Journal of the College of Physicians and Surgeons--Pakistan : JCPSP
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J Coll Physicians Surg Pak · Jan 2023
Case ReportsOmphalomesenteric Duct Fistula: A Rare Manifestation of Omphalomesenteric Duct Anomalies.
Omphalomesenteric duct (OMD) anomalies occur as a result of resorption failure during gestation. Various forms of OMD anomalies are documented depending upon the degree of resorption (complete or partial) including Meckels diverticulum, fistulas, fibrous bands, and cysts to umbilical polyps. Among these, Meckels diverticulum is the most common of these anomalies, and omphalomesenteric duct fistula (OMF) is the most rare. ⋯ We report a rare case of a 10-day male neonate who presented with umbilical swelling and discharge. This case is presented to highlight the occurrence of this extremely rare phenotype to raise a high index of suspicion and awareness among healthcare providers. Key Words: Omphalomesenteric duct fistula, Umbilical swelling, Sinogram.
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J Coll Physicians Surg Pak · Jan 2023
Case ReportsA Suspected Case of COVID-19 with High Altitude-associated Massive Pulmonary Embolism and Right Ventricular Clots.
Pulmonary Embolism (PE) is an elusive entity that has long baffled physicians. At times, it can present as a diagnostic and therapeutic challenge. The aim of this report is to emphasise that high altitude is one of the risk factors for PE. ⋯ A high index of suspicion is required for the diagnosis and management of PE. If standard imaging techniques cannot be used due to clinical constraints, ancillary techniques must be effectively employed during management. Key Words: Pulmonary embolism, Thrombolysis, High altitude, COVID-19.
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J Coll Physicians Surg Pak · Jan 2023
Case ReportsAnaesthetic Management of a Child with Propionic Acidemia.
Propionic acidemia (PA) is an inherited autosomal recessive disorder of metabolism caused by a deficiency of propionyl CoA carboxylase, an enzyme that catalyses the conversion of propionyl CoA (PCA) to methylmalonyl CoA, inside the mitochondria, leading to inadequate metabolism of propionyl CoA causing hyperammonemia and metabolic acidosis. Children with PA require dextrose infusion to avoid protein catabolism. This child presented with severe metabolic decompensation and required urgent venous cutdown as there was a failure in establishing a peripheral intravenous line. Key Words: Propionic acidemia, Propionyl CoA, Emergency, Mitochondrial disorder, Organic acidemias.
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J Coll Physicians Surg Pak · Jan 2023
Case ReportsUnusual Allergic Reaction to Intralesional Bleomycin in Periocular Haemangioma.
Capillary haemangiomas are the most common periocular tumours among children. Most of them resolve spontaneously. The most common indication for intervention is visual impairment. ⋯ Here, we report a highly unusual case of a severe allergic reaction to the fourth dose of intralesional bleomycin injection in a periocular haemangioma in a 7-year child. The clinical features and subsequent management of the patient are also discussed. Key Words: Anaphylaxis, Intralesional bleomycin, Periocular haemangioma.
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J Coll Physicians Surg Pak · Jan 2023
Case ReportsType B Aortic Dissection Converted into Type A Aortic Dissection.
A young patient presented to the emergency room (ER) with Type B aortic dissection and ascending aorta aneurysm. He was planned for medical optimization, close surveillance, echocardiography, and ascending aorta replacement on an urgent basis. His surveillance echocardiogram 2 days later revealed that Type B aortic dissection has converted into Type A aortic dissection. ⋯ A 25-sized SJ aortic valve- conduit was used for root replacement. The patient did very well and got discharged from the hospital on the sixth postoperative day. Key Words: Type A aortic dissection, Aortic root and ascending aorta aneurysm, Type B aortic dissection.