Journal of Case Reports and Medical Images

Short Name: J Case Rep Clin Images
ISSN: 2639-9237
Publisher: MedDocs Publishers LLC

Archive

Complex congenital heart disease

Inês Araújo Oliveira*; Cláudio Henriques; Filipa Vila Cova; Sílvia Álvares

    A male infant, delivered prematurely at 36 weeks and 2 days, received a prenatal diagnosis of a cardiac malformation, specifically a ventricular septal defect. He was admitted on the neonatal intensive care unit for monitoring and potential initiation of therapy. At birth, only transient alveolar recruitment was necessary.


Protein-Losing Enteropathy in an Operated Gastric Cancer Case

Irem Demirtas; Elif Sahin*

    Purpose: Of all cancers, Gastric Cancer (GC) is the third leading cause of cancer mortality and the fifth prevalent malign tumor to be diagnosed (except skin cancers) [1]. Adenocarcinomas, which develop from the glands of the stomach's mucosaor superficial layer, account for themajority of stomach cancer cases [2].


Performance of Clinicians Regarding Survival Prediction in Advanced Cancer Patients: A Portuguese Multicenter Analysis

Rita Gameiro-dos-Santos*; Carolina Trabulo; Joana Gonçalves; João Gramaça; Isabel G Fernandes; Idília Pina; Paulo Luz

    Purpose: Clinical prediction of survival (CPS) is based on the physician's opinion. Systematic reviews on the subject show that clinicians tend to more often overestimate than underestimate patients' survival. This study aimed to explore the Portuguese experience in prognostication in advanced cancer patients and assess if some clinician´s aspects or patient characteristics may have any impact on the process.


Septal Angioplasty in Acute Coronary Syndrome(ACS) Patient: A Case Report of Revascularization of a Rarely Targeted Coronary Branch

Siddhartha Mani*; Arnab Banerjee; Purushottam Kumar; Ranabrata Sen

    Background: Revascularization of the septal branch of the Left Anterior Descending artery is challenging due to its intramyocardial course. Percutaneous interventions, such as balloon angioplasty or stenting, are preferred in cases where traditional coronary artery bypass grafting is not feasible.


Looking Through the Smoke: A Case Report of Unilateral Moyamoya Disease Resulting In Partial Anterior Circulation Stroke in Young Sri Lankan Female

Arun Rajaratnam

    Moyamoya disease is an uncommon vascular cause of young onset stroke. We present a case of a 35-year-old Sri Lankan female with recurrent transient ischaemic attacks and migrainous type headache presenting with dense Middle Cerebral Artery (MCA) territory ischaemic infarct, who on extensive workup was diagnosed to have typical cerebral angiographic evidence of intracranial cerebrovascular occlusion and "puff of smoke", which are typical of Moyamoya disease


Delayed Presentation of Acute Extensive Cerebral Venous Sinus Thrombosis Following Non- Penetrating, Closed Head Injury: A Case Report

Arun Rajaratnam*; Kiertie Kularatne

    Cerebral Venous Sinus Thrombosis (CVST) is a potentially life-threatening condition associated with high mortality and morbidity. We present a unique case of a young man who presented with acute worsening headache ten days after a non-penetrating head injury, and subsequent neuroimaging revealed extensive CVST without underlying skull fractures.


Mucinous Mayhem: A Case of Self-Healing Juvenile Cutaneous Mucinosis in a Filipino Boy

Juan Paolo David S Villena*; John Ruben C Valeza; Amanda Christine F Esquivel; Eileen Liesl A Cubillan

    Self-Healing Juvenile Cutaneous Mucinosis (SHJCM) is a rare, self-limiting disease with an unknown etiogenesis. Pediatric patients present with a variety of skin lesions that spontaneously resolve in a matter of weeks to months. We present a case of a 14-year-old Filipino boy with a 2-month history of recurrent well-defined, nontender nodules with surrounding halo-like ecchymoses on the trunk and extremities that spontaneously resolve in 10-14 days


Evans Syndrome: A Case Report and Review

Arti Muley*; Sona Mitra; Kuldeep Viramgam; Zinal Patel

    Evans Syndrome (ES) is defined as the concomitant or sequential association of warm Autoimmune Hemolytic Anemia (AIHA) with Immune Thrombocytopenic Purpura (ITP), and less frequently autoimmune neutropenia. Its chronic course is characterized by recurrent relapses and remissions. The typical clinical course is chronic and relapsing, and therapy is generally progressive and of poor outcome. We present a case of evans syndrome who was doing well on treatment with azathioprine and steroids but deteriorated and succumbed to her illness due to non compliance.


