CURRENT ISSUE

The incidence of bladder spasm in children with hypospadias treated with caudal block before surgery is uncommon. We presented a case of bladder spasm after urethroplasty surgery that was successfully treated with anisodamine without any sequelae. The caudal block plane may only reach the sacrum and does not reach the bladder wall. I suggest a local anesthetic drug dose of 1 ml/kg, totaling not more than 20 ml, to avoid the occurrence of postoperative bladder spasm and increase the comfort of children.

The case is a 51-year-old male with obesity, type 2 diabetes (T2D), dyslipidemia, and hypertension. His HbA1c value increased to 8.0%, accompanied by oral semaglutide administration. Glucose variability was exacerbated after that, and then novel imeglimin (Twymeeg) was initiated. HbA1c decreased from 7.4% to 6.7% over 4 months with a 3 kg weight reduction. The case also had low back pain (LBP) and lumbar spinal stenosis (LSS), probably resulting from Metabolic syndrome (Met-S), and had actual experience with a low carbohydrate diet (LCD) in the hospital meals. Four patterns of LCD meals had carbohydrates ranging from 17.8g to 28.0g, with 501-690kcal.

This case report presents a 67-year-old female with Parkinson’s disease who underwent deep brain stimulation (DBS) electrode replacement surgery. Following extubation, the patient developed persistent laryngospasm, requiring immediate intervention. Suspecting symptoms similar to levodopa withdrawal, the patient received intravenous propofol and enteral levodopa supplementation, leading to symptom improvement. The case underscores the importance of perioperative management, including timely medication supplementation and DBS functioning, in Parkinson’s patients to prevent neuroleptic malignant syndrome (NMS)-like complications. Anesthesiologists should be vigilant about potential airway issues and NMS in this population and maintain optimal fluid status during surgery. Prompt intervention can prevent irreversible damage and improve patient outcomes.

There is little information about right-to-left shunting with normal pulmonary artery pressure, which is produced as a consequence of right ventricle systolic dysfunction. We presented a case of unexpected transesophageal echocardiography findings of right-to-left shunting through an atrial septal defect despite normal pulmonary artery pressure, related to right ventricle systolic dysfunction in a 27-year-old young woman. Transesophageal echocardiography imaging revealed right ventricular systolic dysfunction and normal pulmonary artery pressure.

Complications of laparoscopic surgery include carbon dioxide (CO₂) embolism, primarily caused by the entry of CO₂ gas into blood vessels or solid organs. If significant clinical symptoms occur, timely intervention is crucial as it can be life-threatening. We report a case of CO₂ embolism during laparoscopic right hepatectomy. The patient was a 37-year-old male with no history of liver or kidney dysfunction. During the procedure, there were two episodes of oxygen desaturation (SpO₂), and the second episode was accompanied by a significant drop in blood pressure and an increase in heart rate. However, there was no sudden decrease in the end-tidal CO₂ partial pressure (ETCO₂). Simultaneously, a grinding murmur was auscultated in the precordial area, and foamy blood was aspirated from the right internal jugular vein catheter. This article describes a case of CO₂ embolism during laparoscopic surgery and provides a summary of its causes, clinical manifestations, diagnosis, and treatment. It is hoped that this article will contribute to the timely recognition and management of such cases, thereby preventing any potential adverse outcomes for patients.

The bacteria Actinomyces spp. a gram-positive bacteria responsible for the actinomycosis disease. Its 15–20% pulmonary presentation is generally chronic, progresses slowly, and might be misinterpreted as lung cancer or other long-term conditions. We describe a man in his 60s with weight loss and dyspnea. The presence of Actinomyces spp. was identified in a bronchial biopsy of the middle lobe, ruling out lung cancer as the initial diagnostic possibility. After a month of intravenously administered antibiotic treatment, the patient experienced bronchiectasis. Pulmonary actinomycosis should be considered since it is challenging to detect and sometimes mistaken for lung neoplasia or TB due to its comparable clinical and radiographic presentations. The prognosis of pulmonary actinomycosis (PA) is favorable, and it is feasible to avoid recurring complications with the correct antibiotic treatment.

Introduction: Splenic abscess is rare in children. This report discusses a case of splenic abscess complicating an infarction in a teenager at the Teaching Hospital of Borgou/Alibori in Benin Republic.
Patient and Observation: The patient was a 14-year-old teenager with hemoglobinopathy (SC), admitted to the pediatric department for generalized abdominal pain associated with fever and a dry cough. On physical examination, he presented with an infectious syndrome, generalized abdominal pain, highly sensitive splenomegaly, left lung consolidation, and severe malnutrition. Abdominal ultrasound and thoraco-abdominal CT-scan revealed a splenic infarction abscess. Following medical treatment, which included broad-spectrum antibiotic therapy and analgesia, a total splenectomy was performed. During surgery, the spleen appeared greyish and contained pus, which, upon cytobacteriological examination, isolated a Klebsiella pneumoniae strain sensitive to the combination of amoxicillin-clavulanic acid. The patient showed favorable evolution under this treatment.
Conclusion: Splenic abscess should be suspected in any subject with sickle cell disease presenting with painful and febrile splenomegaly.

