Treatment of Post Traumatic Internal Carotid Artery Pseudo Aneurysm with Intravascular Coil Embolization

Introduction: Vascular complications such as bleeding and pseudoaneurysm following an endoscopic trans-sphenoidal approach for the basal skull pathology are rare but when it occurs it brings a significant risk of morbidity and mortality along with it. Intraoperative bleeding can be managed with manual packing and in case of pseudoaneurysm formation, it can be successfully managed with endovascular coiling.Case presentation: One month after an endoscopic sphenoidal resection of mucocele. A 49-year-old female presented with massive left sided epistaxis due to formation and rupture of pseudoaneurysm at left cavernous segment of internal carotid artery. She was managed with multiple coil embolization of pseudoaneurysm.Conclusion: A patient with pseudoaneurysm formation following an endoscopic trans-sphenoidal approach for a mucocele resection was successfully managed by the emergency endovascular coiling, with complete obliteration of the aneurysm and bleeding while maintaining the vessel patency. This approach is less invasive, quick as well as safe and do not require long term anticoagulation. However, long term follow and larger sample are required to evaluate its efficacy

Origin of the Oligocene Tuolangla porphyry-skarn Cu-W-Mo deposit in Lhasa terrane, southern Tibet

Although some porphyry-skarn deposits occur in post-collisional extensional settings, the post-collisional deposits remain poorly understood. Here the authors describe the igneous geology, and mineralization history of Tuolangla, a newly-discovered porphyry-skarn Cu-W-Mo deposit in southern Tibet that belongs to the post-collisional class. The deposit is associated with Lower Cretaceous Bima Formation. It was intruded by granodiorite porphyry intrusions at about 23.1 Ma. Field investigation indicated that mineralization is spatially and temporally associated with granodiorite porphyry. Molybdenite yielded a Re-Os weighted mean age of 23.5 +/- 0.3 Ma and is considered to represent the age of skarn mineralization at the deposit. The delta S-34 values of sulfides, concentrated in a range between 0.6 parts per thousand to 3.4 parts per thousand, show that the sulfur has a homogeneous source with characteristics of magmatic sulfur. The Pb isotopic compositions of sulfides indicate that ore-forming metal materials were derived from the mantle and ancient crust. The granodiorite porphyry displays high SiO2 (68.78%-69.75%) and K2O (3.40%-3.56%) contents, and relatively lower Cr (2.4x10(-6) -4.09x10(-6) ), Ni (2.79x10(-6)-3.58x10(-6)) contents, and positive epsilon(Hf)(t) values (7.7-12.9) indicating that the mineralization porphyry was derived from the partial melting of juvenile lower crust. The Tuolangla deposit is located in the central part of Zedang terrane. This terrane was once considered an ancient terrane. This terrane is in tectonic contact with Cretaceous ophiolitic rocks to its south and Mesozoic continental margin arc volcanics and intrusions of the Gangdese batholith of the Lhasa terrane to its north. Thus, the authors proposed that the Oligocene porphyry skarn Cu-W-Mo mineralization is probably associated with the Zedang terrane. This finding may clarify why the Oligocene (about 23 Ma) deposits are found only in the Zedang area and why mineralization types of the Oligocene mineralization are considerably different from those of the Miocene (17-14 Ma) mineralization. (C) 2020 China Geology Editorial Office

Pseudomonas aeruginosa ecthyma gangrenosum in a woman with recurrent Graves’ disease

SummaryA 35-year-old woman with postoperative recurrent Graves’ disease presented with a 5-day history of a red swelling on the right cheek associated with 4 days of remittent hyperpyrexia. Investigations revealed fever, a gangrenous ulcer on the right cheek, submandibular lymphadenopathy, and thyroid gland enlargement. Her white blood cell count, immunoglobulins, and lymphocyte subsets were unremarkable. Thyroid function tests showed low thyroid-stimulating hormone, high free thyroxine, and elevated radioactive iodine uptake. Repeated pus cultures grew Pseudomonas aeruginosa, but blood cultures were negative. An ill-demarcated erythematous plaque occurred on the right leg on hospital day 3. She was treated with intravenous antibiotics with topical gentamicin, recombinant bovine basic fibroblast growth factor, and radioiodine therapy with anti-thyroid drugs. The ulcer healed leaving a depressed scar at 35 days after discharge. This patient may represent the first case of P. aeruginosa ecthyma gangrenosum and cellulitis in postoperative recurrent Graves’ disease