"Looks Can Be Deceiving": Atypical Brain Metastases Mimicking Neurocysticercosis, A Case Report and a Review of the Literature

Luigi F Saccaro*; Simone Ferranti; Enrico Tagliaferri; Valentina Galfo; Silvia Fabiani

    Background: The ingestion of eggs of Taenia solium (also called pork tapeworm) determines infestation of the Central Nervous System (CNS) by the larval form of parasites with the formation of multiple cysts. The main diagnostic criteria for neurocysticercosis is the evidence of cystic lesions showing the presence of scolex on neuroimaging studies, typically MRI) or CT.


"From Tumor Terror to Hematoma Hilarity: A Surgical Tale Unexpected": Case Report

Bhoopendra Singh Gora; Agil Babu; Pinakin Patel; Kamal Kishor Lakhera; Suresh Singh; Mahesh Daima

    Background: Desmoid tumors are a rare type of soft tissue tumor that arise from connective tissue cells known as fibroblasts. They occur most commonly found in the abdominal wall. They are typically locally invasive and cause significant morbidity [1].


Multimodality Imaging Evaluation of a Unilateral Madelung Deformity

David Cyruz Jan; Sydiongco-Inocencio Paula Marie

    A Filipino female teenager with gross deformity of her right wrist, came as an outpatient for radiographic evaluation nonspecific pain and numbness after prolonged repetitive, active wrist movements like writing and clapping, are noted with no history of trauma, infection, or surgical intervention of the aforementioned wrist.


How Dermatology Failed Me

Sydella Emily Lily Nahama

    In this article I will be reviewing my personal experience with acne and the wide range of treatments I have received, which includes multiple antibiotics, spironolactone, numerous topical creams, holistic remedies, the contraceptive pill, Roaccutane and not to mention the numerous specialists I have seen. My acne journey has thus far lasted over three years and I believe it is the right time to share my experience to let people know they are not alone.


Unexpected Elevation of the Right Diaphragm After Laparoscopic Surgery

Haruka Katafuchi; Yukari Adachi; Masahiro Nishida; Tsukasa Koyama; Yukio Hayashi*

    Several complications are reported after laparoscopic surgery. In this case, we underestimated small elevation of the right diaphragm in preoperative chest X-ray photograph, resulting in hypoxia due to atelectasis after laparoscopic surgery.


Will Mosquito Bite Causes Infertility? – A Case Report

Taranya R*; Shanmugapriya N; Kalpana S; Srinivas G; Jasmine S Sundar; Valarmathi S; Ramkumar G

    Filariasis is a rare disease which is a parasitic infection caused by Wuchereria Bancrofti. In 2006 there were 50 million people infected with or without symptoms. In 2005 95% of the cases in India were in Andhra Pradesh, Bihar, Gujarat, Kerala, Maharashtra, Orissa, Tamil Nadu, Uttar Pradesh and West Bengal [1].


Consanguinity and Tgm1 Mutation in a Neonate with Non-Bullous Congenital Ichthyosis: A Rare Case Report

Mohammed Misbah Ul Haq*; Mohammed Yousuf Younus; Mohammed Atiqh Ur Rahman

    Non-Bullous Congenital Ichthyosis (NBCI) is a rare genetic disorder that presents with dry, scaly skin due to impaired shedding of skin cells. We report a case of NBCI in a neonate born to consanguineous parents, who was diagnosed with a TGM1 gene mutation. The patient received treatment with oral retinoids, which were carefully monitored by clinical pharmacists to minimize the risk of adverse effects.


Prognosis Prediction In NPC Based on Radiomic Models Of F-18 FDG PET/CT Images

Chia Ni Lee; Yi-Ching Lin; He-Yuan Hsieh*; Jui-Yin Kung; Chun Ting Chiang; Jyh-Cheng Chen*; Shih-Chuan Tsai*

    Nasopharyngeal Carcinoma (NPC) is one of the most common head and neck cancers. Positron emission tomography/computed tomography (PET/CT) combines biological metabolic information and anatomical images, and therefore, plays a crucial role in the diagnosis, treatment, and prognosis of NPCs.


Tumours Have a Mind of Its Own? Metaphorically Yes!

Naina Kumar

    We have entered 2023. Humans have the utmost staging and prognostic criterias for cancers. Yet we can never predict how a stage I breast tumour shockingly metastasizes to stage IV within a month in some cases. Or miraculously a patient on palliative care for recurrent carcinoma head and neck stabilizes and lives a long life on targeted therapy.


