RESUMO
Heterotopic pregnancy involves the coexistence of both an intrauterine and an extrauterine pregnancy occurring simultaneously. The spontaneous incidence of heterotopic pregnancy in the general population has been estimated to be 1/30,000. This report discusses the case of a 37-year-old female who presented to the emergency department with vaginal bleeding and lower abdominal pain. Upon workup, a transabdominal and transvaginal ultrasound demonstrated a heterotopic pregnancy with an estimated gestational age of seven weeks. The ultrasounds confirmed an intrauterine pregnancy with fetal cardiac activity and a fetal pole along with a right adnexal ectopic pregnancy with fetal cardiac activity and a fetal pole. Additionally, a right paratubal cyst was incidentally found. The patient subsequently underwent exploratory laparotomy with a right salpingectomy for the removal of the right tubal pregnancy and a right paratubal cyst. This case denotes the significance of a carefully performed ultrasound examination, especially in the early weeks of pregnancy. Even when a standard pregnancy is visualized with ultrasound examination, it remains imperative for the examiner to meticulously examine the adnexa and interstitial portion of the fallopian tube. A heterotopic pregnancy has the potential to be life-threatening and can often go undetected, resulting in missed diagnoses.
RESUMO
Brachial plexus palsy is a complex neuropathy associated with traumatic injuries, inflammatory processes, and tumors. In this report, we present an unusual case of brachial plexus palsy in a 72-year-old man with a history of chronic alcohol abuse. The patient presented to the emergency room with left arm weakness following a fall under the influence of alcohol that resulted in prolonged immobilization. An initial neurologic exam identified paralysis, numbness, and pain in the left upper extremity; however, further studies confirmed the absence of acute fractures or evidence of compartment syndrome. This case highlights the potential for alcohol intoxication and prolonged immobilization, in the absence of traumatic injury, as a contributing cause of brachial plexus palsy. Furthermore, this case emphasizes the importance of considering alternative causes of brachial plexus injury for prompt diagnosis and treatment.
RESUMO
Diabetic foot ulcers represent a significant complication of diabetes mellitus, characterized by mechanical changes of bony architecture often leading to chronic wounds with increased risk of infection and impaired healing. Morganella morganii, a Gram-negative bacterium, is one of the pathogens found in infected diabetic foot ulcers. It is a human gastrointestinal commensal organism that may cause widespread deadly infections. This report discusses the case of a 76-year-old male with diabetes mellitus who presented with M. morganii diabetic foot ulcer to an in-patient rehabilitation facility. Despite conventional wound care and antibiotic therapy, the ulcer failed to improve. The management approach for this patient consisted of a rehabilitation modality called Vaporox, a machine that utilizes vaporous hyperoxia therapy (VHT), as it combines ultrasonic mist and high concentration of oxygen to fasten revascularization and healing. This case highlights the potential efficacy of VHT as an adjunctive therapy for the management of diabetic foot ulcers, particularly those complicated by pathogens, such as M. morganii.