Resumen es: La enfermedad de Kawasaki es una enfermedad febril aguda infantil. La morbimortalidad se relaciona con la existencia de aneurismas coronarios. Se p...
Miller Fisher syndrome (MFS) and Bickerstaff brainstem encephalitis (BBE) represent two clinical entities within the anti-GQ1b antibody spectrum, both characterized by acute onset and immune-mediated pathophysiology. We report the case of a 22-year-old woman who presented with dorsal pain, visual disturbances, ophthalmoplegia, and ataxia, showing a progressive neurological decline. Neuroimaging and cerebrospinal fluid analyses revealed no structural or cytochemical abnormalities. Despite this, the patient tested positive for anti-GQ1b antibodies, confirming the diagnosis of an atypical Miller Fisher syndrome associated with brainstem involvement. Early initiation of intravenous immunoglobulin and corticosteroid therapy led to a rapid and almost complete recovery of neurological function. This case highlights the diagnostic challenges of anti-GQ1b antibody syndromes, emphasizing the need for high clinical suspicion and early immunotherapy to prevent irreversible neurological damage.
Objective: Achilles tendon rupture is a common injury, particularly in active individuals. Traditional surgical techniques for acute Achilles tendon rupture repair often focus on knot-tying and may result in bulky knots, foreign body reactions, wound complications and discomfort. We present the drawbridge (DB) technique, aiming to improve patient outcomes and minimize these complications. Materials and Methods: The DB surgical technique benefits from reduced knot volume, effective tension distribution (based on intraoperative assessment and clinical follow-up), and an absence of visible knots. It involves inserting a strong suture through the tendon both stumps in a Krakow pattern, and uniting both repair within each other and placing knots distally to the injury (cephalus-caudal) in an inverted manner. The tension is then distributed evenly across the sutures, resulting in a low-profile repair with minimal knot bulk, improving tissue approximation, without knots in-between or recurring to terminal-term corepair. Results: DB demonstrates promising outcomes compared with traditional surgical techniques. Its advantages include improved biomechanical strength, reduced foreign body reactions, and reduced long-term discomfort (based on our clinical experience, as no comparative data are yet available) for patients. It has the advantages of the well know Krakow repair with a higher patient satisfaction score when using the DB technique in comparison to other techniques. Conclusion: DB represents a significant advancement in the surgical repair of acute Achilles tendon ruptures. The technique offers biomechanical advantages, reduces complications, and improves patient outcomes. Further research is warranted to validate and expand upon these encouraging findings and to assess its long-term effectiveness in active populations.