Potential of Functional Near-Infrared Spectroscopy for Diagnostics of Depression

Triana Rahayu; Saara Ryynänen; Teemu Myllylä*

    There is lack of accurate methods to diagnose Major Depressive Disorder (MDD), one of the most prevalent global psychiatric disorders. Possible pathophysiological effects could be used in assessment of depression, and for this purpose Electroencephalography (EEG) and Functional Magnetic Resonance Imaging (fMRI) are being studied. In addition, Functional Near-Infrared Spectroscopy (fNIRS) shows promising results as a method to assess MDD.


Rapid Progression of Cerebral Atrophy Associated with SARS-Cov-2 Infection: Case Report

Azin Aein; Shekhar Khanpara; Luis C Nunez-Rubiano; Lilit A Sargsyan; John A Lincoln; Roy F Riascos*

    COVID-19 is nowadays understood as a systemic disease rather than an acute respiratory infection. Neurotrophic properties have been attributed to this virus, generating great concern due to its long-lasting consequences. Hereby we present the first case of rapid progression of cerebral atrophy associated with SARS-CoV-2 infection.


Retrograde Transbronchial Intubation: Solution for a ‘Lost Airway’ During Open Thoracic Surgery

Brenda Lin, MD; Alexandra Forsyth, MD; Venkatesh Srinivasa, MD; James McPhee MD

    Airway loss during an operative procedure is potentially fatal. This is especially challenging in patients that are positioned non-supine as is the case in lateral decubitus positioning that is standard for the majority of lung resections. We present a novel approach that enabled rapid control of a lost airway during open thoracotomy and endotracheal tube exchange for such a patient.


Non-Communicable Diseases of Humans versus Palliative Care: An Insightful Data Centric Approach

KGGS Karunathilaka; GS Dissanayake*

    Estimates on palliative care and mortality due to Non-Communicable Disease (NCD) for most nations are seemingly absent in the literature. An insightful data centric approach is a requisite need to fill in the void as a contribution to the existing body of knowledge.


Spindle Cell Melanoma Masquerading as a Lipoma: An Interesting Case Study on the Presentation of a Rare Cancer

Ryan Lamm*; Walker Lyons; Stacey M Gargano; Alliric I Willis

    Overall survival is directly correlated to melanoma thickness and definitive surgical excision. Spindle cell melanoma is a rare subtype of malignant melanoma and particularly difficult to diagnose. Identification of histopathological features and referral to specialists are essential.


Traumatic Supraclinioid Internal Carotid Artery Pseudoaneurysm and Carotid-Cavernous Fistula: A Case Report and Review of Literatures

Irene (Tai-Lin) Lee*; Stephanie Katherine Rivero; Yen-Jun Lai; Wei-Jen Lai

    We present a teen scooter rider who suffered from a major traffic accident. Multiple skull base fractures, subarachnoid hemorrhage (SAH), and a supraclinoid ICA pseudoaneurysm with transdural connection to the Cavernous Sinus (CS), forming Carotid-Cavernous Fistula (CCF), were diagnosed by brain computed tomography (CT) and angiography. Endovascular treatment was done 4 days later, and initial complete occlusion was achieved by combined transarterial and transvenous coil embolization.


An Aborted Fetus in the Second Trimester of Pregnancy due Osteogenesis Imperfect (Diagnosed After Miscarriage): A Case Report

Habib Ibrahim Jarbouh; M SUBHI MURAD*; Nour Alkhateb; NOUR ALI ALOLIWI; Huda Hossin

    Osteogenesis imperfecta (OI) is a group of disorders characterized by osteopenia, fractures, short statures, bone deformity, blue sclera and hyper laxity of ligaments and skin, with a prevalence 6-7 per 100 000 individuals. There are four main kinds of OI with type II being the most severe; it is inherited in an autosomal recessive pattern with prenatally lethally deforming OI with multiple congenital fractures, micromelia and severe lung disease.


A Case of Carbapenem-Induced Encephalopathy

Tamer Shalaby Boutrus

    A 74-year-old female patient under the care of the medical team was admitted as a failed discharge from Urology. The patient had undergone bilateral nephrostomy placement for obstructive nephropathy. The left-sided nephrostomy had previously been removed and the right-sided nephrostomy was on free drainage until follow-up Urology appointment 6 weeks from the point of review.


A Rare Case of Splenic Flexure Volvulus

Min Yien Tan*; Michelle Zhiyun Chen; Arsalan Bakhtiar; Ewan MacDermid

    Splenic Flexure Volvulus (SFV) is rare and accounts for only 1-2% of all colonic volvulus, with approximately 50 cases being described in the literature. Patients typically present with non-specific symptoms of a large bowel obstruction such as abdominal pain, distension, obstipation, nausea or vomiting.


