Open Access Case Study

Celiac Artery Stenting without Guide Catheter: Bare Wire Stenting

Ayhan Olcay, Vedat Ertunc, Elif Gumus

International Journal of Medical and Pharmaceutical Case Reports, Page 82-86
DOI: 10.9734/IJMPCR/2015/18739

Chronic mesenteric ischemia is the most common vascular disorder of the intestines though it is rarely observed in daily clinical practice. Presence of multiple collateral arteries between the superior mesenteric artery and the inferior mesenteric artery is the most likely explanation for the infrequent occurrence of chronic mesenteric ischemia in clinical practice. Atherosclerosis is the most common cause of chronic mesenteric ischemia. The increased utilization of computed tomography and magnetic resonance imaging of abdominal vasculature has increased the diagnosis of the atherosclerotic mesenteric stenosis. Chronic mesenteric ischemia is a clinical diagnosis; it is based upon symptoms and should be supported by anatomic findings. Endovascular therapy has been increasingly utilized for chronic mesenteric ischemia, furthermore early outcomes compare favorably with open mesenteric bypass. Our case study depicts a female patient aged 69 years presenting with post-prandial abdominal discomfort that results in significant weight loss. We here present a case of celiac artery stent restenosis treated by percutaneous transluminal angioplasty and later stenting over bare. 035 inch hydrophylic wire without a guide catheter or sheath because guide catheter was damaged at distal end and stent was not advancable through guide catheter.

Open Access Case Study

Gastric Outlet Obstruction as an Initial Presentation of Stage IV Colon Cancer Successfully Treated with Only Surgery with 4 Year Survival- A Case Study

T. Gavrancic, V. Jain, D. Sharma, K. Simeunovic, Ava Anklesaria

International Journal of Medical and Pharmaceutical Case Reports, Page 87-91
DOI: 10.9734/IJMPCR/2015/17179

Introduction: Gastric outlet obstruction (GOO) is an unusual initial presentation of locally advanced colorectal cancer (CRC).
Case Description: A 76-year-old male presented with nausea, vomiting, and weight loss. Physical exam was remarkable for cachexia and epigastric tenderness. Blood analysis was remarkable for microcytic anemia. CT scan of abdomen revealed a soft tissue mass surrounding the pylorus of the stomach and a concentric mass-like thickening in the transverse colon with lymphadenopathy. Colonoscopy revealed a partially obstructive and fungating mass in the transverse colon. Biopsy confirmed invasive adenocarcinoma. The patient underwent extensive surgery. However, due to a poor performance status, he did not receive adjuvant chemotherapy. He continues to survive 4 years post-surgery, without any evidence of recurrence.
Conclusion: Surgical resection of locally advanced stage IV CRC causing acute GOO in the patient with poor performance status can lead to prolonged disease free survival in individual cases after curative surgery, even without adjuvant chemotherapy.

Open Access Case Study

Stevens-Johnson Syndrome Treated with Ozone Hemo Therapy: A Case Report

Lamberto Re, Giuseppe Malcangi, Oriano Mercante, Cristina Gagliardi, Nadia Rampoldi

International Journal of Medical and Pharmaceutical Case Reports, Page 92-96
DOI: 10.9734/IJMPCR/2015/18947

We report a case of Stevens-Johnson Syndrome treated with ozone autohemotherapy. The patient had been diagnosed with Stevens-Johnson syndrome 3 months before admission to our clinic by the treating physician. There was ulceration of the buccal, nose and ocular mucosa (varying grade). Previous treatment with antiviral and anti-inflammatory drugs was done without any apparent result. The patient received a total of eight major autohemotherapies, with treatments administered every third day. We start with a first infusion of blood treated with low ozone doses followed by vitamin C 7.5 g. After the first treatment the patient showed a sudden relief of symptoms and the ulcers disappeared. The treatment was repeated to reach a stable condition and a follow up of six months showed the complete healing of the patient.

Open Access Case Study

A Rare Coexistence; Scaphoid and Triquetral Fracture without Perilunate Dislocation

Hakan Koray Tosyali, Erdem Cevik, Yahya Ayhan Acar, Banu Karakus Yilmaz, Demir Demirci, Tackin Ozalp, Guvenir Okcu

International Journal of Medical and Pharmaceutical Case Reports, Page 97-100
DOI: 10.9734/IJMPCR/2015/18748

The scaphoid is the most commonly fractured carpal bone, accounting for approximately 68 % of all carpal fractures. Triquetral fractures are the second most common carpal bone fracture and are usually ligamentous avulsion fractures. The aim of this paper is to report the co-existence of scaphoid and triquetral fractures with an adult patient.
Case: A twenty one years old man was admitted to the emergency department after falling on an outstretched hand. He was complaining about a mild pain in his wrist. There was swelling and tenderness of the anatomic snuff box and ulnar aspect of wrist, decreased range of motion in flexion and extension. X-ray showed fractures at both scaphoid and triquetral bones. Computed tomography showed that proximal fracture of scaphoid and fracture at triquetral body. The scaphoid fracture was treated with internal fixation and any complication was not observed.
Conclusion: Triquetral fractures are associated with carpal instability and there is an increased risk of avascular necrosis for scaphoid fractures. Emergency physicians should be careful at wrist injuries because of accompanied unclear fractures.

Open Access Case Study

A Case of QT-interval Prolongation in the Context of High-dose, Intravenous Midazolam in a Methadone Maintained Patient

Lena Jellestad, Lea Stocker, Josef Jenewein, Soenke Boettger

International Journal of Medical and Pharmaceutical Case Reports, Page 101-104
DOI: 10.9734/IJMPCR/2015/18840

The following case illustrates a case of significant prolonged QT-interval (QTc) prolongation following intravenous administration of high-dose midazolam in a patient with severe hyperactive delirium. A prolonged QTc represents a potentially life-threatening condition associated with Torsades de Pointes (TdP) and sudden cardiac death (SCD). Although the predictive value of a prolonged QTc and the occurrence of TdP and SCD has not yet been fully established, heightened awareness in medicine and psychiatry has arisen with respect to the administration of psychotropics. Benzodiazepines, although known to prolong the QTc, have been considered as rather safe medications with this respect. For example, low-dose midazolam has not been shown to cause QTc prolongation. In the following case, however, high-dose midazolam caused a significant prolongation of the QTc, which has to date, not yet been reported.