Paragangliomas are rare neuroendocrine neoplasms, commonly located in the head and neck. They are sometimes first found in the bone, especially when there are contributing factors such as trauma, which can make clinical diagnosis more challenging. In this reported case, a patient presented with a painful mass in the right thigh caused by trauma. During the procedure for resecting the right femoral mass, the patient’s blood pressure significantly increased upon touching the tumor. Subsequently, a biopsy of the right thigh femur and a whole-body contrast-enhanced computed tomography (CT) examination confirmed the diagnosis of a right femoral paraganglioma with metastasis to the right neck.

The current case is a 102-year-old female centenarian with slight bronchopneumonia. She did not have any remarkable health or medical problems until 2022. In May 2023, she developed a cough and fever and underwent a lung CT scan, which revealed a consolidation shadow in the left posterior middle lung. This image was created with a 1mm width for each 1mm interval. Additionally, a further image was generated using maximum intensity projection (MIP) with a 3mm width for a slab thickness of 20mm. Based on this data, a diagnosis of slight bronchopneumonia in the left lung was made. She was treated with levofloxacin 500mg/day for 5 days, which led to clinical improvement.

Background: Carbon dioxide (CO₂) embolism is a rare but potentially life-threatening complication of endoscopic surgery. While endoscopic thyroidectomy is superior to traditional open thyroidectomy in terms of cosmetic results, it may lead to venous or fatal paradoxical CO₂ embolism. CO₂ embolism involves the inadvertent injection of carbon dioxide into a large vein, artery, or solid organ. The clinical manifestations of CO₂ embolism can vary from asymptomatic to neurological damage, cardiac failure, and even death, depending on the rate and volume of CO₂ entry and the patient’s general condition. This case can enhance our understanding of CO₂ embolization during endoscopic surgery.
Case Presentation: This case report describes an incident in which a gas embolism occurred during endoscopic right lobe and isthmus thyroidectomy, resulting in arrhythmia and dramatic fluctuations in circulation and oxygen levels. The operation was halted, and CO₂ injection was stopped. The surgical wound was covered with saline gauze, and the patient inhaled 100% pure oxygen while undergoing aggressive repeated manual pulmonary recruitment maneuvers. Additionally, vasoactive drugs such as m-hydroxyamine and ephedrine were administered to aid in treating the condition. The patient’s position was adjusted using the Durant maneuver (partial left lateral and Trendelenburg position). Following the aforementioned treatments, the patient’s ventricular arrhythmia transitioned back to a normal and regular sinus rhythm, and both circulation and oxygen levels stabilized.
Conclusions: Carbon dioxide embolism is an uncommon yet potentially severe complication of laparoscopic procedures. We anticipate that this particular case will enhance our comprehension of carbon dioxide embolism during endoscopic surgery.

Transfusion-related hyperkalemia leading to ventricular arrhythmia is rare in neonates. We report a case of a 9-day-old neonate who developed severe hyperkalemia and ventricular arrhythmia after receiving a packed red blood cell transfusion during hepatectomy. After successful resuscitation, further transfusion was required. Subsequently, hyperkalemia was prevented by infusing packed red blood cells with saline in a ratio of 2:1, based on careful calculation.

This case involves a 76-year-old female patient with type 2 diabetes (T2D), diabetic gastroenteropathy, and slight arteriosclerosis. Her HbA1c levels have been unstable for years due to her typical carbohydrate intake. Her symptoms include constipation, nausea, and abdominal fullness. Despite being on magnesium oxide and picosulfate, she experiences difficulty achieving smooth bowel movements for an extended period.
In March 2023, her HbA1c levels increased to 8.5%. Subsequently, EquMet and Twymeeg were initiated, resulting in remarkable clinical effects, with her HbA1c dropping to 5.9% by August 2023. A Holter ECG recorded ventricular premature contractions (VPC) occurring 10 times (0.010%) over a 24-hour period. Additionally, plethysmography indicated a cardio-ankle vascular index (CAVI) of 9.5/9.3, suggesting slight arteriosclerosis.

This paper provides a detailed historical account of the Spanish Miliary Hospital in Cayey, Puerto Rico during the latter part of the 19th century, focusing on its role during the Spanish-American War and its impact on public health in Puerto Rico. The paper is divided into ten sections, each highlighting the development, growth, and function of the hospital during the Spanish American War and concludes with a look at the hospital today. Overall, this paper provides a comprehensive historical account of the Spanish Hospital in Cayey in Puerto Rican history, shedding light on its role in military medicine and public health during the Spanish-American War in the Central Mountain Region of Puerto Rico.

The presented case is a 68-year-old female with Type 1 diabetes (T1D). She was admitted for an emergency case with acute distress in January 2018 and was diagnosed with T1D with a blood glucose (BG) level of 459 mg/dL, HbA1c of 13.7%, glutamic acid decarboxylase autoantibody (GADA) level >2000 U/mL (<5 U/mL), and C-reactive protein (CRP) level of 1.10 ng/mL. She received Multiple Daily Injections (MDI) of insulin for 3 months, and then her HbA1c decreased to 7.3%. After that, she has been on a super-low carbohydrate diet (LCD) and received only Lantus XR and ipragliflozin. Serum CRP showed 0.2 ng/mL, suggesting a prolonged honeymoon period for years through continuous LCD.