Celiac Artery Compression Syndrome, Case Report

Walter Camilo Mera Romo*; Juan Pablo Pérez Daza; Karen Yuliana Ramírez Iriarte; Sebastian Felipe Navarro Téllez; Wilmer Aponte Barrios; Carlos Alfonso Cortes Ortega

    Median arcuate ligament syndrome (MALS) is defined by the clinical presentation and radiological findings of compression of the celiac trunk by the median arcuate ligament. The diagnosis is controversial, and generally one of exclusion due to poorly understood pathophysiological processes, variable clinical severity, and unpredictable response to treatment.


Painful Facial Disfiguring Swelling in A 33 Year-Old Male with End-Stage Kidney Disease: A Case Report of Sagliker Syndrome With 2-Year Follow-Up Outcomes

Hannah Gaulden; Manasi Singh; Monika Gööz; Vinayak Rohan; Tibor Fülöp; Blaithin A McMahon*

    Dialysis-dependent stage 5 chronic kidney disease with renal osteodystrophy can lead to a rare and extreme form of cranial deformities called Sagliker syndrome, a condition driven by extreme parathyroid hormone production and characterized by disordered skeletal remodeling resulting in severe facial abnormalities, dental deformities, and possible psychological changes.


A Rare Presentation of Bowel Evisceration Through Vaginal Cuff Dehiscence

Sena Park*; Michelle Zhiyun Chen; Kate McKellar Stewart; Sinan Albayati

    Bowel evisceration is a rare complication of hysterectomy with only 100 cases reported so far. The evisceration occurs through the vaginal cuff dehiscence, which is found in 0.24-0.39% of all hysterectomies. This is a surgical emergency where bowel injury and peritonitis can occur if not treated promptly. Some studies report increased rate of the vaginal cuff dehiscence associated with minimally invasive techniques of hysterectomy


A Rare Case of Disseminated Tuberculosis with Perianal Tuberculosis

Deepak Kumar Suthawal*; Virendra Mahatma; Ratan Choudhary

    Disseminated tuberculosis defined as concurrent involvement of at least two non-contiguous organ sites organ sites of the body or involvement of blood or bone marrow by tuberculosis process [1]. Disseminated tuberculosis continue to be a diagnostic problem even tuberculosis endemic areas. Its account less than 2% of all cases of tuberculosis [2]. Among extra pulmonary tuberculosis only 3-4% develop abdominal tuberculosis and in case abdominal tuberculosis perianal involvement is a rare phenomenon...


A Novel Four-Way Translocation t(1;3;9;22)(p36;p14;q34;q11.2) involving Philadelphia Chromosome in a Patient of Chronic Myeloid Leukemia: A Case Report

Priya K Varma; Pina J Trivedi*; Dharmesh M Patel; Mahnaz M Kazi; Prabhudas S Patel

    90% of Chronic Myeloid Leukemia (CML) patients having Philadelphia (Ph) chromosome or t(9;22)(q34;q11.2), and the remaining 5–8% of CML patients demonstrate variant translocations, with the involvement of third, fourth, or fifth chromosome other than 9;22. Though, in very rare cases, the fourth chromosome is involved. Here, we found a novel case of four-way translocation involving 46,XY,t(1;3;9;22)(p36;p14;q34;q11.2) in CML-chronic phase...


Diabetes as the Cause of a Stroke Mimic

Lucinda Tran; Roy G Beran*

    The case of a 58 year old, Caucasian man, presenting with homonymous hemianopia, in conjunction with previously undiagnosed diabetes, who attend the Emergency Department with an elevated haemoglobin A1c of 16.5% and a random serum glucose of 23.0 mmol/L, was published in your journal [1]. This case was identified as the first report of a ‘stroke mimic’, presenting with hemianopia in conjunction with diabetes, confirmed following full investigation, including repeated Magnetic Resonance Imaging (MRI)...


Cerebral Oligodendroglial Tumor Coexisting With Adrenal Ganglioneuroma; A Case Report

Ataollah Shahbandi; Saeid Atashpanjeh; Aileen Azari-Yam; Hojatollah Raji; Farideh Nejat; Zohreh Habibi*

    Purpose: Multiple primary neoplasms are defined as two or more synchronously or metachronously occurring tumors of separate origins in the same individual. Either cerebral oligodendroglioma or adrenal ganglioneuroma have been diagnosed as constituents of multiple primary neoplasms in several patients. However, there is no report of concurrent occurrence of these two tumors in a single patient.


