Case Report: Catatonia Associated With Post-traumatic Stress Disorder

We report here about a 12-year-old female patient who had two life-threatening accidents that led to post-traumatic stress disorder associated with catatonia. She had closed eyes, had urinary and fecal incontinence, and had been in an abnormal position for one and half month. Moreover, she had complications such as dehydration, malunion of the fractured arm, and deformities in hand and foot. After detailed psychiatric examination, neurological assessment, and laboratory investigation, the patient received successful treatment in the form of benzodiazepine injections, intravenous fluid, oral antidepressants, and six sessions of electroconvulsive therapy (ECT). We discuss the pathophysiology of catatonia, which remains elusive, and recommend evaluating catatonic children for any possible trauma during psychiatry assessment.

Inadvertent placement of a nasogastric tube following traumatic nasal tube intubation

Adequate nutrition is necessary in head and neck surgery. Enteral feeding via a nasogastric tube is often required due to the altered anatomy and to allow sufficient intraoral healing. Insertion of a nasogastric tube is commonly performed without complication and confirmation of its position by a number of different methods. Incorrect positioning can cause significant morbidity with associated mortality. This case report describes the inadvertent placement of a nasogastric tube in a patient with a mandibular squamous cell carcinoma, into the abdominal cavity following a failed traumatic nasal tube intubation. Chest radiography and auscultation failed to identify the abnormal position with subsequent commencement of feeds for a number of days. Following a laporotomy and insertion of abdominal drains, the patient recovered and was discharged from hospital. To prevent recurrence, it is suggested that direct laryngoscopy or direct visualisation of the upper aspect be performed.

Diagnostic Yield of Chilaiditi’s Sign in Advanced-Phase Late-Onset Pompe Disease

Purpose: Chilaiditi’s sign (CS), hepatodiaphragmatic interposition of the intestine, was caused by morphological abnormalities such as diaphragmatic atrophy, intestinal dilation, and liver atrophy. The sign is potentially important due to associations with clinically recurrent abdominal pain or even colonic volvulus. In general, neuromuscular disease (NMD) could have the high prevalence of CS because of widened hepatodiaphragmatic space, following diaphragmatic atrophy. Particularly, in late-onset Pompe disease (LOPD), glycogen accumulation in smooth muscle of intestine could lead to the abnormal dilation of intestine. Though the prevalence of CS in LOPD could be high because of developing two main factors of CS, no studies have evaluated the prevalence of CS in LOPD. Our aim was to investigate the prevalence of CS in LOPD, and to identify the risk factors of CS in LOPD patients. Methods: Medical records of genetically confirmed patients of Pompe disease at the National Center Hospital, National Center of Neurology and Psychiatry were retrospectively reviewed. We evaluated CS using chest X-ray (CXR) and abdominal CT and assessed the prevalence of CS in LOPD patients. We also divided the patients into two groups, CS and non-CS group, and evaluated the factor associated with CS compared to clinical variables between groups. Results: Three of seven (43%) were detected in CS. CS group (P5-7) and non-CS group (P1-4) were obtained. In comparison of clinical variables, the severity of atrophy in right diaphragms was significantly higher in CS than non-CS groups (p =0.029). Also, the frequency of abnormal position of right diaphragm and liver, and abnormally dilated bowel was seen in all of CS patients, but none of non-CS patient (p = 0.029, each). Conclusion: In LOPD patients, the prevalence of CS was much higher of 43%, compared to healthy groups, or even in similarly respiratory muscle impaired neuromuscular diseases such as Duchenne muscular dystrophy (DMD) or Myotonic dystrophy type 1 (DM1). The anatomically abnormal position of diaphragm and liver, atrophy and fat infiltration of diaphragms, and abnormally dilated bowel were significantly associated with CS in LOPD. Since CS can cause intestinal symptoms or even contribute to sudden-death of intestinal volvulus, we should pay more attention to CXR or abdominal CT as follow up in LOPD patients.

