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  • ISSN: 2373-9819
    Volume 5, Issue 1
    Case Report
    Anand Manthal*, Sandeep Reddy, Krishna Prasad, Sreeramulu PN, and Amit Mittal
    Introduction: Duodenal obstruction is related to the orifice of the bile duct in 83% of the cases. 50% of cases of duodenal atresia have a true atresia, 40% cases have a duodenal diaphragm with or without central opening and 10% cases show stenosis [1]. Duodenal diaphragm develops due to failure of vacuolation of the proliferating epithelial lining of the duodenum [2]. Congenital obstruction of the duodenum accounts about one half of all the intestinal obstruction seen in the new born.
    Case report: Full term female baby presented with multiple episode of vomiting, refusal of feeding and not gaining weight with severe dyselectrolytemia. Surgical intervention through excision of duodenal diaphragm with transverse closure of the duodenum (excision with duodenoplasty) was done along with post-operative balanced nutritional support.
    Conclusion: Early diagnosis, surgical intervention, use of total parenteral nutrition and adequate investigations for congenital anomalies may improve the outcome.
    Shirin Shahnaseri, Amirhossein Moaddabi, Parisa Soltani*, and Sobhan Pourarz
    As defined by World Health Organization, Central Giant Cell Granuloma (CGCG) is an intraosseous lesion consisting of cellular fibrous tissue that contains multiple foci of hemorrhage, aggregations of multinucleated giant cells, and occasionally trabeculae of woven bone. Management of CGCG varies from a simple curettage in nonaggressive cases to complex surgical options in more aggressive forms. Several non-surgical treatment protocols have been suggested based on various biologic behavior of giant cell granuloma including Interferon therapy, administration of calcitonin or steroids. In this case a conservative treatment consisting of curettage and calcitonin therapy was administered in the treatment of a large CGCG lesion to prevent consequences of radical resection.
    Ingo Schmidt*
    A 72-year-old female presented with a 4-year history of a giant lipoma of the thenar region extending up into the first web space with size of 7 x 3 x 3 cm that was accompanied with entrapment of all peripheral branches of the median nerve and loss of function of long fingers I-III. The benign tumor could be completely excised after careful dissection of all palmar finger nerves I-III. Six months after surgery, the function and sensitivity of all affected fingers were completely restored.
    Michael G. Ross*
    Background: With an anterior placenta at Cesarean section, obstetricians often will transect the placenta to deliver the infant. Occasionally (e.g., malpresentation, low station), infants are not rapidly delivered and severe neonatal anemia/hypovolemia may result. Options for the prevention of fetal bleeding may be life saving.
    Case: At the time of Cesarean section, an anterior placenta was transected to enter the uterine cavity. With difficult elevating the fetal head, the infant was delivered 6 minutes following uterine incision. The infant demonstrated severe anemia and acidosis, and died following attempted resuscitation.
    Conclusion: Ultrasound placental location may facilitate blunt dissection around the placenta rather than transection, as fetal blood loss may be life threatening. Although counterintuitive, in utero umbilical cord clamping may prevent exsanguination with minimal hypoxic consequences.
    Teaching points:
    1. With knowledge of placental location, clinicians should consider blunt dissection around an anterior placenta rather than sharp or blunt placental transection.
    2. In cases in which the placenta is transected, and when there is difficulty delivering the infant, rapid clamping of the umbilical cord in utero will minimize potential fetal hemorrhage with minimal hypoxic consequences.
    Precise: If Trans section of the placenta is required at Cesarean section, in utero umbilical cord clamping prior to delivery may prevent exsanguination with minimal hypoxic consequences.
    Arda Kiani, Atefeh Abedini*, Fatemeh Yasari, Davood Mansouri, and Raziyeh Abooshahab
    Sarcoidosis is a chronic, multi-systemic disease with granulomatous condition and unknown etiology. Hypercalcemia is an uncommon medical condition which may arise as a consequence of a reduced renal excretion, hyperparathyroidism and cancer. Here, we report a case of 50-years old man with renal failure associated with sarcoidosis. Clinical manifestation and histological sections are also presented.
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