Anterior lamellar corneoscleral keratoplasty for the management of corneal thinning following treatment with mitomycin-C and interferon to treat highly suspected ocular surface squamous neoplasia: a case report

ABSTRACT A patient presented with corneoscleral thinning five months after the treatment of suspected ocular squamous surface neoplasia with mitomycin-C and interferon. For tectonic and aesthetic purposes, we decided to perform lamellar corneoscleral transplantation. The approach used established new tectonic support and corneal homeostasis. This technique might be an option in similar cases.

Acidente crotálico seguido por primeiro episódio psicótico: um folclore clínico / Rattlesnake bite accident followed by first psychotic episode: a clinical folklore / Accidente crotálico seguido de primer episodio psicótico: un folclore clínico

Introdução: Acidentes ofídicos são doenças negligenciadas e constituem uma parcela importante da morbidade de pessoas em idade produtiva que vivem em zonas rurais. A maior parte dos seus efeitos a curto prazo é amplamente conhecida, especialmente aqueles de natureza clínica; no entanto, ainda se observa lacuna importante do conhecimento das consequências a longo prazo de tais agravos, notadamente as de ordem psíquica. Este artigo relata um caso de adoecimento mental subsequente a um acidente crotálico e gera reflexões de âmbito cultural e fisiopatológico a respeito das sequelas de tais eventos. Apresentação do caso: Trata-se de adolescente residente no interior baiano que foi vítima de mordedura por cascavel e teve necessidade de hospitalização em unidade de terapia intensiva. Observou-se que, mesmo após melhora clínica, iniciou com sintomas psicóticos prodrômicos e progrediu para piora mental grave, que culminou em internação psiquiátrica e diagnóstico de esquizofrenia no decorrer dos meses seguintes. Conclusões: Nota-se, neste caso, correlação direta entre esses dois eventos; mas, em razão da escassez de trabalhos científicos que abordem tais questões, depreende-se que é preciso investigar e estudar com maior profundidade possíveis associações entre acidentes crotálicos e psicoses.

Introduction: Snakebites are neglected diseases and constitute an important part of the morbidity of working-age people who live in rural areas. Most of their short-term effects are widely known, especially those of a clinical nature; however, there is still an important gap in the knowledge of the long-term consequences of such injuries, notably those of a psychotic nature. This article aims to report a case of mental illness subsequent to a rattlesnake bite accident and generate cultural and pathophysiological reflections regarding the consequences of such events. Case presentation: An adolescent residing in the interior of the state of Bahia was bitten by a rattlesnake and required hospitalization in an intensive care unit. It was observed that even after clinical improvement, the case started with prodromal psychotic symptoms and progressed to severe mental deterioration that culminated in psychiatric hospitalization and diagnosis of schizophrenia over the following months. Conclusions: In this case, there was a direct correlation between these two events, but because of the scarcity of scientific works that address such issues, it is necessary to investigate and study in greater depth possible associations between snakebite accidents and psychoses.

Introducción: Las mordeduras de serpientes son enfermedades desatendidas y constituyen una parte importante de la morbilidad de las personas en edad laboral que viven en zonas rurales. La mayoría de sus efectos a corto plazo son ampliamente conocidos, especialmente los de carácter clínico; sin embargo, todavía existe un importante vacío en el conocimiento de las consecuencias a largo plazo de este tipo de lesiones, en particular las de carácter psíquico. Este artículo tiene como objetivo informar un caso de enfermedad mental posterior a un accidente crotálico y generar reflexiones culturales y fisiopatológicas sobre las consecuencias de tales eventos. Presentación del caso: Se trata de un adolescente residente en el interior de Bahía que fue mordido por una serpiente cascabel y requirió hospitalización en unidad de cuidados intensivos. Se observó que, aún después de la mejoría clínica, comenzó con síntomas psicóticos prodrómicos y progresó a un deterioro mental severo que culminó con hospitalización psiquiátrica y diagnóstico de esquizofrenia en los meses siguientes. Conclusiones: En este caso, existe una correlación directa entre estos dos eventos pero, debido a la escasez de trabajos científicos que aborden tales cuestiones, parece necesario investigar y estudiar con mayor profundidad posibles asociaciones entre accidentes crotálicos y psicosis.

