A RARE CASE: AN ADVANCED STAGE HEPATOCELLULAR CARCİNOMA PATİENT PRESENTED WİTH MULTİPLE SPLENİC METASTASES SUMMARY: Hepatocellular carcinoma is the most common primary liver tumor and it is one of the most common cause of deaths in patients with cirhosis. İt’s histopathologic diagnosis is difficult because biopsy usually couldn’t perform due to risc of bleeding. Clinicians especially diagnose it with radiologic and clinical parameters of patient. Splenic metastases are rarely conditions. But when its present we should make an examination for finding primary tumor.
The consciousness that affects the size and mass effect must be operated in order to decrease the intracranial pressure and prevent death. Intraparenchymal hematoma posttraumatic Patients with diffuse axonal injury is a problem unique in that traumatic damage is microscopic and not visible on CT scanning. Diffuse axonal axonal injury difuzaInjurie Patients with diffuse axonal injuries have stretched severe brain damage. The goal of treatment in these cases is to prevent other secondary intracranial lesions increased intracranial pressure and cerebral edema decrease. Intracranial pressure monitoring practice in patients with diffuse axonal injury and GCS under 8.
Safe and effective airway management is the foundation of quality anaesthetic practice. Securing and maintaining the airway is top priority of every anesthesiologist. Endotracheal intubation remains gold standard for this purpose, which requires special training and skills like mask holding, oxygenation, laryngoscopy etc. Intubation process is not without airway complication.1, 2 Misplaced tracheal tubes in difficult circumstances outside operating room may cause brain damage or death of patient. Katz et al reported that up to 25% of endotracheal tubes inserted by paramedics in emergency were found to be improperly placed.3 Supraglottic airway devices (SAD’s) have revolutionized airway management since the invention of the LMA Classic™ (LMA North America Inc., California, USA) by Dr Archie Brain in 1988.
Rotational anomalies are one of the most frequent of embryonic malformations related to the digestive tract. The incidence of malrotation is ∼1:500 births and the symptomatic incidence is 1:6000 [1, 2]. Intestinal malrotation refers to incomplete midgut rotation and fixation in early fetal life and can consist of complete absence of rotation, incomplete rotation—less than 270—or inverse rotation. In most cases Malrotation can present with other congenital anomalies and It is typically diagnosed during the first year. We report a rare case of malrotation with LADD band presenting in an 11 year old girl accompanying intrinsic duodenal stenosis and annual stenosis.
DISCUSSION The Main anesthetic goal in Intraocular surgery is the maintenance of a stable intraocular pressure, as the sudden raise in Intraocular pressure during open eye surgery can cause prolapse of iris or lens and vitreous loss leading to permanent loss of vision. Conventional laryngoscopy with general anesthesia is usually practised in paediatric patients coming for Intraocular procedure. This causes sympathetic stimulation with resultant increase in IOP, with associated raise in MAP & HR. There are few studies conducted in children to compare the effect of insertion of LMA with endotra-cheal intubation on IOP. But there are a number of studies done on adults, to confirm that LMA serves as an effective alternative to endotracheal intubation.
External periocular soft tissue and determine global integrity must be done before proceeding ocular functioning test. Some signs of possible globe rupture are 360of subconjunctival hemorrhage, misshapen pupil (peaked, corectopia), and at anterior chamber. If the globe is intact, the next most important exam element is the eye pressure. A slit-lamp examination can be another way to further evaluate the cornea and retina. With a slit-lamp associ- ated injuries such as corneal abrasions, lens dislocations, hyphema, commotio retinae, and retinal detachments.
The history of the headache An acute onset of the headache of the patient’s life associated with a stiff neck. Figure 3 CT-scan & MRI An ill appearing patient on physical examination typically lead the health care practitioner to consider the diagnosis and order a CT (computerized tomography) scan of the head. If the CT scan is performed within 72 hours of the onset of the headache it will detect 93% to 100% of all aneurysms. Figure 4 Lumbar Puncture In the few cases that are not recognized by CT the health care practitioner may consider performing a lumbar puncture to identify blood in the cerebrospinal fluid that runs in the subarachnoid space. Angiography If the CT or the LP reveals the presence of blood angiography is performed to identify where the aneurysm is located and to plan treatment.
