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INTRODUCTION: Plexiform neurofibromas (PNs) are characterized by their diffuse masses with tortuous expansion along nerve branches. While surgery is the primary management for PNs, the optimal surgical approach remains unestablished. CASE PRESENTATION: A 35-year-old lady presented with a large hanging mass covering the medial aspect of the thigh and the leg. It caused discomfort, disfigurement, and occasional pain. The patient was planned for the debulking surgery under spinal anesthesia. Incisions were given on the normal-looking skin adjacent to the mass, through the skin layers, subcutaneous tissue and deep fascia until the muscles were seen. The mass was then approached and elevated in the subfascial plane (relatively avascular). Large, dilated, dense tortuous vessels could be seen in the suprafascial and subcutaneous planes. Maximum area that could be removed was marked and excised. The normal contour of the left lower extremity was restored close to achieving a thigh and a leg lift. DISCUSSION: PNs pose surgical challenges due to their vascularity and difficult locations. The subfascial debulking approach presented in the case aims to reduce intraoperative hemorrhage by avoiding highly vascular areas and preventing entry into blood sinuses within the neurofibromatous tissue. This technique also minimizes the risk of inadvertent injury to nearby neurovascular structures. CONCLUSION: The proposed subfascial approach, significantly reduces intraoperative hemorrhage during the debulking of a PN.
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Introduction: Chilaiditi's sign is a rare radiological sign characterized by interposition of the colon between diaphragm and liver. It is called Chilaiditi's syndrome if the patient presents with associated symptoms. Its diagnosis is incidental and can be confused with other acute conditions. Case presentation: This is a case of 85-year-old gentleman who presented with complaints of epigastric pain and vomiting. The patient had a history of long-term antidepressant medications. X-ray of chest and abdomen revealed presence of bowel loops under the diaphragm. CT scan helped confirm the diagnosis of Chilaiditi's sign. Discussion: Chilaiditi's sign has a low prevalence on chest and abdominal X-rays. Common associated symptoms include abdominal pain, nausea, vomiting and constipation. It can be misdiagnosed as bowel perforation and can lead to unnecessary surgical interventions. Symptomatic patients are managed conservatively. Conclusion: Chilaiditi's syndrome is a rare radiological entity and should be diagnosed carefully to avoid unwanted surgical procedures.
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Introduction: Anti NMDAR encephalitis is a neuropsychiatric syndromic disease caused by an immunological response. Acute behavioral changes, psychosis, and catatonia are common clinical manifestations, are seizures, amnesia, speech difficulties, dyskinesia, and autonomic dysregulation. Case presentation: We discuss the case of a 14-year-old girl who had psychotic symptoms and tested positive for anti-NMDAR antibodies. Discussion: Patients present with psychiatric symptoms such as delusions, hallucinations, agitation, changes in speech mania, disorganized thinking, catatonia, insomnia, and often seizures. Anti-NMDAR encephalitis should be suspected in teenage patient with acute psychotic symptoms and seizure episodes. A multidisciplinary treatment strategy is required. Conclusion: The delayed treatment can lead to complications and delayed recovery complicating the disease process so multidisciplinary approach of treatment is necessary.
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INTRODUCTION: Stereopsis is defined as the ability to perceive object depth. It is measured in seconds of arc. Reduced stereoacuity impinges one's academic as well as a professional performance. Hence in this study, we aim to find out the mean stereoacuity among the undergraduate medical and nursing students using the Titmus fly test. METHODS: A descriptive cross-sectional study was conducted among undergraduate students at a medical college of Nepal from April 2021 to July 2021. Ethical approval was obtained from the Institutional review committee (Registration number: 487 (6-11) E2 077/078). Simple random sampling method was used. Data were collected from undergraduate medical and nursing students while the post-graduate students were excluded from the study. Overall, 80 students were included in the study. Titmus fly test was used to assess the stereopsis. Statistical Package for Social Sciences version 21 and Microsoft Excel was used for data analysis. Point estimate at 95% confidence interval was calculated along with mean, standard deviation, frequency, and proportion. RESULTS: The mean stereoacuity was 62.63±46.56 (range 40-800) sec of arc (52.77-72.49 at 90% Confidence Interval). A total of 80 participants in our study among which 50 (62.5%) were male and 30 (37.5%)were female. About 41 (51.2%) of the study participants had normal, borderline (>40 and ≤ 120) stereopsis was seen in 35 (43.8%) of the study participants while only 4 (5%) had reduced stereopsis (≥120 sec of arc). CONCLUSIONS: This study showed that the mean stereoacuity among the undergraduate medical and nursing students was in subnormal range which was similar to other studies.
Subject(s)
Students, Medical , Students, Nursing , Cross-Sectional Studies , Depth Perception , Female , Humans , Male , Tertiary Care Centers , Visual AcuityABSTRACT
This case demonstrates pneumothorax as a consequence of COVID-19 and emphasizes the significance of follow-up of the COVID-19 patients.