Disease Progression after Discontinuation of Lenvatinib in a Patient with Known Thyroid Cancer, Pleural Metastasis, and COVID-19

Nawar Hasan*; Heerani Woodun; Omar Ahmad; Nicolae Culis; Abigail Pascoe

    A 77-year-old female, with background of refractory metastatic papillary thyroid cancer after a 2-stage thyroidectomy in 2016 and radioactive iodine ablation, presented with dyspnea and chest pain. She was COVID-19 positive. Computed tomography of thorax demonstrated marked progression in pleural soft tissue metastasis with pleural thickening and a large pleural effusion. She required chest drainage...


Cognitive Performance after using Atypical Medication in a Drug-Free Bipolar

Milena EC Oliveira*; Gabriella M Silva; Natanael A Santos; Givago S Souza; Thiago P Fernandes

    Bipolar Disorder (BPD) is a complex disorder and it is essential to understand the mechanisms underlying the disease stages. We present a case report of a 25-year-old male patient was diagnosed with type 1 BPD according to the DSM-5 and the SCID for DSM-5. He was referred to a private clinic because of complaints of persecutory delusions, mystical delirium, and hallucinations...


Graves’ Disease As a Manifestation of IRIS in an HIV Patient: Case Report

Isabella Sued Leão*; Bernardo Baêta Bastos Leão Maia; Fernando Salles Filho; Marcus Vinícius Leitão de Souza

    Highly Active Anti-Retroviral Therapy (HAART) may be related to Immune Restoration Inflammatory Syndrome (IRIS). Although rare, Graves’ disease may present as part of IRIS but usually presents 12-24 months after HAART initiation. We report a case of hyperthyroidism that developed 34 months after initiation of a new HAART regimen.


Hyperglycaemia as a Stroke Mimic: A Case Report of Homonymous Hemianopia Due to Hyperglycaemia

Lucinda Tran ; Roy G Beran*

    Focal neurological symptoms, in the context of non-ketotic hyperosomolar hyperglycaemic state (HHS), are a well-documented phenomenon. It is less clear whether focal neurological symptoms can be a manifestation of hyperglycaemia without evidence of ketosis or hyperosmolality. This report describes a case of a 58 year old Caucasian male who presented with a macula-sparing left homonymous hemianopia in the context of hyperglycaemia and a new diagnosis of type 2 diabetes mellitus without any radiological evidence of stroke on Computer Tomography (CT) or Magnetic Resonance Imaging (MRI) of the brain...


An Aberrant Crossover Path of Right Subclavian Venous Catheter

Chanchal*; Usha Bafna; Rohit Jindal

    Central venous access in an intensive care unit is indicated for venous access, parenteral nourishment, inotrope infusion and blood transfusions. Central venous access can be obtained in multiple veins like the internal jugular, subclavian and femoral vein. It can be obtained via either ultrasound-guided or landmark-guided approach. Infection, catheter malpositioning, venous perforation, arterial puncture, hemothorax and pneumothorax are some of the associated complications...


Mucinous Tubular and Spindle Cell Renal Cell Carcinoma about an Observation and Review of the Literature

Yassir Himmi*; Baby Moutah; Amine Slaoui; Karmouni Tarik; Elkhader Khalid; Koutani Abdellatif; IBN Attya Andaloussi Ahmed

    Mucinous tubular and spindle cell carcinoma is a rare tumor described in the 2004 WHO classification as a new entity with a relatively indolent behavior. We report a case of 60 year old man with a large left upper pole tumor. The patient was treated by left radical nephrectomy. The histologic findings confirmed that it was a tubulo -mucinous carcinoma and spindle cell grade I Furhman contours with non-infiltrating hilar invasion...


Massive Retroperitoneal Haematoma Following Bone Marrow Trephine Biopsy: An Unexpected Fatal Complication

Rohit Jindal*; Tanay Shah; Kamal Kishor Lakhera; Sanjeev Patni

    A 30 year old female, with clinical suspicion of chronic myeloid leukaemia, was advised to have a Bone Marrow (BM) triphene biopsy to establish the diagnosis. The BM trephine biopsy was done from the right posterior superior iliac spine. 10-12 hours following the BM biopsy, she complained of severe abdominal pain and distension along with a few episodes of non-bilious vomiting...


