Rapports de cas cliniques et médicaux

The duties of a dialysis unit medical director, which cover a range of quality, safety, and educational components, are outlined in the ESRD Criteria for Coverage. Several of these positions call for leadership abilities that the medical director neither demonstrates nor develops during their school. Patients and staff can voice their concerns about subpar systems without fear of reprisal thanks to the efforts of a capable medical director, and there is a constant iterative process of quality improvement and safety that values input from all stakeholders.

Acute cerebellar ataxia (ACA) is a clinical syndrome presenting with gait abnormality and instability while the mental status remains intact. Although it is the commonest cause of ataxia within pediatric population; patients presenting with a rapid onset gait disturbance must undergo a comprehensive diagnostic approach in order to exclude more serious etiologies that might have a similar presentation. In this article, we report a case of a previously well 2-year-old boy with a recent enterovirus infection, presenting with acute cerebellar ataxia. This case report aims to highlight the appropriate approach to diagnosing post-infectious ACA.

Interstitial ectopic pregnancy is rare and results in the embryo being implanted in the uterine tube's intramural region which is the most proximal part of the Fallopian tube inside the myometrium. 1-2% of pregnancies result in ectopic pregnancy and only 3-4% of ectopic pregnancies are interstitial. It has a significat risk of catastrophic hemorrhage from uterine rupture. The mortality rate for interstitial ectopic pregnancies is high, ranging between 2-2.5% with a rupture rate of about 15%. Therefore, it contributes significantly to maternal morbidity and mortality. 7–12 weeks is the typical gestational age at presentation and majority of interstitial ectopic pregnancies rupture before 12 weeks of gestation; however, our case report presented at 15 weeks of gestation. Here, we present a 32-year-old, gravida 11 para 5 plus 5 female. The gestational age was 15 weeks. She had a history of 5 previous spontaneous vaginal deliveries and 5 spontaneous first trimester miscarriages. She complained of pain in the epigastrium and lower abdomen, fainting and vomiting. There was no vaginal bleeding. Her examination revealed sever pallor, impaired conciosness, tenderness all over the abdomen with voluntary guarding, tachycardia at 130/min and blood pressure of 90/60. Serum beta-hCG test was positive. An ultrasound scan demonstrated an empty uterus with a non-viable fetus in the left adenexal region. She had significant free fluid throughout the abdomen with severe peritoneal effusion in the pouch of Douglas extending around the uterus and through the Morison's pouch. An emergency laparotomy was performed under general anesthesia. Intraoperatively a ruptured left interstitial ectopic pregnancy of 15 weeks gestation on the left aspect of the uterus was detected. A cornuostomy with left salpingectomy were performed. Haemoperitoneum was encountered and approximately 1500 ml of blood was evacuated from the abdomen. The patient was transfused with 6 units of blood. Post operation recovery was uneventful and she was discharged home on day 4 postoperatively. She was scheduled to have hysterosalpingography after the surgury to exclude uterine anomalies.

Fitz Hugh Curtis syndrome has been described mainly in females with characteristic peri hepatic fibrosis sparing the liver parenchyma and presence of pelvic inflammatory disease. The peri- hepatic fibrosis is usually between the liver capsule and the diaphragm. This has been mainly described in female patients and thought to be as a result of Pelvic Inflammatory Disease (PID). However in our setting we have noticed cases occurring mainly in young men that fit the above description. These have presented with mainly pain in the upper abdomen. Epigastrium, left and hypochondrium. In our setting some of these patients have had upper GIT Endoscopies done and a diagnose of esophageal reflux and hiatus hernias diagnosed. Pelvic manifestations of inflammation have not been present in any of these patients An abdominal CT scan may report per capsular thickening in some of these patients, however in our setting, the majority of these patients are diagnosed at laparoscopy. We therefore report a case of Fitz Hugh Curtis diagnosed at laparoscopy, the patients symptoms of upper abdominal pain have completely resolved after lysis of these peri hepatic adhesions.