Open Access Case Study

Compartment Syndrome in Hand Related to Streptokinase: Full Recovery after Fasciotomy

Thiago Andrade Macedo, Antônio Cláudio do Amaral Baruzzi, Pedro Gabriel Melo de Barros e Silva, Jose Carlos Teixeira Garcia, Marcio Campos Sampaio, Roberto Nery Dantas Jr, Liliane Gomes da Rocha, Bernardo Baptista da Cunha Lopes, Luciana de Padua Silva Baptista, Valter Furlan

International Journal of Medical and Pharmaceutical Case Reports, Page 1-4
DOI: 10.9734/IJMPCR/2016/21752

Aims: The use of fibrinolytic for the treatment of patients with ST segment elevation myocardial infarction (STEMI) reduces mortality but is associated with an increased risk of bleeding, especially when are performed in combination with invasive procedures.

Presentation of Case: A 58-year-old woman transferred due to STEMI was submitted to fibrinolytic therapy (streptokinase: 1,500,000 units). Despite improvement in symptoms and ECG findings, the patient developed sudden pulmonary congestion requiring noninvasive ventilatory support. Despite the risk of bleeding, the medical team who provided initial care decided to perform a radial arterial puncture to collect a blood sample for gas analysis due to clinical instability. When the patient arrived in our Emergency Department, she had an extensive hematoma in the right hand after the radial puncture reducing perfusion and venous return with edema and blisters. The patient was submitted to urgent ventral and dorsal fasciotomy with improvement in distal perfusion and complete recovery of the functional status of the hand is 30 days.

Discussion: This kind of compartment syndrome is associated with risk of necrosis and hand amputation. The vascular surgeon was urgently convoked and the approach with rapid surgery, reversal of hemostasis with blood products, and dressing series allowed the functional recovery of the hand without re-occurrence. This risk should be taken into account by the physicians when an invasive procedure is considered hours after the use of a fibrinolytic. In case of a similar complication, an urgent approach with fasciotomy can be associated with great clinical results in 30 days.

Conclusion: This case demonstrates serious post-puncture complications of radial artery with a risk of necrosis and hand amputation. This procedure should be avoided after recent administration of fibrinolytic therapy. Fasciotomy performed early allowed full recovery of the hand.

Open Access Case Study

Seven Year Survival After Multiple Recurrences and Repeated Metastasectomies with Targeted Therapies for Renal Cell Carcinoma

Erkan Arpaci, Selcuk Ergen, Yasemin Bakkal Temi, Burak Bahadir, Huseyin Engin

International Journal of Medical and Pharmaceutical Case Reports, Page 1-6
DOI: 10.9734/IJMPCR/2016/21419

Background: In spite of resistance and limited response to chemotherapy, radiotherapy and immunotherapy, recent advances led to several targeted agents that showed the prolongation of progressive free survival. Due to these facts, surgical resection of multiple recurrences may be worthwhile in selected patients with kidney cancer.  

Case Report: We report a case of a 47-year-old man who underwent nephrectomy for T4N0 RCC, clear cell type, Fuhrman grade 2/4 in 2007. The patient afterward had multiple tumor recurrences. He underwent four metastasectomies, including liver, skin, rectum and scalp. And he received immunotherapy and multiple lines biological targeted treatments. He remains stable for 7 years after initial diagnosis.

Conclusion: In patients with metastatic RCC, recurrent resections can be achieved safely and giving biological drugs may prolong survival. Close follow-up is important for the early detection of recurrence and complete resection of metastases can improve the outcomes of patients.

Open Access Case Study

The Histological Diversities of Granular Cells in Ameloblastoma- A Diagnostic Quandary

H. S. Sreeshyla, Usha Hegde, Vidya Gowdappa Doddawada

International Journal of Medical and Pharmaceutical Case Reports, Page 1-5
DOI: 10.9734/IJMPCR/2016/20502

Granular cells are the histological components in various odontogenic and non-odontogenic tumors of the oral cavity. Among the odontogenic tumors they are seen in granular cell ameloblastoma, plexiform granular cell odontogenic tumor, central granular cell odontogenic tumor earlier called as granular cell ameloblastic fibroma or central granular cell odontogenic fibroma, calcifying epithelial odontogenic tumor and granular cell odontogenic cyst. We report two cases of ameloblastoma showing granular cells, with questionable categorization of the lesion.

Open Access Case Study

A Case Report of Community Acquired Pneumonia Due to Multi-drug Resistance Pseudomonas aeruginosa Treated with Elores

Danish Menon

International Journal of Medical and Pharmaceutical Case Reports, Page 1-5
DOI: 10.9734/IJMPCR/2016/21765

Community-acquired pneumonia (CAP) is a common and potentially serious illness associated with considerable morbidity and mortality, particularly in patients infected with Multidrug resistance (MDR) Gram-negative bacilli. After S. pneumoniae, Pseudomonas aeruginosa is the second most common pneumonia causing pathogen followed by K. pneumoniae and S. aureus in India. An alarming rise in the incidence of bacteria resistant even to last resort of antibiotics in recent years, forced clinicians to change antibiotic treatment options in pneumonia. Here we discuss a case of CAP infected with MDR Pseudomonas aeruginosa which is resistant to carbapenems and successfully treated with a new antibiotic adjuvant entity (AAE); ELORES (Ceftriaxone + Sulbactam with adjuvant Disodium edetate).

Open Access Case Study

Are We Missing Any Other Components of Saint Triad?

Jayabal Pandiaraja, Arumuguam Sathyaseelan

International Journal of Medical and Pharmaceutical Case Reports, Page 1-5
DOI: 10.9734/IJMPCR/2016/22364

Saint triad consists of colonic diverticulosis, gall stone and hiatus hernia. But there are reports of colonic diverticulosis with cardiomyopathy. This is a case report of Saint Triad with dilated cardiomyopathy and duodenal diverticulosis. So all patients who fall under Saint Triad have to undergo upper gastro intestinal endoscopy to identify duodenal diverticulum apart from hiatus hernia and echo cardiography to identify cardiomyopathy as a part of screening.