Hyperglycaemia-Related Visual Seizure.

Introduction: Visual seizure is one of the rare complications of poorly controlled chronic hyperglycaemia. This condition can be debilitating for patients. Early recognition and careful control of hyperglycaemia is vital. Case description: A middle-aged female was found collapsed at her home after missing insulin for several days. She was found to have diabetes ketoacidosis (DKA) and she was started on treatment for DKA. She reported visual hallucinations in the right side of her visual field for a week. Further assessment with EEG and brain MRI suggested an occipital seizure consistent with metabolic disturbances. She was initially started on antiepileptic medication. After strict diabetes control, her symptoms resolved, and she no longer needed antiepileptic treatment. Conclusion: Experiencing diabetes-related seizures can be terrifying both for patients and their family. Early recognition and quick control of hyperglycaemia is important in treating these patients. LEARNING POINTS: Hyperglycaemia can present with different symptoms of osmotic imbalance including seizures.All patients presenting with visual seizures should be investigates for all metabolic abnormalities including hyperglycaemia.Correction of hyperglycaemia can improve clinical symptoms as well as physical and psychological well-being of patients.

Modified Borggreve-Van Nes-Winkelmann rotationplasty for surgery in developing countries.

BACKGROUND: Amputation is still the most common therapy for patients suffering from osteosarcoma in Myanmar, despite the fact that limb salvage surgery e.g. Borggreve-Van Nes-Winkelmann rotationplasty for malignant tumors located within the distal femur or proximal tibia is the current state-of-the-art reconstructive procedure. A safe and reliable operation technique is crucial in order to perform a complex surgical procedure like the rotationplasty in lower-middle income economies with limited infrastructure and resources. The authors present seven cases of patients with osteosarcomas that received a Borggreve-Van Nes-Winkelmann rotationplasty with an evaluation of the procedures focusing on safety and sustainability. METHODS: From 2019 until 2020, seven young patients with osteosarcomas of the distal femur or proximal tibia were treated with Borggreve-Van Nes-Winkelmann rotationplasties in the Orthopaedic Hospital in Mandalay, Myanmar. As modification of the standard procedure the dissection and subsequent clamping of the femoral artery in order to minimize blood loss as well as the formation of an adipocutaneous flap that minimizes swelling and decreases the pressure on the vessels were successfully performed. This modified procedure resembles a safe and simplified surgical technique that is feasible under the circumstances of lower-middle income economies with good outcomes. RESULTS: All patients showed good functional and aesthetic results. One of the seven patients needed secondary wound closure due to wound dehiscence. CONCLUSIONS: A simplified and safe operation technique for the performance of the Van Nes-Borggreve rotationplasty was adapted to the given constraints in lower-middle income economies and proved to be successful. Trial registration All patients approved to participate in the study and have given consent to publication.

Cor Triatriatum and Recurrent Thromboembolic Stroke.

A woman with recurrent thromboembolic stroke was found to also have cor triatriatum. When the patient first presented with weakness, she was thought to have ischaemic stroke because she had conventional risk factors, but she was later confirmed to have cor triatriatum. The main method of treatment is surgery. However, if surgery is contraindicated, anticoagulation can be used as second-line treatment, but this can be difficult. This report describes the follow-up of a middle-aged female patient with cor triatriatum over 6 years during which she experienced multiple strokes despite different methods of anticoagulation. LEARNING POINTS: Cor triatriatum is a rare heart condition which may not be detected by routine transthoracic echocardiography and so requires transthoracic echocardiography and CT angiography.Surgical membrane resection is the main treatment option but thromboembolic stroke should be considered when surgery is not possible.Anticoagulation may not be as effective at preventing embolic stroke in this rare heart defect as it is in other conditions.