Open Access Case Report

Adolescent Female Patient with Hip Pain: Slipped Capital Femoral Epiphysis (SCFE)

Aung Kyi Winn, Htay Lwin, Zay Yar Naing, Khine Lynn Phyu

International Journal of Medical and Pharmaceutical Case Reports, Page 1-7
DOI: 10.9734/IJMPCR/2017/35178

SCFE is the most common hip disorder affecting the young age between 8 and 16 year old. The prevalence of SCFE is 10 per 100,000 children. The incidence of SCFE is more on boys than girls.

We would like to report a case of SCFE with different clinical presentation. A 13-year-old girl presented with the history of pain in the left hip for 1 year and limping for 4 months. The left hip pain became worsened over the last few months together with development of the limping. The pain was also associated with stiffness of the left hip joint and she was unable to squat on the left side. Physical examination including ROM (Range of Movement) and orthopaedic testing were done. X ray and CT scan were done. Patient was diagnosed with SCFE.

The patient was subsequently treated successfully with In situ fixation. The small incision was made near the left hip and the slipped femoral head was gently rotated and then a screw was inserted to stabilize the bones in their places.

This case is selected for reporting because the incidence of SCFE in girls lower than boys and unusual presentation in this patient because the patient came to hospital after one year and 4 months.

Open Access Case Report

Arterial Vascular Complications after Total Knee Arthroplasty Decrease the Quality of Post-op Rehabilitation (A Case Report)

Ivet Koleva, Frederic Milvoy, Borislav Yoshinov

International Journal of Medical and Pharmaceutical Case Reports, Page 1-8
DOI: 10.9734/IJMPCR/2017/35909

Introduction: Routinely patients with hip or knee arthroplasty are transferred from acute clinic to rehabilitationdepartment at an ever earlier stage (one week post-op).

The most frequent complications after lower extremity arthroplasty are: local pain, edema, contracture, tardive calcification, infection, hemorrhage, pulmonary embolism and deep vein thrombosis. Sometimes unexpected complications can provoke a delay or even suspension of the rehabilitation.

Aims of the Study: The principal objective of the current article is to remind to the wide public the possible presence (and subsequent care) of other complications, e.g. the lower limb arteritis.

Case Presentation: The presented patient is 77 years old male. Hospitalized in our PRM Department one week after operation, with the objective of post-op orthopedic rehabilitation after total knee arthroplasty (for advanced gonarthrosis - genu varum with angle 4°). Arterial Echo-Doppler of the lower extremities: Acute thrombosis of the left femoral superficial arteria, and the left popliteal supra-articular arteria (aneurysm of 30 mm), missing images of retro & supra-articular popliteal arteriae. Urgent operation was needed for the left leg diagnosed with Arteritis: femoro-peroneal distal pontage in the intern saphenous vein with angioplasty of the distal anastomosis.

Discussion: In every case our goal is to prevent possible complications and to assure a high quality of the rehabilitation.

Conclusion: Vascular complications after joint replacement can postpone or even interrupt the fluency of the rehab process. In every clinical case the PRM & OT medical doctors must be immediately alerted of any suspicion for complication or significant variation in expected progression / outcomes.

Open Access Case Study

Ultrasound-Assisted Pulsed Radiofrequency Targeting the Dorsal Root Ganglion for Intractable Postherpetic Neuralgia with Lumbar Radicular Pain

Minsoo Kim, Byoungjoo Park, Choonghyo Kim, Taeyoon Jeong, Innam Kim, Tsongbin Chang, Hyunho Seong, Byeongmun Hwang

International Journal of Medical and Pharmaceutical Case Reports, Page 1-7
DOI: 10.9734/IJMPCR/2017/36315

Aims: We report the successful use of ultrasound-assisted pulsed radiofrequency (RF) treatment of the L2 dorsal root ganglion (DRG) for intractable post-herpetic neuralgia (PHN) with lumbar radicular pain, wherein ultrasound-guided pulsed RF targeting of the lumbar DRG was effective in providing satisfactory pain relief.

Case Presentation: An 86-year-old man suffering from intractable PHN for over a year was referred to our pain clinic. The chronic pain radiated into the superior medial thigh of the right leg ever since the onset of herpes zoster. Physical examination revealed dynamic allodynia with scarred skin on the right medial thigh. In spite of repeat epidural blocks, the duration of therapeutic effect was not prolonged. Therefore, we decided to attempt ultrasound-assisted RF treatment of the L2 DRG for intractable PHN with lumbar radicular pain. Ultrasound-guided pulsed RF targeting of the lumbar DRG provided satisfactory pain relief. Following the procedure, the visual analogue pain score decreased from 7 to 1 and remained constant even after 6 months.

Conclusion: Pain physicians should consider pulsed RF for lumbar DRG since this method appears to offer long-lasting therapeutic effects for intractable PHN with lumbar radicular pain.

Open Access Case Study

Gingival Overgrowth Associated with Phenytoin Therapy: Report of a Case

Kavita Nagar, R. Poornima, G. P. Sujatha, L. Ashok

International Journal of Medical and Pharmaceutical Case Reports, Page 1-6
DOI: 10.9734/IJMPCR/2017/36322

Gingival overgrowth (also called gingival hyperplasia, or gingival hypertrophy) refers to an increase in the size of the gingiva. It is seen as an adverse effect of drugs such as anticonvulsants, immunosuppressants, and calcium channel blockers. Phenytoin is a commonly used anticonvulsant for treatment of epilepsy. Phenytoin-induced gingival overgrowth is a well-known and frequently reported gingival disease. The pathogenesis of phenytoin-induced gingival overgrowth is multifactorial. The phenytoin-induced gingival overgrowth (PIGO). is noticed first in the interdental papilla region which gradually coalesce extending along the labial, lingual, and coronal aspect. In severe cases, it may cover the entire anatomic crowns of teeth. These changes are most apparent in the anterior part of the mouth. The gingiva appears dense, resilient, and stippled, giving a beaded appearance. The color ranges from pink to a deep bluish red depending on the amount of inflammatory infiltrate present in the gingival tissues and secondary inflammation by local factors may induce edema, ulcerations and bleeding. Providing suitable drug substitution often brings about the partial or complete regression of the lesion and can be considered after a physician consult. However, in severe enlargements surgical gingival resection is required. Hereby, a case of phenytoin induced gingival overgrowth is reported which showed a substantial reduction in gingival growth after substitution of phenytoin therapy by phenobarbitone for treatment of epilepsy.

Open Access Case Study

Mucinous Neoplasm of the Appendix – An Incidental Histopathologic Finding after Appendectomy Due to the Acute Appendicitis – Case Report

Jurij Janež, Klemen Mihelčič

International Journal of Medical and Pharmaceutical Case Reports, Page 1-4
DOI: 10.9734/IJMPCR/2017/36692

This paper presented a case of a male patient, who was referred from the gastroenterology unit to our department for an emergency surgery due to an acute appendicitis with suspected perforation as shown on the abdominal computed tomography scan. The patient underwent a laparoscopic appendectomy. Samples of the appendix were sent to the pathology department and the histopathological diagnosis was a low-grade appendiceal mucinous neoplasia with perforation.