Relato de caso de lombalgia inflamatória com extenso comprometimento anatômico-funcional: a importância de uma adequada abordagem da dor lombar na Atenção Primária à Saúde / Case report of inflammatory low back pain with extensive anatomical-functional impairment: The importance of an adequate approach to low back pain in Primary Care / Presentación de un caso de lumbalgia inflamatoria con afectación anatómico-funcional extensa: La importancia de un abordaje adecuado de la lumbalgia en Atención Primaria de Salud

Introdução: A lombalgia é uma condição prevalente e que apresenta importante impacto na capacidade funcional e na qualidade de vida, sendo a sua correta abordagem na Atenção Primária à Saúde fundamental para a identificação e o estabelecimento de um diagnóstico etiológico precoce de possíveis patologias que possam estar relacionadas a desfechos mórbidos e a graves limitações funcionais. Apresentação do caso: Paciente de 56 anos, sexo masculino, hipertenso, foi encaminhado para serviço especializado de reumatologia com histórico de lombalgia havia mais de 20 anos. Ao exame físico foi constatada presença de deformidades da coluna vertebral e extensa limitação de movimentos. Exames radiográficos mostravam esclerose de articulações sacroilíacas, osteopenia difusa e coluna vertebral em aspecto de "bambu". Conclusões: Constata-se a importância de que na abordagem das lombalgias na atenção primária se busque o reconhecimento de possíveis etiologias graves e potencialmente incapacitantes que possam estar subjacentes à queixa de dor lombar. Com esse objetivo, é fundamental o reconhecimento das chamadas red flags relacionadas às lombalgias, além de sua caracterização como mecânica ou inflamatória. Perante a atuação da atenção primária no oferecimento de um cuidado pautado na integralidade e na prevenção de agravos, reafirma-se a importância de uma avaliação clínica pormenorizada das lombalgias nesse nível de atenção à saúde.

Introduction: Low back pain is a prevalent condition that has an important impact on functional capacity and quality of life, and its correct approach in Primary Care is fundamental to the identification and establishment of an early etiological diagnosis of possible pathologies that may be related to outcomes morbid conditions and serious functional limitations. Case presentation: 56-year-old male patient, hypertensive, referred to a specialized rheumatology service with a history of low back pain for over 20 years. Physical examination revealed the presence of spinal deformities and extensive movement limitations. Radiographic examinations showing sclerosis of the sacro-iliac joints, diffuse osteopenia and a "bamboo" appearance of the spine. Conclusions: It is important that in the approach of low back pain in Primary Care, we seek to recognize possible serious and potentially disabling etiologies that may underlie the complaint of low back pain. For that, it is essential to recognize the so-called "red flags" related to low back pain, in addition to its characterization as mechanical or inflammatory. Given the role of Primary Care in offering care based on integrality and in the prevention of injuries, the importance of a detailed clinical assessment of low back pain at this level of health care is reaffirmed.

