RESUMEN
A complex liver lesion presents a significant challenge in terms of diagnosis and management. This case is an illustrative example, highlighting the steps involved in managing such complex scenarios. This patient, in her early 20s, presented with a fever associated with worsening abdominal pain, as well as a background history of chronic abdominal pain, anorexia, vomiting, constipation and weight loss. The radiology revealed an irregular complex cyst in the liver with biliary and vascular invasion, raising concerns about hepatocellular carcinoma. The diagnosis was changed to alveolar echinococcosis after the infectious diseases consultant gave helpful advice, and echinococcosis antibodies were found. We subsequently started the patient on albendazole therapy. Following prudent advice from hepatobiliary surgeons and given the complexity of the hepatic lesion, a liver transplant was considered the best management option due to the extensive involvement of the biliary and venous systems. The combined approach of albendazole and a liver transplant marked a transformative phase for this patient, putting an end to her prolonged suffering.
Asunto(s)
Albendazol , Carcinoma Hepatocelular , Equinococosis Hepática , Neoplasias Hepáticas , Trasplante de Hígado , Humanos , Equinococosis Hepática/diagnóstico , Equinococosis Hepática/diagnóstico por imagen , Carcinoma Hepatocelular/diagnóstico , Femenino , Neoplasias Hepáticas/diagnóstico , Diagnóstico Diferencial , Albendazol/uso terapéutico , Adulto Joven , Antihelmínticos/uso terapéutico , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: The cataract surgery anesthesia should be to make the procedure as safe and as satisfactory as possible for all concerned. The recent progress in anesthesia and surgery now allow cataract extraction to be done with minimal physiological changes to the patient. We aimed in the study to compare between two different doses of dexmedetomidine combined with lidocaine and bupivacaine during retrobulbar anesthesia for cataract extraction by phacoemulsification. MATERIALS AND METHODS: This study was done on forty patients with cataract. The patients were enrolled in two groups: Group (A):Twenty patients were received 1.5 ml 2% lidocaine + 1.5 ml 0.5% bupivacaine + 0.25 µg/kg of dexmedetomidine and Group (B): Twenty patients were received 1.5 ml 2% lidocaine + 1.5 ml 0.5% bupivacaine + 0.5 µg/kg of dexmedetomidine. RESULTS: The globe anesthesia duration, globe, and lid akinesia were significantly longer in the Group B than in the Group A (P < 0.05). Intraocular pressure decreased through the first 15 min after anesthesia in the two groups, and the changes were not significant between the two groups but highly significant in every group when compared to its baseline reading. As regards the conscious level in the two groups, there was a significant difference (P < 0.001). Group A is higher regarding score 2 and 3, and Group B higher in score 4. CONCLUSIONS: We concluded that dexmedetomidine 0.25 µg/kg, when added to retrobulbar block for cataract surgery, will significantly increase the duration of retrobulbar block and improve both the surgeon and the patient satisfaction.