Carbamazepine Cutaneous Adverse Reactions: The Importance of an Alternative Anticonvulsant

Eleonora Nucera*; Angela Rizzi*; Alessandro Buonomo; Domenica Immacolata Battaglia; Roberta Massaro; Marinella Viola

    Antiepileptic drugs frequently provoke Cutaneous Adverse Drug Reactions (cADRs). The management of these reactions often requires discontinuation of the therapy. Cross reactivity among the most common antiepileptics (phenytoin, carbamazepine, and oxcarbazepine) is reported.


Lateral Pterygoid Muscle Preservation in Total Temporomandibular Joint Reconstruction with Stock Prosthesis

Shijing Yue; Jiong Zhao; Guo Bai; Minjie Chen*; Chi Yang*

    End-stage temporomandibular joint diseases often cause pain in the area of joint, jaw opening limitation or facial deformity, and treatment of total joint reconstruction is recommended. However, the surgical procedures generally ignored the reconstruction of Lateral Pterygoid Muscle (LPM), leading to mouth opening deviation unilaterally or vanishment of lateral movement bilaterally...


A "Looped In" Malpositioned Cephalic Venous Catheter

Rohit Jindal*; Pranav Mohan Singhal; Pinakin Patel; Suresh Singh

    Chemoports are implantable devices that provide central venous access for chemotherapy, parenteral nourishment, and blood transfusions, among other procedures. They have significantly reduced the morbidity associated with chemotherapy administered peripherally. Cephalic venous cut down technique is a well-known approach for central venous catheter implantation among the several proven procedures...


Case Report of a Rapidly Progressing Thyroiditis Following Immune Checkpoint Inhibitor Therapy with Pembrolizumab and Accidential Exposure to Iodine in a 30-Year-Old Male Patient With Metastatic Melanoma

Sebastian Schmidt*; Christoph Werner; Steven Goetze; Christof Kloos; Gunter Wolf

    Immune checkpoint Inhibitor Therapy (ICI) represents a novel approach of modern oncology and has improved survival in metastatic melanoma, lung cancer and renal cancer. The main endocrine complications of ICI, usually irreversible, include thyroid dysfunctions and hypophysitis. The exact mechanisms by which ICI may induce a stimulated immune response leading eventually to Immune Related Adverse Events (irAEs) are still not fully understood...


Bilateral Femoral Neck Stress Fractures in a Female Athlete Triad: Treated by PCCP and Cannulated Screws

Mohamed Elamin*; Amgad Fadlelseed; Lyndon Low; Paul O'Grady; Osman Yagoub; Bridget Hughes

    Introduction: Stress fractures are common in athletes, accounting for 1-20% of all sports injuries attending sport clinics. Literature has reported few cases of femoral neck stress fractures (FNSF) which represent only 10% of all stress fractures.


Peculiar Predictors for Failed Extubation among Patients Undergoing Elective Cranial Neurosurgical Procedures at Neuro-Critical Care Unit (NCCU): A Systemic Review

Mestet Yibeltal Shiferaw*; Tsegazeab Laeke T/Mariam; Abenezer Tirsit Aklilu; Yemisirach Bizuneh Akililu; Bethelhem Yishak Worku

    To predict “extubation failure” is essential, as both delayed and failed extubation have detrimental consequences such as prolonged ventilation and long Intensive Care Unit (ICU) stay, need for tracheostomy, increased cost of treatment and mortality. However, it is not an easy task to predict which patients are to fail with the extubation process merely based on the conventional parameters of extubation for any critical patient in an ICU setting in general and neurocritical patient in particular...


Transcortical Connection between Periosteal Ganglion and Intramedullary Ganglion Involving the Distal Ulnar Shaft: Demonstration on MRI

Rajendra Kumar; Gauri Panse; Behrang Amini; Wei-Lien Wang; Patrick P Lin

    A soft tissue ganglion presents as a localized cystic mass about a joint, usually at the wrist and ankle. An uncommon intraosseous ganglion resembling a geode may be seen in a bone adjoining a normal-appearing joint. A rare periosteal ganglion with variable cortical bone erosion occurs at surface of a bone...


Methamphetamine Abuse during Pregnancy and Its Effect on Fetal and Neonatal Outcome: A Review

Eugenia Maranella*; Claudia Basti; Sandra Di Fabio

    The objective of this study is to summarize and review the literature data about Methamphetamines use during pregnancy, its effects on fetal and neonatal outcome. In the recent years, the increase of Methamphetamines abusers women has become an emerging problem. Very little data has been published regarding the effects of prenatal methamphetamines exposure. We reviewed articles reporting the Methamphetamines related toxicity both in the mothers and in the newborns...