Comparative Study of Ultrasound with Transvaginal Finger Examination in Diagnosis of Abnormal Position and Presentation of Fetal Head

Background: Abnormal position and presentation are challenges for obstetricians in about 10% of all pregnancies. Objectives: The purpose of this study was to compare ultrasound with transvaginal finger examination in detecting abnormal position and presentation of fetal head. Methods: This was a cross-sectional study performed in Ali ibn-e Abitaleb Hospital of Zahedan in 2018. The women underwent vaginal finger examination in the first phase of delivery, and then trans-abdominal ultrasound was performed for pregnant women. All examinations and ultrasounds were performed by one person with the same ultrasound device. Data were analyzed with SPSS software. Results: In this study, 100 pregnant women were studied in the first phase of pregnancy. The mean age of the subjects was 24.7 ± 5.5 years old. Fetal head position was determined in 81 and 93% of women with vaginal examination and ultrasound, respectively. There was weak agreement (kappa = 0.416). Fetal presentation was determined by finger examination in 93% of cases and by ultrasound in 100% of cases. There was moderate agreement (kappa = 0.783). Conclusions: In general, the results of this study showed that there was no significant difference between ultrasound and finger examination in the presentation and position of fetal head.

Hypertelorism and orbital dystopia

Orbital hypertelorism is defined as an abnormally wide distance between the orbits. It is a physical finding often associated with other cranial and facial malformations. Orbital dystopia refers to an abnormal position or shape of the orbits. These orbital abnormalities can be associated with visual problems including amblyopia, astigmatism, squints, and loss of vision. Patients are managed by a multidisciplinary team.

Új műtéti képalkotó lehetőség a belsőfül-implantátum elektródasorának dinamikus helyzetmeghatározására

Összefoglaló. Bevezetés: A cochlearis implantátum egy műtétileg behelyezett elektromos eszköz, amely az akusztikus hanghullámokat elektromos jelekké alakítja, közvetlenül a hallóideget stimulálja, így segíti a súlyos fokú hallássérüléssel vagy teljes hallásvesztéssel élők életét. Cochlearis implantációt követően a legjobb rehabilitációs eredmény elérésének technikai feltétele többek között az esetre szabott elektródaválasztás és az elektródasor teljes, kontrollált, szövődménymentes bejuttatása a scala tympaniba, miközben a cochlea belső struktúrája a lehető legkisebb mértékben sérül. A rutin intraoperatív elektrofiziológiai tesztek fontos információt adnak a készülék működőképességéről és a hallóideg stimulációjáról, azonban nem hagyatkozhatunk rájuk az elektródasor cochleán belüli helyzetének igazolásában. Mivel előfordulhat, hogy a rendelkezésre álló elektrofiziológiai vizsgálatok eredménye megfelelő, és mégis rendellenes helyzetbe kerül az elektróda, az arany standardot a képalkotó vizsgálatok jelentik. Módszer: Közleményünkben egy modern, hibrid műtő által nyújtott technológiai háttér új alkalmazási területét mutatjuk be. Szimultán kétoldali cochlearis implantációt végeztünk Cochlear Nucleus Slim Modiolar típusú perimodiolaris elektródasorral, a belső fül fejlődési rendellenességével rendelkező betegen. Az intraoperatív képalkotást Siemens Artis pheno C-karos robot digitális szubtrakciós angiográfiás rendszer biztosította valós idejű átvilágító és volumentomográfiás funkcióval. Eredmények: Az intraoperatív képalkotás által dinamikusan követhető az elektródasor bevezetésének folyamata, ellenőrizhető az elektródasor statikus helyzete, így kiváltható a rutinnak számító posztoperatív képalkotó vizsgálat. A rendellenes helyzetbe kerülő elektródasor pozíciója egy ülésben korrigálható, az újból bevezethető, így elkerülhető az újabb altatással járó, bizonytalan kimenetelű revíziós műtét. Következtetés: A hibrid műtő jól kontrollált, minimálisan invazív eljárások elvégzését biztosítja. Különösen a hallószerv fejlődési rendellenessége vagy egyéb, az elektródának a cochleába vezetését nehezítő rendellenesség esetén javasolt a műtői képalkotó diagnosztika. Orv Hetil. 2021; 162(22): 878–883. Summary. Introduction: The cochlear implant is a surgically inserted electrical device that converts acoustic sound waves into electrical signals to stimulate the cochlear nerve, thus helps the rehabilitation of people with severe to total hearing loss. One of the most important technical conditions for achieving the best rehabilitation result after cochlear implantation is the personalized choice of electrodes. Additionally, it is vital that there is a complete, controlled, uncomplicated delivery of the electrode array to the scala tympani while minimizing damage to the inner structures of the cochlea. Routine electrophysiological tests provide important information about device functionality and auditory nerve stimulation. However, they probably do not show an abnormal position of the electrode array within the cochlea. Thus, imaging studies remain the gold standard. Method: In our paper, we present a novel application field of the modern technological background provided by a hybrid operating room. Simultaneous bilateral cochlear implantation was performed with cochlear implants with perimodiolar electrode array (Nucleus Slim Modiolar) in a patient with cochlear malformation. Intraoperative imaging was provided by a Siemens Artis pheno C-arm robot digital subtraction angiography system with real-time fluoroscopy and volume tomography function. Results: Intraoperative imaging ensures dynamic follow-up of the introduction and static determination of the position of the electrode array and replaces routine postoperative imaging. If the electrode array was inserted in an abnormal position, the revision can be performed in the same sitting. Also, the revision surgery with a potential risk of uncertain outcome, alongside additional anaesthesia, can be prevented. Conclusion: The hybrid operating room ensures that well-controlled, minimally invasive procedures are performed. Intraoperative imaging can be imperative in malformed cochleae and conditions that may complicate electrode insertion. Orv Hetil. 2021; 162(22): 878–883.