Introducción: La lumbalgia es una patología prevalente que tiene un impacto importante en la capacidad funcional y la calidad de vida, y su correcto abordaje en Atención Primaria de Salud es fundamental para la identificación y establecimiento de un diagnóstico etiológico precoz de posibles patologías que puedan estar relacionadas con los resultados, condiciones morbosas y limitaciones funcionales graves. Presentación del caso: Paciente masculino de 56 años, hipertenso, remitido a servicio especializado de reumatología con antecedentes de dolor lumbar de más de 20 años. El examen físico reveló la presencia de deformidades de la columna y amplias limitaciones de movimiento. Los exámenes radiológicos muestran esclerosis de las articulaciones sacroilíacas, osteopenia difusa y una apariencia de "bambú" de la columna. Conclusiones: Es importante que al abordar la lumbalgia en Atención Primaria de Salud busquemos reconocer las posibles etiologías graves y potencialmente incapacitantes que pueden subyacer a la queja de lumbalgia. Con este objetivo, es fundamental reconocer las llamadas "banderas rojas" relacionadas con la lumbalgia, además de su caracterización como mecánica o inflamatoria. Dado el papel de Atención Primaria de Salud a la hora de ofrecer una atención basada en la integralidad y prevención de enfermedades, se reafirma la importancia de una evaluación clínica detallada de la lumbalgia en este nivel de atención sanitaria.

Rotura do peitoral maior: relato de caso de uma rotura incomum / Pectoralis major rupture: case report of an unusual rupture / Rotura del pectoral mayor: informe de un caso de rotura inusual

Apesar de não muito frequente, nos últimos 20 anos, houve um aumento significativo dos relatos sobre rotura do peitoral maior, normalmente associadas à prática de atividade física em que ocorre contração intensa e/ou uso de cargas pesadas exercendo resistência sobre o músculo. Neste relato de caso temos um paciente de 51 anos referindo dor no tórax à direita e no braço direito há 3 dias após tentar consertar o guidão da moto. Apresentava assimetria dos peitorais, perda de força do membro superior direito, dificuldade de movimentação e hematoma. A ressonância magnética demonstrou rotura completa da junção miotendínea do peitoral maior, com tendinopatia com fissuras insercionais e intrasubstanciais infraespinhal e tendinopatia com rotura parcial do tendão subescapular. Foi indicado por médico ortopedista o acompanhamento com o uso de medicação analgésica.

Although not very common, in the last 20 years, there has been a significant increase in reports of rupture of the pectoralis major, normally associated with the practice of physical activity in which intense contraction occurs and/or the use of heavy loads exerting resistance on the muscle. In this case report we have a 51-year-old patient reporting pain in his right chest and right arm for 3 days after trying to fix his motorcycle's handlebars. He had asymmetry of the pectorals, loss of strength in the right upper limb, difficulty moving and hematoma. Magnetic resonance imaging demonstrated complete rupture of the myotendinous junction of the pectoralis major, with tendinopathy with insertional and intrasubstantial infraspinatus fissures and tendinopathy with partial rupture of the subscapularis tendon. An orthopedic doctor recommended follow-up with the use of analgesic medication.

Aunque no es muy común, en los últimos 20 años se ha observado un aumento significativo en los reportes de rotura del pectoral mayor, normalmente asociado a la práctica de actividad física en la que se produce una contracción intensa y/o al uso de cargas pesadas ejerciendo resistencia sobre el mismo. el músculo. En este caso clínico tenemos un paciente de 51 años que refiere dolor en el pecho derecho y en el brazo derecho durante 3 días después de intentar arreglar el manillar de su motocicleta. Presentó asimetría de pectorales, pérdida de fuerza en miembro superior derecho, dificultad de movimiento y hematoma. La resonancia magnética demostró rotura completa de la unión miotendinosa del pectoral mayor, con tendinopatía con fisuras de inserción e intrasustancial del infraespinoso y tendinopatía con rotura parcial del tendón subescapular. Un médico ortopédico recomendó seguimiento con el uso de medicación analgésica.

Indolent systemic mastocytosis (ISM) without skin lesions as a recurrent anaphylaxis: a case report study.