Enhanced Recovery: A Reality in Cancer and Pregnancy: A Case Report

Sindhu Sankaran; Amrithavarshini Ragavan; Pradeep Chirravur; Meera VV Ragavan*; N Ragavan

    Background: Renal malignancies in pregnancy are rare occurrences with a little over 100 cases described in literature. It is usually diagnosed and managed in the first trimester but we present the management of a third trimester pregnancy with renal mass
Case Presentation: A 27-year-old primigravida presented with a left sided intermittent pain at 32 weeks of pregnancy that on an ANC ultrasound revealed a renal mass...


Thalassaemia - The Need of the Day to Address the Issue; Awareness and Prevalence of Carrier Rate in a Cohort of University Students in Sri Lanka

Gunawardena D; Herath P; Wasana N; Perera MSM*

    Objective: The α and β Thalassaemias, a disorder of globin chain production, is an increasing global health problem. We performed a cross-sectional study of 384 undergraduates of the University of Sri Jayewardenepura to determine the prevalence and awareness of thalassaemia-minor among the students.


Non-Major Bleed in a Non-Hospitalized Patient with COVID-19 on Direct-Acting Oral Anticoagulant Apixaban - A Case Report

Varsha Narayanan

    Coronavirus Disease (COVID-19) has presented significant challenges and burden to healthcare. Majority of patients have mild-moderate disease and are managed in a non-hospitalized home care setting by family physicians. COVID has pathological mechanisms that include endothelial injury and hypercoagulability due inflammatory mediators...


Duplicated Gallbladder: A Case Report of a Previously Unreported Variant

Brendan D Winkle

    Background: Variations in biliary anatomy are frequently encountered. Of these, a Double Gallbladder (GB), with or without duplication of cystic duct is a very rare surgical encounter, with an incidence of approximately 1 in 4000-5000 population. There are multiple different subtypes of gallbladder duplication and knowledge of these is essential for diagnosis and operative management. We report a case of a previously unreported variant that lies outside of the current accepted classification.


Exertional Rhabdomyolysis Due to Spin Class is a New Problem in Young People in Singapore

Aaron Ng Qiyuan; Benedict Cesar Azucena; Ashish Anil Sule*

    Exertional Rhabdomyolysis (ER) finds itself an increasingly common cause of rhabdomyolysis as spin classes gain popularity amongst Singaporeans as a means to keep fit. We report 2 cases of ER, both of which were associated with recent attendance at spin classes. Both cases were treated with vigorous hydration and discharged with good renal function and mobility. This paper aims to raise the awareness of ER, which may be especially pertinent for general practitioners and emergency physicians...


Persistent Acidosis in DKA Due To Covid-19 Infection despite Optimal Management

Joby Landa; Ibrahim Benshaban; Tamer Shalaby*

    Covid-19 has a worse prognosis on diabetic patients who can present with severe metabolic complications. We present a case of a new diagnosis likely type 1 diabetes in a middle age non-obese white female, who presented with severe Diabetic Ketoacidosis (DKA), which was resistant to treatment, and her management required slight deviation from the guidelines to improve her outcome...


Omalizumab Therapy in Severe Allergic Asthma with Co-Morbidities during the COVID - 19 Pandemic - A Case Series

PC Kathuria*; Manisha Rai

    There is a dangerous liaison between severe asthma with co-morbidities and COVID-19 disease. There are several factors, which have been associated with increased risk for COVID-19 severity and mortality. Severe allergic asthma with co-morbidities such as poor lung function, adrenal suppression, recurrent nasal polyposis, food and drug hypersensitivity reaction in addition to older age, endocrine-metabolic and cardiovascular disease, have increased risk of hospitalization and mortality...


Cramped Into a Jam-Packed Region: The Carcinoma Invades All!

Bhushan Sanjay Bhalgat*; Kamal Kishor Lakhera

    Head neck region is a complex region with multiple structures close to each other. The maxilla is bounded by orbit superiorly, nasal cavity medially, the oral cavity inferiorly and the pterygomaxillary fissure posteriorly. Carcinomas arising in such a location with sarcomatoid histology tend to invade almost all the surrounding structures. Management of such a locally advanced cancer with such an unfavourable histology requires a bloc excision of the involved structures with a wide margin...


Hypertrophic Cardiomyopathy Associated with Mid-Cavity Obstruction

Deepak Agrawal*; Prashant Wankhade; Ashok Garg

    A 36 years old male presented with complaints of chest pain and palpitation for 5-7 days. He had similar complaints intermittently since last one year. He was examined in outdoor and his blood pressure was found as 172/96 mmHg with heart rate of 116 per minute. His ECG was done, which revealed ST segment depression in leads II, III, AVf, V5-V6 and peaking of T wave in V2 to V4...


