The Story For Ku-0059436

In addition to rapid onset of symptoms and systemic response, patients with lymphedema cellulitis are at risk for prolonged symptoms, treatment failure, and recurrent episodes. Conflict of Interests The authors declare that there is no conflict of interests regarding the publication of this paper.""In the evening, a 32-year-old man and two policemen were trying to pacify another man in a case of domestic violence. The accused took out the revolver of one of the policemen and shot him on the left side of his chest. The RG7204 purchase bullet came out through the back of the policeman and entered through the open mouth of the patient, who was standing behind him. The policeman died on the way to the hospital. The patient became unconscious and was admitted to the nearby hospital. After initial treatment, the patient was referred to a Medical College and was admitted there. He was given supportive treatment including blood transfusion and he regained his consciousness in the next morning. On examination, there was a huge haematoma over the left side of the face. The entry wound (Figure 1) was found in the inner aspect of the cheek adjacent to the left lower third molar. There was dental malocclusion. A fracture line could be palpated near the angle of the mandible on the left side. The patient was unable to open his mouth completely. Figure 1 Preoperative photograph showing the entry point (EP) of the bullet (1.2?cm �� 1.0?cm) on the cheek mucosa adjacent to the left lower third molar. There was no injury in the pharynx. Airway was clear. There was an area of bruise with extra tenderness over the left infra-auricular area. On bimanual palpation, the patient complained of sharp pain and was able to feel the bullet there. The cranial nerves were normal. Lateral view of the X-ray of the skull (Figure 2) revealed a bullet in the base of the skull on the left side at the level of the atlas. It was placed obliquely occupying an area posterior to the neck of the mandible, extending from the level of the atlas to the basiocciput. The base was directed anteroinferiorly and the tip was directed posterosuperiorly. Anteroposterior view of the X-ray of the skull (Figure 3) revealed that it was lying in a sagittal plane passing through the middle of the left maxillary sinus. The body and ramus of the mandible were broken near its left angle with multiple fracture fragments. Figure 2 Preoperative X-ray of the skull, lateral view, showing the bullet (B) in the left parapharyngeal space at the level of the atlas (A). Figure 3 Preoperative X-ray of the skull, anteroposterior view, showing the bullet (B) lying in a sagittal plane passing through the middle of the left maxillary antrum. Note the multiple fracture fragments (f) of the mandible on the left side. CT scan revealed the bullet in the parapharyngeal space (Figure 4) about one cm anterolateral to the transverse process of the atlas on the left side.