Introduction and importance: Mastocytosis encompasses a diverse range of disorders characterized by the clonal accumulation of mast cells in various tissues, including the skin, bone marrow, and gastrointestinal tract. Case presentation: This case report describes a 32-year-old male patient who presented with a history of recurrent anaphylactic attacks and elevated serum tryptase levels without apparent skin involvement. The diagnostic process and clinical implications of non-cutaneous mastocytosis are discussed in the context of existing WHO criteria. Clinical discussion: Mastocytosis, although a rare disease, carries the potential for severe complications and can present with atypical symptoms, thereby complicating its diagnosis and management. Consequently, the development of a reliable diagnostic and therapeutic strategy is of paramount importance. Conclusion: There is a pressing need to delve deeper into the investigation of the potential impacts and manifestations of mastocytosis to further our understanding and enhance patient care.

Unveiling post-COVID-19 Rasmussen's encephalitis: a case report of rare neurological complication.

Introduction and importance: Rasmussen encephalitis (RE) is a rare autoimmune disorder that causes unilateral inflammation of the cerebral cortex and can lead to drug-resistant epilepsy and progressive neurological decline. Although the emergence of RE following COVID-19 has not been well documented, it emphasizes the need to understand the impact of COVID-19 on neurological health. This case emphasizes the importance of early recognition and intervention to prevent adverse outcomes related to post-COVID-19 neurological complications. Case presentation: A 30-year-old woman, recently diagnosed with COVID-19, experienced recurrent seizures that primarily affected the left side of her body. Despite medical management, signs of progressive weakness and altered consciousness were observed. Neurological examination, imaging, and electroencephalography confirmed a diagnosis of post-COVID-19 RE. Despite conservative management, the patient's condition continued to deteriorate, ultimately resulting in fatal outcomes. Clinical discussion: The relationship between COVID-19 and autoimmune responses, which can lead to neurological complications, such as RE, is a matter of concern. Accurate diagnosis of RE depends on imaging and EEG studies; however, a definitive diagnosis often requires histopathological examination. The management of RE involves the use of anti-seizure medications and surgical interventions to control symptoms and improve outcomes. However, the unusual presentation of this case, along with challenges in diagnosis and treatment, underscores the need for increased awareness and extensive research on the neurological consequences of COVID-19. Conclusion: This case underscores the severe neurological consequences that can emerge after COVID-19, emphasizing the need for prompt identification and intervention. Additional research is essential to improve the comprehension and management of the neurological aftermath of COVID-19 with the ultimate goal of enhancing patient outcomes.

Diagnosis and management of spontaneous coronary artery dissection: Two cases and a review of the literature.

Introduction and importance: Spontaneous coronary artery dissection (SCAD) is a rare but potentially fatal condition, often underdiagnosed despite its significance in acute coronary syndrome (ACS). The true prevalence remains uncertain due to diagnostic challenges. Identifying SCAD cases is crucial for reducing mortality and morbidity, especially considering the recurrence risk. The authors present two cases highlighting the importance of multimodality imaging in diagnosing and managing SCAD. Case presentation: Case 1: A 53-year-old man with a history of brain aneurysm presented with chest pain and shortness of breath. Despite negative EKGs and stress tests, coronary computed tomography angiography (CCTA) revealed non-obstructive dissection flaps. Medical management improved his condition.Case 2: A 55-year-old woman with no significant medical history experienced recurrent chest pain. Initial tests were negative, but CCTA revealed SCAD. Further screening uncovered undiagnosed fibromuscular dysplasia. Clinical discussion: SCAD poses diagnostic challenges, often mimicking other cardiac conditions. Traditional tests may yield negative results, necessitating advanced imaging techniques like CCTA. Recognizing SCAD's association with connective tissue disorders (CTD) is vital for comprehensive patient care. The authors' cases emphasize the importance of a systematic approach to diagnosing chest pain, including noninvasive modalities and considering underlying etiologies. Conclusion: SCAD diagnosis requires a high index of suspicion, especially when traditional cardiac tests are inconclusive. Beyond treatment, patients should undergo further evaluation for CTDs, particularly in those with minimal risk factors for atherosclerosis. Increased awareness and a multimodal diagnostic approach are crucial for timely intervention and improved outcomes in SCAD patients. Learning objectives: The authors aim to increase awareness regarding different clinical presentations of SCAD to decrease the risk of missed or late diagnosis. The authors' case series also signifies the multimodal imaging approach's role in evaluating chest pain. Upon diagnosis of SCAD, it is imperative to go beyond treatment and implement a reverse algorithmic strategy to discover any underlying causes and risk factors for SCAD predisposition.

