ABSTRACT
Hemophagocytic syndrome or hemophagocytic lymphohistiocytosis (HLH) is a rare but potentially fatal disease caused by dysregulated activation of macrophages against one's blood cells. Major pathologic feature of HLH is hemophagocytosis. We present a case of HLH complicating methotrexate toxicity in a 65-year-old psoriatic patient with history of renal disease. Diagnosis of HLH was established as he fulfilled five out of eight HLH diagnostic criteria. This case report is presented to enlighten clinicians about the clinical entity of HLH and to suspect and recognize this rare and generally fatal disease at the earliest.
ABSTRACT
BACKGROUND: Maxillofacial trauma is any physical trauma to the facial region, commonly encountered by maxillofacial surgeons, and is often associated with high morbidity. Maxillofacial injuries can occur as an isolated injury or may be associated with multiple injuries in other parts of the body. AIM: This study aims to assess the patterns, etiology, and management outcomes of maxillofacial trauma in a teaching hospital in Chennai, South India, over an 8-year period. METHODS: Patients with maxillofacial injury were identified using the department database and clinical records. Nine hundred and forty-four patients were identified with maxillofacial trauma in the Department of Oral and Maxillofacial Surgery between January 2009 and December 2017. RESULTS: The mean age of the patients was 30 ± 12 years. Of the 944 patients with maxillofacial injuries, 64% had isolated lower face (mandibular) fractures, followed by isolated midface fractures (19%). Road traffic accidents were the most common form of etiology for trauma. CONCLUSION: The etiology and pattern of maxillofacial injuries reflect the trauma patterns within the community and can thus provide a guide to help design programs toward prevention and treatment.
ABSTRACT
AIM: The purpose of this study was to clinically and radiologically assess and compare the outcome of internal orbital reconstruction with an iliac bone graft and mandibular symphysis graft in orbital blow out fractures. MATERIALS AND METHODS: Eight consecutive patients with unilateral orbital blow out fractures were enrolled in this prospective study. CT scan imaging and volumetric assessment of the orbit was done for all patients using GE Discovery VCT Workstation 4.4. Patients with defect of area less than 2 cm(2) and orbital volume expansion of less than 4.7 cm(3) were treated with mandibular symphysis graft, in contrast the others were treated with a medial cortical graft from the anterior ilium. At each follow-up visit, globe posture, diplopia, and eye movements were assessed. Coronal and sagittal computed tomography and volumetric assessment were used to observe graft posture, bone defects and contour. RESULTS: Group I cases showed that orbital volume changes of less than 2cm(3) can be effectively reduced. Group II cases showed that orbital volume changes of more than 4.5 cm(3) could not be effectively restored in spite of using large iliac graft. All eight patients had satisfactory correction of hypoglobus. Diplopia and ocular motility restriction resolved in all affected patients post operatively between 4(th) day and 2(nd) week. At 3-month follow-up, computed tomography demonstrated that the middle section of the orbital floor was well elevated in all 8 orbits. All grafts were still in situ, with density measured in Hounsfield units revealed that the Mandible Symphyseal graft was denser. CONCLUSION: The mandibular symphysis graft is a good, simple reconstructive option in small orbital floor defects with orbital volume change less than 4.71 ml. In larger defects with huge orbital volume changes that require more volume of graft, iliac graft is useful albeit, perfect, volumetric restoration is not always possible.