Duodenal Volvulus due to Duodenum Inversum

Duodenum inversum, or inverted duodenum, is a rare congenital disorder resulting in an abnormal position of the third and/or fourth portions of the duodenum. Most patients are asymptomatic, but others can experience pain, nausea, vomiting, peptic ulcer disease, pancreatitis, and even intestinal obstruction. In this case, we report a patient who presented with acute abdominal pain and vomiting. He was diagnosed with duodenal volvulus and obstruction due to duodenum inversum. After failing nonoperative management, the patient was successfully treated with surgical resection.

SOCIAL AND PROTECTIVE ACTIVITY OF LABOR BUREAU OF “THE SOCIETY OF URAL MINING TECHNICIANS”

The article is devoted to the socio-protective activities of the Society of Ural Mining Technicians (SUMT). It was founded in 1901 in the Perm province as a professional scientific and technical community. The organization was formed at the stage of the final phase of the industrial revolution in the late 19th and early 20th centuries, which contributed to the development of scientific thought in the Ural region, the formation of new social relations and the emergence of professional associations. The main staff of the Society included engineers, technicians, teachers and students of the Ural Mining School. The author considers in detail the activities of the Bureau of Labor as one of the structural subdivisions of SUMT. It began its work in 1902 and acted as an intermediary between the employee and the employer. Its purposes were to collect data from employers on the availability of vacancies at enterprises, to compile a database of unemployed members of SUMT, to resolve issues of their employment, and to prepare recommendations and guarantees when applying for a job. The Bureau of Labor also provided material support to family members of the community. In addition, the Bureau of Labor monitored the observance of the employees’ working conditions, ensured the protection of the interests of the members of the Society at work, protected their interests in case of conflicts with the employer or the abnormal position of technicians, and was engaged in workers' health insurance. The revealed violations by the employer were published by the Bureau of Labor in the journal of the Society "Ural Technician". The Bureau of Labor of the Society of Ural Mining Technicians implemented social protective functions in the Ural region associated with labor exchanges in the pre-revolutionary period of Russia’s development.