A rare well-differentiated renal retroperitoneal liposarcoma: a case report.

Introduction and importance: Retroperitoneal liposarcomas (RPLPSs) are rare tumors that arise from mesenchymal cells in the peritoneum cavity. The sites of PRLPSs vary a lot, but renal PRLPSs are extremely rare (there are only 45 cases of Renal retroperitoneal liposarcomas on PubMed). In this case, the authors present a rare renal retroperitoneal liposarcoma case, describe the major concepts, and raise awareness about this rare tumor. Case presentation: A 44-year-old woman presented to the clinic with hirsutism and irregular menstruation; upon physical examination, a large abdominal mass was accidentally identified; the patient had Doppler ultrasound (Doppler US) and MRI, which both showed a mass arising from the right upper pole of the kidney, fine needle aspiration (FNA) confirmed the diagnosis of retroperitoneal liposarcoma, patient underwent surgical removal and her symptoms disappeared. Clinical discussion: The retroperitoneum is a cavity behind the abdominal wall containing organs like the pancreas and kidneys. Retroperitoneal tumors (RPTs) are rare neoplasms, primarily of mesenchymal origin. Retroperitoneal liposarcomas (RPLPS) are the most common RPT, often asymptomatic until large, and rarely metastasize but frequently recur. Liposarcomas are classified into five subtypes, with well-differentiated liposarcoma being the most common and characterized by high local recurrence. The presence of specific oncologic mutations affects the prognosis and the response to treatment. Conclusion: In rare cases, retroperitoneal liposarcomas can arise from sites near the kidney and compress the adjoining adrenal gland.

The effect of psychological and behavioral problems on the quality of life of children and adolescents based on self-reports and proxy reports.

PURPOSE: Investigations of the quality of life (QoL) of young people have shown that psychological and behavioral problems are associated with lower subjective well-being. The QoL ratings of children and adolescents based on self-reports and proxy reports are significantly different. The aim of the present study was to examine youth self-reported and parent proxy-reported QoL and investigate the effects of age, gender and psychological/behavioral symptoms on the QoL reports of youth. We hypothesized that self-reported emotional and anxiety problems influence self-reported QoL, while proxy-reported behavioral problems influence proxy reports of QoL. METHODS: The sample consisted of 284 parent-child pairs. Youths were between the ages of 11 and 18 years, the mean age was 14.3 (SD 2.1) years, and 35.6% were males. The Inventory of Life Quality (ILK) scale was used to measure QoL, and the Strengths and Difficulties Questionnaire was used to assess psychological and behavioral problems. RESULTS: Males had higher self-reported QoL than females, and younger children had better QoL than older children. Emotional peer problems and hyperactivity reported by youth and hyperactivity and conduct problems reported by parents predicted youth self-rated ILK. Only parent-reported psychological/behavioral problems predicted proxy-rated ILK. CONCLUSION: The evaluation of QoL of children and adolescents should involve both self and proxy reports in order to capture the effects of various psychological/behavioral symptoms and the perspectives of both youth and parents.

Primi at 16 weeks and 5 days of Gestation with Hypovolemic Shock Secondary to Ruptured Rudimentary Horn Ectopic Pregnancy: A Case Report.

