American Research Journal of Clinical Case Reports

Ahmed Orieby, Mostafa Khalil,Yasser Ali Kamal1Mostafa El-sayed

Blunt trauma is a rare cause of complete tracheal transection (CTT). We present a young adult male, with CTT after accidental hanging with men scarf. Initially, he had non-significant signs, and then respiratory distress occurred with immediate orotracheal intubation. Computed tomography and bronchoscopy confirmed the diagnosis of CTT. intraoperatively, tracheostomy tube was placed followed by surgical repair of cricotracheal separation and injured posterior wall of the trachea. The patient was decannulated after 3 weeks. The medical treatment and voice training continued after decannuation for unilateral vocal cord paresis as a result of unilateral injury of recurrent laryngeal nerve.In conclusion, initial airway securing with rapid stepwise diagnosis and early surgical repair are helpful for life-saving of a patient with CTT due to blunt trauma. Keywords: Trachea, airway, trauma, injury

Salem Bouomrani1 Mayeda Ben Hamad1, Belgacem1,  Nesrine RegaieSafa Trabelsi1,Hassène Baili1,Najla Lassoued1

Renal involvement in the course of primary antiphospholipidsyndrome (APS) is exceptional and typically results in vascular nephropathy. Other nephropathies are rarer. We report an unusual case of acute interstitial nephritis associated with primary APS in a 38-year-old man with a history of recurrent venous thrombosis of the lower and upper limbs which was admitted for exploration of organic acute renal failure with creatinine level at 700µmol/l and both normal-sized kidneys. Biology showed a prolonged activated partial thromboplastin time; protein C, S, and anti-thrombin III were at normal levels; the antiphospholipid antibodies were positive at significant levels: Ig G at 38 GPL and IgM at 25 MPL. Nuclear antibodies were negative. Renal biopsy concluded to an isolated acute interstitial nephritis (AIN). There was no prior history of suspicious drug intake, nephrolithiasis, and neither old nor recent urinary tract infection. Under anticoagulants and corticosteroid therapy at full dose, the outcome was favorable with a check-up ofcreatinine level at 82µmol/l after 2 months. To the best of our knowledge, the isolated AIN has not been described during the primary APS. This nephropathy could be a new event enriching the spectrum of renal complications during this syndrome. Keywords: Acute interstitial nephritis; primary antiphospholipid syndrome; nephropathy.

Aparna Sarkar   Nitika Gupta

Abstract Back ground & Introduction: The gastrocnemius and the soleus are the parts of calf muscle. The larger muscle gastrocnemius is situated below the knee on the back of the leg. The soleus muscle, which is a smaller muscle, is lower down the leg and beneath the gastrocnemius. Age causes structural and functional changes in skeletal muscle in a wide range of species, including humans. Aims & Objectives: To compare the impact of age and gender on length and passive elastic stiffness characteristics of the calf muscle tendon unit of active women and men. Materials & methods Subjects: Forty healthy subjects from both genders were recruited for the study by randomization on the basis of inclusion and exclusion criteria. Subjects were allotted into two groups. Group A (n=10) comprised of females of 20- 39 age group. Group B (n=10) consisted of males of 20- 39 age group. Group C had ten females at age group of 40- 59 age group and Group D had ten males at the age group of 40-59. Subjects having any pathological problem like orthopedic or neurological disorders were excluded from this study. Calf muscle tightness were effectively measured by measuring the range of motion of ankle dorsiflexion using Goniometer with knee extended for gastrocnemius muscle and knee flexed for soleus muscle. Statistical analysis: Effects of age and gender on calf muscle tightness were compared by applying student’s t- test. P –value was set at 0.05 considered to be significant. Results: The results showed that the mean difference of gastrocnemius muscle tightness between females and males at the age of 20- 39 years was significant at p < 0.01 and the mean difference of gastrocnemius muscle tightness between females and males at the age of 40- 59 yrs was significant at p < 0.05. It was evident that the mean difference of gastrocnemius muscle tightness between 20- 39yrs and 40-59yrs of age group in females was not significant at p > 0.05 and the mean difference of gastrocnemius muscle tightness between 20- 39yrs and 40-59yrs of age group in males was significant at p < 0.01. The mean difference of soleus muscle tightness between females and males at the age of 20- 39 yrs was significant at p < 0.01 and the mean difference of soleus muscle tightness between females and males at the age of 40- 59 yrs was significant at p < 0.02.The mean difference of soleus muscle tightness between 20- 39yrs and 40-59yrs of age group in females was not significant at p > 0.05 and the mean difference of soleus muscle tightness between 20- 39yrs and 40-59yrs of age group in males was significant at p < 0.01. Discussion & Conclusion: We concluded from this study that there was a significant increase in calf muscle tightness with aging in males and females. The study also showed that there was gender based difference in males and a female at the age of 40- 59years but there was no gender based difference in males and females at the age group on 20- 39 years. Keywords: gastrocnemius , soleus, calf muscle, plantar flexors, age, gender

Ibrahim Osman, MD, OlisaemekaAchike,Ibrahim Osman, MD, OlisaemekaAchike, MD,  Dan Le,MD, Assad Movahed  M

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS). The true incidence of SCAD is underestimated. The pathophysiology is still not fully understood and its management can be challenging.Patients may present with a broad spectrum of clinical scenarios, ranging from angina pectoris to myocardial infarction, cardiogenic shock, and sudden death. Standard therapy has not been established; current treatments range from conservative management to percutaneous revascularization or coronary artery bypass surgery. SCAD greatly mimics ACS, and this diagnosis should be considered when evaluating young patients who present with ACS with or without classical risk factors for coronary artery disease. We report a case of a 39-year old man who presented with diabetic ketoacidosis (DKA) and presentation of ACS. He had multiple risk factors for CAD such as a smoking history of two pack-years, hypertension and poorly controlled diabetes mellitus type I. Once the clinical findings were suggestive of acute anterior and inferior myocardial infarction, the patient underwent emergent cardiac catheterization, which revealed distal left anterior descending coronary artery dissection. Conclusion: This case highlights the fact that although SCAD is a rare entity, it is increasingly being recognized as a significant cause of ACS. Urgent angiography should be considered if SCAD is suspected, because early diagnosis and appropriate management significantly improves the outcome.