Introduction: In India, oral malignancies account for 35% of total malignancies. Surgical excision of tumor and neck dissection forms the mainstay of treatment in addition to adjuvant chemotherapy and radiotherapy. The resulting anatomical defect, functional loss, cosmetic disfigurement and the accompanying psychosocial effects can be devastating to the patient. Reconstructive surgery for head and neck defects remains an evolving challenge and plays a crucial role in improving the quality of life by restoring anatomical defect, achieving functional rehabilitation and aesthetic outcome. For many years reconstructive surgeons have used regional flaps, such as the pectoralis major myocutaneous, trapezius, latissimus dorsi or deltopectoral flaps
Introduction: Intussusception is a common gastrointestinal emergency in the pediatric population. This illness is a conversion in which a portion of the intestine telescopes into another adjacent distal segment of the intestine and causes bowel and ileocolic obstruction. Intussusception is considered a frequent cause of abdominal pain in pediatric patients. It is well described in infants, with an incidence of 0.1 to 0.4 % nonetheless it is less well-established in neonates.1, 2 In fewer than 10% of the patients, a surgical lead point can be determined as a plausible etiology. Cecal duplication as a lead-point of neonatal intussusception is extremely rare.
One form of conservative therapy which has gained increased attention from clinicians and researchers in the management of back pain among general population is that advocated by McKenzie (1980 and 1981) [15, 16]. Studies from different parts of the world had offer strong support for the acceptance of the McKenzie protocol (MP) in treating back pain in the general population [17, 18, 19]. (Battie et al., 1994; Foster et al, 1999, Ayanniyi et al, 2006) Such investigations, however, have left unclear the specific effect of MP on back pain in pregnancy. Nevertheless, according to Rath (1997)  MP is a very useful and safe method in the management of back pain in pregnant women. In the light of the above observation this study was designed to evaluate the efficacy of MP in the management of pregnancy related back pain.
Several detailed laboratory investigations are performed to exclude systemic causes, malignancy, or any other ongoing process that must be excluded prior to repair. In our study most of the septal perforations were caused following septal surgery as mentioned above. Tomography of the paranasal sinuses is indicated to evaluate the nasal septum and the presence of concomitant paranasal sinus disease9. We assessed the size of perforations and the size of the flap available preoperatively using Plain CT-scan of Nose and Paranasal sinuses with a combination of axial and coronal sections. This gave us a clear picture of the defect in the nasal septum along with accurate information of the availability of nasoseptal flap.
Anhidrosis of emifaccia, inability to sweat, 5. Facial flushing, Diagnosis: While a doctor can diagnose Horner on the basis of symptoms and the appearance of the eyes, there are still several tests needed to confirm and look for the cause. Eye drops containing cocaine can be applied to the eye hit. The diagnosis is confirmed if the pupils do not dilate in 30 minutes. Other drugs may be applied to determine the location of the nerve damage.
ADEs associated with medication discrepancies can prolong hospital stays and, in the post-discharge period, may lead to emergency room visits, hospital readmissions, and utilization of other health care resources. Preventable adverse drug events (PADE) are associated with 1 of 5 injuries or deaths and a result of poorly designed systems, which often lack independent redundancies. Preventable ADEs at transition points of care account for 46-56% of all medication errors. One strategy to reduce PADEs and ADEs is to reconcile the medication orders between the two transition points. The Institute for Healthcare Improvement (IHI) deﬁnes medication reconciliation as a formal process to compile a list of all the medications a patient is taking before admission, and comparing it with the doctor’s admission, transfer and discharge orders.
Other types of biopsy methods may be used such as wedge or punch biopsy, but these techniques tend to be less accurate. After the biopsy is performed a wide excision should follow. This should encompass a l good margin of healthy tissue. Any further excision will depend on the thickness of the tumor. Depending on the invasive ness of the tumor a lymph node biopsy might be conducted to see if any of the draining lymph nodes were affected (Hodgetts, 2013).
There are other TCM disease names that harbor aspects of AR but pattern differentiation is still the one and only way of hoping to correctly diagnose and treat patterns of disharmony within the TCM framework. Therefore, when working with a patient with "Allergic Rhinitis", a TCM practitioner may diagnose his or her patient as having one or more patterns (of disharmony) such as Lung qi deficiency, Spleen qi deficiency, Kidney qi deficiency, Wind heat, Gallbladder fire, disharmony of the Ying and Wei, and many more. Although there are many possible patterns applicable to AR three organs primarily involved when dealing with the nose and AR. The Lungs - said in the classics to open to the nose, the Kidneys - having a direct link with the nose via the Du channel