ABSTRACT: Developmental anomalies of genital tract result from defective fusion and absorption of various parts of Mullerian ducts in fetal life. Rudimentary horn pregnancy (RHP) is a rare occurrence of one in 76,000 and one in 160,000. We present a case of a 24-year-old primigravida with ruptured RHP initially managed in the line of an intrauterine pregnancy with severe anemia. Hemodynamic instability made us suspect ruptured RHP and lifesaving laparotomy was performed for the same. A 1.5-liter hemoperitoneum was encountered with a right RHP. Multiple adhesions were present with necrotic tissue adherent and clumped together as tubo-ovarian mass. Resection of rudimentary horn was performed. We report this case to emphasize the need to consider rare uterine anomalies as a possibility in patients presenting with acute abdomen in early pregnancy. So, Obstetricians can consider these rare entities in differential diagnosis and management.

Post-operative Unilateral Visual Loss and Ophthalmoplegia following Cervical Spine Surgery in Prone Position: A Case Report.

ABSTRACT: Visual loss following a spine surgery in a prone position is a disastrous and irreversible complication. Moreover, the recommended treatment for such visual loss is lacking and the outcome is not so satisfactory. A 38-year-old gentleman developed profound right sided visual loss after an uneventful cervical spine surgery in a prone position that lasted approximately two and half hours. Immediate ophthalmic consultation was done and the case was diagnosed as right-sided central retinal artery occlusion. Despite the initiation of vasodilatation, anticoagulation, and adequate fluid infusion, satisfactory improvement was not achieved. Extensive review of pertinent literature highlighted limited efficacy of treatments for postoperative visual loss after prone spinal surgery, further emphasizing the importance of preventive measures as the cornerstone in such procedures.

[Combined epilepsy with generalized and focal seizures]. / Kombinált epilepszia generalizált és fokális rohamokkal.

Background and purpose:

Combined epilepsy (with generalized and focal seizures) is a recently accepted and yet underreported epilepsy type. We intended to review the literature of combined epilepsy and to report the individual findings of the 31 combined epilepsy patients in our database. Thereafter, we investigated the characteristics of the patients at the group level.

The individual findings of the 31 patients were tabulated. We characterized the group with special reference to epide­miology, timing and the sequence of gene­ralized and focal seizures, family history of seizures and severity of the electro-clinical phenotype. The variables were compared to those of the generalized epilepsy and the focal epilepsy groups of our database. We carried out statistical analyses by the two-sided Fishers’s exact test and the Kruskal-Wallis and post-hoc Dunn tests.

The prevalence of combined epilepsy was 1.56% within the total sample of the classifiable epilepsy patients. Females were affected more often than males (67.7% and 32.3%, respectively). Statistically significant associations emerged firstly between the “short interval” subgroup (where the generalized and focal seizures occurred with short time difference) and the lack of other cerebral abnormality, and secondly between the “long interval” subgroup (where 4 to 37 years elapsed between the occurrence of the two seizure types) and the presence of other brain abnormality (p = 0.02). The proportion of patients with positive family history of seizures was greater in the combined epilepsy- than in the generalized epilepsy group (p = 0.03) and the focal epilepsy group (p < 0.0001) of the database. The electro-clinical phenotype of the absence seizures showed more atypical findings (indicating poor prognosis) in combined epilepsy than in the generalized absence epilepsy patients of the database (p < 0,0001). Despite dissimilar patient selection and study design, our main findings were in accord with those of prior studies. The dissection of the combined epilepsy group into the “long interval” and “short interval” subgroups was a novel approach that highlighted the dissimilar pathogenetic and clinical correlates of each.

The case reports might facilitate the spread of information about combined epilepsy in the medical community. Analyses of the patients at the group level resulted in clinically useful pieces of evidence.

An unstable patient with a large sucking chest wound managed with gauze packing for preventing tension and bleeding control before surgery in Korea: a case report.

