Navickaitė, Danielė

Introduction (Case Reports Only) We present a case report of an 18-year-old male who was first diagnosed with ocular toxocariasis (OT) in 2010 and experienced two recurrences of the disease since 2019. Case Description (Case Reports Only) An 18-year-old male presented with complaints of decreased vision in his right eye. His medical history revealed that he had been diagnosed with OT 9 years ago, and at that time, a blood test had shown a positive result for serum anti-Toxocara IgG. After treatment, the patient's symptoms had improved, and a focal, raised whitish retinal lesion in the right eye had disappeared. However, in 2019, examination revealed a decrease in visual acuity (VA) (Snellen chart) to 0.3 in the right eye. Slit lamp examination revealed cells in the anterior chamber and vitreous. Fundus examination revealed a swollen optic disc and a whitish, focally raised lesion with a swollen inferotemporal arcade. A blood test revealed eosinophilia, negative anti-Toxocara IgG (tested 6 days after recurrence), and anti-Toxocara IgM was not determined. The diagnosis OT was made based on the patient's history and clinical presentation. The patient was treated with albendazole 400 mg twice daily and topical eye drops for 5 days. All of the above findings improved significantly, and best corrected visual acuity (BCVA) increased to 0.8 within 3 months. Two years later, the patient's vision in the right eye deteriorated after infection COVID -19. Clinical examination revealed a VA of 0.4, and fundus examination revealed an active focal lesion, and systemic treatment was not prescribed at this time. Improvement in the condition was observed, and within 2 months, the BCVA improved to 1.0. Summary (Case Reports Only) An 18-year-old patient had two recurrences of OT in two years, but his VA fully recovered. Conclusions Monitor patients closely after treatment as parasites can remain in the body for years and cause recurrences.

Funkcinė endoskopinė sinusų operacija atliekama siekiant pašalinti patologiškai pakitusią sinusų gleivinę ar darinius. Chirurgams išvengti gyvybei grėsmingų komplikacijų, susijusių su kaukolės pamato chirurgija, labai svarbus geras operacinio lauko matomumas. Operacijos metu (prieš ar per anesteziją) siekiant sumažinti gerai vaskuliarizuotos gleivinės gausų kraujavimą, naudojami įvairių grupių vaistai. Šios integruotos literatūros apžvalgos tikslas − apibūdinti kraujavimo valdymo endoskopinių sinusų operacijų alternatyvas. Paieška buvo atlikta PubMed duomenų bazėje, kuri apėmė klinikinius tyrimus, susijusius su sistemiškai ir lokaliai veikiančiais vaistais ir jų veiksmingumu kontroliuojant kraujavimą iš sinusų gleivinės. Literatūros apžvalgoje pateikiami tyrimai bei rezultatai vertinami gerai. Atlikti tyrimai su preparatais rodo teigiamos dinamikos ženklus, operuojant pacientus, tačiau lyginant vaistus, ne visi yra vienodai efektyvūs. Atsižvelgiant į šiame tyrime pateiktas analizes, daroma išvada, jog tam tikros tiriamos vaistų grupės pagerina kraujavimo kontrolę operacijų metu ir operacinio lauko matomumą chirurgams.

Introduction: Brain abscess is often a localized brain infection, requiring prompt surgical intervention and high-dose antibiotic therapy. In most cases, brain abscesses are caused by a contiguous spread of infections, such as sinusitis or otitis. We present a case report of patient with pneumonia complicated by a brain abscess. Case report: A 58-years-old man presented to his local hospital with symptoms of dyspnoea, fever around 39.5°C and disorientation lasting for five days. Laboratory investigation revealed high inflammatory markers. The chest X-ray (CXR) showed lung infiltration on the left. Patient was admitted to the Intensive care unit (ICU) with severe respiratory failure and was intubated because of hypercapnia, hypoxemia and acidosis. Treatment with cefuroxime was started. The next day, inflammatory markers increased and cefuroxime was changed to ampicillin-sulbactam. Computed tomography (CT) scan revealed abscess in right frontal lobe and edema near the corpus callosum. Patient was emergently transferred to the Neurosurgical center of the university hospital for further care. There he underwent urgent stereotactic puncture of the intracerebral abscess, about 7 ml of yellow-green pus gushed out and a pus sample was collected during the operation. During surgery, ventriculitis was suspected and external ventricular drainage was formed. The patient was treated with ceftriaxone, vancomycin and metronidazole combination. He remained critically ill, with abscessed pneumonia on both sides, unstable hemodynamics and shock. Head CT was repeated: intracerebral abscess with positive dynamics, but was found ischemic lesions of cerebellar. Abdominal and chest CT was performed, showing abscesses of the lungs, pleura and thrombosis of the splenic artery. Clindamycin was additionally administered as sepsis and Multiple Organ Dysfunction Syndrome (MODS) progressed. Despite treatment, shock and hypoxemia deteriorated with 2 vasopressors at maximum doses. On the third day, the patient died without response to cardiopulmonary resuscitation. Conclusions: Brain abscess is a focal infection that originates from locally inflamed areas of the brain parenchyma and develops into a collection of pus surrounded by a well-vascularized capsule. It is a rare but severe disease and can result in severe disability or even death, especially if misdiagnosed or improperly managed.

Introduction: Acquired hemophilia A (AHA) is a rare disease of the coagulation system caused by autoantibodies to clotting factor VIII (FVIII) with no personal or family history of diseases related to coagulation. In this thesis, we present a case of AHA complication, which presented with intracranial hemorrhage. Case report: A 61-year-old man presented to his local hospital with symptoms of disorientation. The day before he complained of severe headache and increased blood pressure. The patient’s Glasgow Coma Scale (GCS) was 9 (E2; V2; M5). Computed tomography (CT) scan revealed a possible rupture of anterior choroidal artery aneurysm. The patient was sedated, intubated, and emergently transferred to the Neurosurgical center of the university hospital. Clinical examination revealed hematomas at the site of injection on the forearms. Laboratory investigation showed anemia, an activated partial thromboplastin time (aPTT) of 86.0 s. Liver function tests were within the normal ranges. Urgent head CT revealed signs of obstructive hydrocephalus and intraventricular hemorrhage. CT angiography (CTA) showed no aneurysms. The patient was admitted to the Neurointensive care unit. Due to the observed increase in the aPTT and suspected coagulopathy two units of fresh frozen plasma was infused before the surgery. The patient underwent placement of a right external ventricular drain. Next day, the coagulation tests were available, which revealed a reduction in FVIII activity (1%). The patient was prescribed with activated prothrombin complex concentrate and methylprednisolone. Red blood cell transfusion was performed. Later CT scan demonstrated hemorrhages in the brainstem, signs of cerebral edema and herniation. Further surgery was not considered due to his difficult condition. Sedation was discontinued and hemodynamics was maintained with noradrenaline. Following day CTA was performed and results showed no intracerebral blood flow in any of major arteries of the brain. The patient died on the 4th hospital day. Conclusions: Intracerebral hemorrhage is a severe complication that is relatively common among patients with hemophilia. Most patients are diagnosed with AHA on the basis of prolonged aPTT and additional tests after massive bleeding. If the patient delays going to hospital and arrives without an established clotting disease, even with appropriate treatment, the outcome can be fata capsule. It is a rare but severe disease and can result in severe disability or even death, especially if misdiagnosed or improperly managed.