Surgical Blowhole Incision - An Unconventional Approach to Subcutaneous Emphysema Management Following Blunt Neck Trauma.

Subcutaneous emphysema is the fortuitous entry of air into subcutaneous tissue. Its occurrence in the head, neck, and mediastinum is a result of trauma or surgery. This case describes a 45-year male who presented with massive progressive subcutaneous emphysema, spreading from the peri-orbital area to the upper mediastinum, secondary to tracheal injury following blunt trauma sustained two days before presentation. We present this case to emphasize on simple management and observation of minor laryngo-tracheal trauma which can prevent further unexpected complications. In this case, we used an unconventional approach of making blowhole incision which is not in routine practice. Key Words: Subcutaneous emphysema, Blowhole, Neck trauma.

Resilience Through Squamous Cell Carcinoma and Rhabdomyosarcoma of Oral Cavity: A Unique Case Report.

Rhabdomyosarcoma (RMS) is a soft tissue neoplasm of mesenchymal origin. It is a commonly encountered malignant tumor amongst pediatric patients, yet relatively rare in adults. It usually involves the head and neck region, genitourinary organs and retroperitoneal structures. In adults, the most commonly affected area is the head and neck region. We present here a case of a 30-year-old male patient with a primary squamous cell carcinoma of the tongue (T1, N0, M1), successfully cured with surgery and chemoradiotherapy and later on development of metachronous ipsilateral lesion on the left lower alveolus. Biopsy was consistent with spindle cell RMS. Immunohistochemistry demonstrated positivity for desmin, vimentin and myogenin, thus confirming the mesenchymal origin. With the best of our literature search, this is an exceptional case presenting two malignant lesions with diverse genetic origins, diagnosed at stage 1 and giving a favorable outcome.

Weight gain and hypertension at three years of age and older in extremely low birth weight infants.

OBJECTIVE: To determine the prevalence and weight gain as a risk factor of hypertension (HTN) at three years of age and older among extremely low birth weight (ELBW) infants. STUDY DESIGN: Retrospective cohort study of all ELBW infants born and followed up at our institution over 15 years. RESULTS: 204 infants were followed up for [median (inter-quartile range)] 10.2 years (6.9-13.0). Their birth weight and gestational age were (mean±standard deviation) 758±149 g and 26.4±2.1 weeks respectively. At 3 years of age and older, the prevalence of HTN was 7.3% (15/204), and the prevalence of obesity was 13.2% (27/204). Obesity was more prevalent in children with than without HTN [33% (5/15) vs. 12% (22/189); p = 0.01]. In a regression analysis, body mass index (BMI) percentile at 3 years of age and older (p = 0.04) and increase in weight Z scores since birth (p = 0.008) were associated with a higher systolic blood pressure (SBP; R = 0.386, p <  0.001). CONCLUSION: Obesity is prevalent in ELBW infants at three years of age and older, and it is significantly associated with hypertension. An increase in BMI percentile at ≥3 years of age, and the rate of weight gain since birth among ELBW infants are associated with an increase in SBP.

Haemorrhagic stroke after thrombolysis with streptokinase.

A 54 years old male presented with central chest pain for five hours in a local hospital, Comilla. He was diagnosed as a case of acute STEMI (Extensive Anterior) and was thrombolized with Streptokinase 1.5 million IU. His pain was relieved, ST segment was depressed by >50% after thrombolysis. While in hospital, he developed weakness of his left limbs with gradually deteriorating level of consciousness. A CT scan of brain showed haemorrhage in the right frontoparietal region. This is a rare case of haemorrhagic stroke after thrombolysis with streptokinase.

Hereditary ADAMTS 13 deficiency presenting as recurrent acute kidney injury.

We report here a case of 26-year-old male who presented with history of recurrent acute renal failure associated with microangiopathic hemolytic anemia and thrombocytopenia. ADAMTS 13 deficiency due to mutation in the gene encoding for ADAMTS 13 was identified as the cause. After eight episodes of acute kidney injury (AKI), patient started developing hypertension, proteinuria, and renal insufficiency. Treatment with regular monthly plasma infusions prevented further episodes of AKI and stabilized the renal function. Hypertension and proteinuria are controlled with angiotensin II receptor blockers.

Cytogenetic characterization of sarcomas of bone and soft tissues.

Specific chromosome rearrangements in different types of solid tumors have been described recently in a number of studies. However, the frequency and diagnostic importance of these chromosome rearrangements are currently under intensive investigation. The objective of this study is to provide a preliminary report on the types of clonal chromosome abnormalities observed in sarcomas of bone and soft tissues. Included in this report are osteosarcoma (five), synovial sarcoma (three), Ewing sarcoma (two), leiomyosarcoma (one), and spindle cell sarcoma (one). Cytogenetic analysis revealed clonal chromosome rearrangements in all of the tumors studied. Our findings correlated well with previously reported cytogenetic data on various types of solid tumors.