This case report describes the management of a 51-year-old female patient who arrived at the emergency room with a stab wound to the upper right chest. Immediate medical interventions were undertaken, including blood transfusions and endotracheal intubation. To prevent tension and control bleeding, gauze packing was applied directly through the large open wound. Further surgical exploration identified a laceration in the lung, necessitating a right upper lobe resection. Postoperatively, the patient's vital signs stabilized, and she was subsequently discharged without complications. This case highlights the decision-making process in selecting between an emergency department thoracotomy and an operating room thoracotomy for patients with penetrating chest trauma. It also illustrates the role of gauze packing in managing tension and hemorrhage. In summary, gauze packing can be an effective interim measure for stabilizing patients with traumatic injuries, unstable vital signs, and large open chest wounds, particularly when a chest tube is already in place, to prevent tension and facilitate bleeding control prior to surgical intervention.

Traumatic arterial thoracic outlet syndrome after multiple rib fractures not including the first rib in Korea: a case report.

Arterial thoracic outlet syndrome (TOS) resulting from thoracic trauma is an exceedingly rare condition, typically caused by a fracture of the first rib or clavicle. In this report, the author presents a case of traumatic arterial TOS precipitated by multiple left rib fractures, notably excluding the first rib, following a fall from a 2-m high stepladder. The patient was treated successfully with first rib resection via a transaxillary approach, and the postoperative course was uneventful. The literature includes no known reports of traumatic arterial TOS in patients with multiple fractures that spare the first rib, making this the first documented case of its kind. In this instance, the patient sustained fractures to the fourth and fifth ribs. The TOS was likely not a direct result of the multiple rib fractures, which were located some distance from the thoracic outlet. Rather, it is hypothesized that the trauma from these fractures caused a soft tissue injury within the thoracic outlet, which ultimately led to the development of TOS.

Relevance of the Watson-Jones anterolateral approach in the management of Pipkin type II fracture-dislocation: a case report and literature review.

Femoral head fractures with associated hip dislocations substantially impact the functional prognosis of the hip joint and present a surgical challenge. The surgeon must select a safe approach that enables osteosynthesis of the fracture while also preserving the vascularization of the femoral head. The optimal surgical approach for these injuries remains a topic of debate. A 44-year-old woman was involved in a road traffic accident, which resulted in a posterior iliac dislocation of the hip associated with a Pipkin type II fracture of the femoral head. Given the size of the detached fragment and the risk of incarceration preventing reduction, we opted against attempting external orthopedic reduction maneuvers. Instead, we chose to perform open reduction and internal fixation using the Watson-Jones anterolateral approach. This involved navigating between the retracted tensor fascia lata muscle, positioned medially, and the gluteus medius and minimus muscles, situated laterally. During radiological and clinical follow-up visits extending to postoperative month 15, the patient showed no signs of avascular necrosis of the femoral head, progression toward coxarthrosis, or heterotopic ossification. The Watson-Jones anterolateral approach is a straightforward intermuscular and internervous surgical procedure. This method provides excellent exposure of the femoral head, preserves its primary vascularization, allows for anterior dislocation, and facilitates the anatomical reduction and fixation of the fracture.

Experiencing cardiac arrest during surgical exploration in hemodynamically stable patients with multiple stab wounds, including lower extremity in Korea: a case report.

Stab wounds, particularly those affecting multiple body regions, present considerable challenges in trauma care. This report describes a case of sustained self-inflicted stab injuries to the abdomen and thighs of a 23-year-old male patient. Although the patient's vital signs were stable and bleeding was minimal from thigh wounds without overt signs of vascular injury, the patient experienced a sudden, profound hemorrhage from the right thigh, leading to cardiac arrest. Successful resuscitation was followed by surgical repair of a right superficial femoral arterial injury accompanying a resuscitative endovascular balloon of the aorta. Subsequent lower extremity computed tomography angiography revealed no additional vascular abnormalities. The patient was discharged in stable condition on the 12th postoperative day. This case underscores the unpredictability of stab wound trajectories and the potential for hidden vascular injuries, even in the absence of immediate life-threatening signs. It also emphasizes the critical role of advanced imaging modalities, such as computed tomography angiography, in identifying concealed injuries, and the importance of strategic intraoperative techniques, including resuscitative endovascular balloon occlusion of the aorta, in achieving favorable patient outcomes.

