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Acquired prothrombin complex deficiency:Case reportsIntroduction: Acquired prothrombin complex deficiency (APCD) is a spontaneous hemorrhage due to decreased activity of vitamin K dependent coagulation factor (factor II, VII, IX, and X). Many factors lead to vitamin K deficiency in newborns. We reported case reports of APCD which were successfully managed with APCD guidelines.Case presentation: First case was baby aged 1 month who came to emergency ward due to seizure four times. Seizures were occurred for 30 minutes and reported unconscious between episode of seizure. Head computed tomography (CT) scan examination revealed crescent shape appearance which suggested subdural hematoma (SDH). Second case was a 2 months old baby came to emergency department unconsciously since two days before. Patient has no history of vomiting and seizures. Non-contrast head CT scan showed appearance of crescent shape, which suggested presence of SDH. Both patients were managed according to APCD guidelines and had improved. Conclusion:Mild APCD has good prognosis and showing improvement in 24 hours after vitamin K injection. The mortality rate is very high in case of severe bleeding in intracranial, intrathoracic, and intraabdominal.

Background: Meningioma of the craniovertebral junction is a unique and rare case. The sensitivity of the region to surgical still debateable. Complete resection is the primary goal of surgery. Aim: We report a unique and rare case of improvement motoric and sensory after surgical resection intramedullary craniovertebral junction meningioma. Case report: 37 years old woman presented tetraplegia (0/0/0/0) and heavy breathing since six month. MRI showed mass on craniovertebral junction. Laminectomy C1, tumor excision, and suboccipital decompression should be done. One week post operation the patient showed an improvement in functional motoric (3/3/2/2) and sensory and improvement in clinical symptoms. Conclusion:Complete resection is the primary goal to prevent sequel and recurrent craniovertebral junction meningioma.

Meningioma is uncommonly found in extracranial. Extracranial meningioma can be extension from primary intracranial tumors that accompany osteolytic changes in the skull or causes bone destruction. In this article, we report about intracranial meningioma in the frontal region that extend to the sinonasal bone causes bone destruction and being predisposing factor for respiratory tract infection. A 47-years old female brought to the emergency department due to dyspnea and fever since a week ago and there was found a lump in the frontal region. During the surgical procedure, there was invasion of tumor and caused sinonasal bone destruction. The endotracheal tube (ETT) can be seen from the surgical field. In this case the patient was threated pneumonia infection, it can be related as complication of sinonasal bone destruction that caused by invasion of meningioma to extracranial manifestation. The clinical important that must be informed to the patient the possibility of recurrent respiratory tract infection incidents.

Introduction:Penetrating trauma that caused by gunshot injuries have been reported about 17-21% of all spinal cord injuries. Transoral approach may facilitate accessing the lumens and sites such as upper cervical spine with minimally invasive surgical exposure. Here, we present an interesting case of removal a bullet in the cervical spine with new method. Case Presentation: A 53-year-old man who underwent a gunshot in the maxillary region of the face. A CT scan of head and neck showed that a metallic foreign body located in corpus vertebrae as high as C1-C2. The bullets in this patient were removed under the minimal invasive surgery through transoral approach. The patients were discharged without neurological deficit. Conclusion:The presented transoral approach can be used as minimal invasive surgery method to extract corpus allienum in upper cervical spinal region without spinal cord tissue damage.