PROGNOSIS OF RETENTION AND ABNORMAL POSITION OF CANINES

Canines play an important role in the act of chewing and especially in the aesthetics of the face when you smile. They also serve as a guide to the movements of the mandible “canine management” and they are more resistant to carious lesions. Germination of the canine embryos, unlike other teeth, occurs closer to the base of the jaw, so they erupt later than all front teeth, encountering a number of barriers and, above all, lack of space in the dental arch or its absence in case of early loss of temporary teeth. Given that the canines erupt after the incisors and the first premolars, it is possible to prevent their retention and abnormal eruption in the dental arch. This can be done by timely detection of changes in their main inclination, both to the base of the jaw and relative to the inclination of the erupted teeth, especially lateral incisors, the roots of which serve as a guide axis for canine eruption. The aim of the research was to increase the effectiveness of treatment of retention and abnormal eruption of canines by developing a method for their prediction and timely detection. During the research, 52 patients aged from 7 to 25 years, were divided into four age groups, and they were examined and admitted for orthodontic treatment: I group – 12 patients (23,1%) aged from 7 to 9 years, - with early variable occlusion; II group – 16 patients (30,7%) aged from 10 to 12 years, - at the final stage of variable occlusion; III group – 12 patients (23,1%) aged from 13 to 15 years, - with early permanent occlusion; IV group – 12 patients (23,1%) aged from 16 to 25 years, - with a permanent bite. All patients did not have acute occlusal abnormalities. The following research methods were used during the examination: clinical (presence of abnormal position of the canines in parents and close relatives); anthropometric (measurements on diagnostic models); radiological, mainly orthopantomography (measurement of the axial inclination of the canines relative to the base of the jaw and adjacent teeth) and static research methods. Research in all four groups determined that the inclining of the upper canines to the base of the jaw, averaged on the Maxilla – 86,4° (right side – 86,7°, left side – 86,2° with a difference – 0,5°), and on Mandible – 100,75° (right side – 100,7°, left side – 100,8° with the difference – 0.1°). Axial inclinations of the upper lateral incisors averaged 99,1° (right side – 95,8°, left side – 102,5° with the difference – 6,7°), and lower lateral incisors – 100,65° (right side – 100,7°, left side – 100,8° with the difference – 0,1°). The difference in the inclinations of the canines and lateral incisors on the Maxilla averaged 11,6° (right side – 9,5°, left side – 13,7° with the difference 4,2°) and on the Mandible – 8,9° (right side – 8,6°, left side – 9,3° with the difference – 0.7°). As for these indicators in patients of each of the four age groups, they varied significantly. Conducted research has detected that the most objective indicator in the eruption of abnormal eruption of canines is the significant difference in their inclinations with lateral incisors, which serve as the guiding axis of eruption. In patients from the I group, the difference in inclinations and lateral incisors was on the Maxilla on the right – 9,3°, on the left – 16,0°; and on the Mandible – right side 11,8°, left side 12,2°. In patients from the II group the difference in inclinations and lateral incisors was on the Maxilla on the right side – 13,8°, on the left side – 18,1°; and on the Mandible – right side 7,1°, left side 10,5°, in accordance. In the III group on the Maxilla from the left side – 10,6° and right side – 8,6°; and on the Mandible – 9,6° and 11,1°, in accordance. The difference in inclinations of these teeth was on the Maxilla – right side 4,3°, left side 12,3°; and on the Mandible – 6,0° and 3,3°, in accordance. On this basis, we proposed a method for predicting abnormal eruption of the canines using the constructed “canine triangle” on the orthopantomogram formed by the intersection of the axial inclinations of the canines and lateral incisors (ւВ) with the plane of the base of the jaw, on which the segment (a) is the base of the triangle. The more difference between the inclinations of the canines and lateral incisors ( > 10°), that is the larger the value (ւВ), the longer the size of the base (a) of the triangle, which indicates the difficulty of eruption of the canines in the future (outside the dentition or retention). Timely detection of a significant difference in the inclinations of canines and lateral incisors can prevent abnormal eruption and retention of canines by adjusting their inclinations with lateral incisors and eliminating the lack of space in the early stages of formation of the dental apparatus.

A case of radical cure of posterior uterus inflection by ventrotixatio surgery

M.M., 31 years old, the wife of an official, was admitted to the clinic of Professor G.E. Rein with complaints of general weakness, nervous disorders, headaches, dizziness, palpitations, constant pain in the abdomen and lower back, significantly increasing during regulation and each tension, pain during copulation, constipation and pain during bowel movement, frequent urge and pain during urination; comes from a consumptive family; In childhood, she suffered from scrofula, an English disease, anemia and pains; at the 15th year she suffered measles, at the 17th - pneumonia; the first month - in the 11th year, very profuse, with severe pains, lasted 7 days; the second - after 2 years, of the same nature; after 16 years, the correct menstruation was established, after 4 weeks for 7 days. She was married twice; in a month after entering the first marriage (husband suffered from overfusion) had an early (2 weeks) miscarriage, 6 weeks old; the second husband suffered from syphilis and transfusion and was relatively impotent; since this time, the patient's suffering has increased significantly; The used doctors determined that she had an abnormal position of the uterus. Upon admission to the clinic, retroflexio uteri fixata, oophoritis et salpingitis duplex (pelveoperitonitis) were found. Applied during the month of treatment (rest, warming compresses, scarification of the vaginal part, idoform in balls, etc.), as well as repeated attempts to correct the position of the uterus without result; in view of this, it was decided to perform a ventrofixatio uteri retroflexi fixati operation (hysteropexia abdominalis anterior. Ref.), moreover, that at the same time it was possible to produce salpingotomy.