A step-by-step intraoperative strategy during one-stage reconstruction of an acute electrical burn injury in the neck for superior surgical outcome in India: a case report.

Electrical burn injuries can cause more damage than clinical evaluations initially suggest. The energy waves penetrate from the surface to the deepest layers of tissue, causing extensive harm at every level. The neck is a critical area, both functionally and aesthetically. We present a case involving a young male patient with a severe fourth-degree electrical burn on the neck, who underwent a single-stage debridement and reconstructive surgery. The pectoralis major myocutaneous flap is a versatile option for various head and neck reconstructions. However, if the donor site cannot be closed primarily and requires split-thickness skin grafting, it can result in unsightly scars and deformities. For large flap paddles, it is ideal to reconstruct the secondary defect with locoregional flaps. In this case, we successfully reconstructed the donor site's secondary defect using a contralateral internal mammary artery perforator flap, without resorting to any skin grafts. The early postoperative results demonstrated satisfactory cosmesis, patient satisfaction, and functional outcomes.

Pneumoperitoneum from vaginal cuff dehiscence following blunt trauma in a patient with a history of robotic hysterectomy in Korea: a case report.

Pneumoperitoneum usually presents as a surgical emergency, especially in patients with a history of trauma. However, we recently encountered an atypical case of pneumoperitoneum at a hysterectomy site following blunt trauma, indicating that immediate laparotomy may not always be necessary. In this report, we present the case of a 45-year-old woman who was transferred to our trauma center from a local hospital after being involved in a traffic accident the day before. Although she underwent an emergency laparotomy, no bowel perforation was detected. Instead, a rupture was found at the site of a hysterectomy that had been performed 8 months earlier. After repairing the hysterectomy site, the pneumoperitoneum resolved, and the patient was subsequently discharged without further complications.

Misinterpretation of a skin fold artifact as pneumothorax on the chest x-ray of a trauma patient in Korea: a case report.

Misinterpreting radiographic findings can lead to unnecessary interventions and potential patient harm. The urgency required when responding to the compromised health of trauma patients can increase the likelihood of misinterpreting chest x-rays in critical situations. We present the case report of a trauma patient whose skin fold artifacts were mistaken for pneumothorax on a follow-up chest x-ray, resulting in unnecessary chest tube insertion. We hope to help others differentiate between skin folds and pneumothorax on the chest x-rays of trauma patients by considering factors such as location, shape, sharpness, and vascular markings.

Treatment of a penetrating inferior vena cava injury using doctor-helicopter emergency medical service and direct-to-operating room resuscitation in Korea: a case report.

Inferior vena cava (IVC) injuries can have fatal outcomes and are associated with high mortality rates. Patients with IVC injuries require multiple procedures, including prehospital care, surgical techniques, and postoperative care. We present the case of a 67-year-old woman who stabbed herself in the abdomen with a knife, resulting in an infrarenal IVC injury. We shortened the transfer time by transporting the patient using a helicopter and decided to perform direct-to-operating room resuscitation by a trauma physician in the helicopter. The patient underwent laparotomy with IVC ligation for damage control during the first operation. The second- and third-look operations, including previous suture removal, IVC reconstruction, and IVC thrombectomy, were performed by a trauma surgeon specializing in cardiovascular diseases. The patient was discharged without major complications on the 19th postoperative day with rivaroxaban as an anticoagulant medication. Computed tomography angiography at the outpatient clinic showed that thrombi in the IVC and both iliac veins had been completely removed. Patients with IVC injuries can be effectively treated using a trauma system that includes fast transportation by helicopter, damage control for rapid hemostasis, and expert treatment of IVC injuries.