for ultrasound guided supraclavicular brachial plexus block. Duration of motor and sensory block and time to first rescue analgesia were recorded. Results: Demographic profile and surgical characteristics were similar in both groups. The onset times for sensory and motor blocks were significantly shorter in BD group (p < 0.05), while the duration of sensory and motor blocks and duration of analgesia (DOA) was significantly longer in BD group. Heart rate level and SBP and DBP levels in group BD were significantly lower 15-20 min after block (p< 0.05). Bradycardia was observed in two patients in the group BD. No other adverse effects were observed in either of the groups. Conclusion: Dexmedetomidine added as an adjuvant to levobupivacaine for supraclavicular brachial plexus block significantly shortens the onset time and prolongs the duration of sensory and motor blocks and duration of analgesia.
RESUMO
Wegener's granulomatosis is a multisystem disorder involving small- and medium-sized vessels, leading to granuloma formation and involvement of upper and lower respiratory tract with or without glomerulonephritis. However, limited forms of angiitis and granulomatosis of the Wegener's type with oligosymptomatic and atypical site involvement are known to occur. We present here a rare case of limited form of angiitis and granulomatosis of Wegener's type who presented sequentially with spontaneous resorption of digits with acro-osteolysis and mononeuritis multiplex over a period of 10 months. His vasculitic workup revealed high proteinase 3 antibodies (c-ANCA) titers and an almost asymptomatic lung involvement, detected on high-resolution computed tomography of chest. The patient was aggressively treated with immunosuppressive therapy, following which he showed good improvement.