Vascular Complications in a Patient Presenting With Headache

Leticia Santos*; Vilma Grilo; Maria Inês Marques; Filipa Monteiro; Sara Ramalho; Conceição Escarigo; Rita Nortadas

    A 35-year-old female with a history of migraine was admitted to the emergency department with severe headache with normal neurological exam. The patient evolved to convulsive crisis with identification of a non-pulsatile left cervical hematoma, chest wall hematoma and exuberant collateral venous circulation (observed in the images)...


Novel Study to See Arterial Stiffness Changes with Posture in Hypertensive Subjects in Asian Population in Singapore

Ashish Anil Sule*; Timothy Boey; Ashita Sule; Anna Marie Borja

    Arterial stiffness is directly related to increased cardiovascular events [1-7]. Increased arterial stiffness, is a measure of the elasticity of arteries, has been shown to increase the risk of myocardial infarction and stroke.
European Society of Hypertension guidelines on the management of hypertension acknowledges that central pressures (measure of arterial stiffness) may be more predictive of cardiovascular events when compared to brachial pressures. This is due to different antihypertensive drugs potentially having different effects on peripheral pressures and central pressures...


Primary Mucinous Adenocarcinoma in Spermatic Cord: A Case Report

Tzu Shuang Chen; Chih Hsiung Kang*

    In general, malignancies of spermatic cord are extremely rare. We herein reported a case of primary mucinous adenocarcinoma of the spermatic cord after radical inguinal orchiectomy with complete excision of the tumor. A mass located in inguinal area should always be considered as a malignant tumor and further general examination is necessary for distant metastatic lesions detection during the perioperative period...


The Administration of Naloxone to Reverse a Case of Cocaine-Induced Complete Heart Block

Ayesha Iqbal; Oluwafemi Augustine Ajibola*; Susan Collins; Matthew Apedo; Taiwo Opeyemi Aremu; Oluwatosin Esther Oluwole; Pang Lam

    Cocaine is a stimulant drug derived from coca plants and known for its addictive potential and toxicity, including cardiovascular complications. Complete heart block is a cardiovascular manifestation of cocaine toxicity, which can be life threatening. We present a case of a 49-year-old woman that presented with abdominal pain, diarrhea, and vomiting. With abnormal EKG readings, the patient was found to have a complete heart block from cocaine ingestion...


Clinical and Genetic Particularities in a Case with a Novel Mutation of MEN1 Gene

K EL Arbi*; Y Lajmi; F Mnif; D Ben Salah; M Mnif; N Rekik; H Kammoun; F Abdelhedi; M Abid

    Primary hyperparathyroidism is a common endocrinological disorder. In rare circumstances, it is associated with familial syndromes, such as multiple endocrine neoplasia type 1. In this context, we report our case. The patient was a 48-year-old female with a hypocalcemia, which was discovered incidentally after total thyroidectomy. It was secondary to multiple parathyroid adenomas, which were mistakenly considered as nodular thyroid tissue both preoperatively, and peroperatively...


The Promising Roles of Intrathecal Magnesium Injection: A Report on Three Cases

Ho Young Gil; Hong Seungbae; Choi Gyu Bin; Jong Bum Choi*

    Patients with neuropathic pain, such as postherpetic neuralgia, complex regional pain syndrome, failed back surgery syndrome, and phantom limb pain rarely respond to traditional treatments and are more likely to develop chronic refractory pain. Even these patients do not respond to invasive treatment using implantable devices such as spinal cord stimulator and intrathecal morphine pump...


Giant Cell Epulis Revealing Hyperparathyroidism in a MEN Patient

Asma Zargni*; Fatma Mnif; Kawthar El Arbi; Dhoha Ben Salah; Mouna Mnif Feki; Nabila Rekik; Faten Hadj Kacem; Mohamed Abid

    Primary hyperparathyroidism is a frequent endocrinological disorder. Rarely, it is associated with hereditary syndromes, such as multiple endocrine neoplasia type 1. In this context, we present the case of a woman with a giant cell epulis that was found to be the initial clinical manifestation of primary hyperparathyroidism...


Giant Aortic Aneurysm: An Asymptomatic and Exuberant Presentation

Rui Seixas*; Sofia Sobral; Henrique Rita

    The giant aortic aneurysm, defined as aortic dilatation with a maximum diameter greater than 10 cm [1], is the most frequent subtype of aortic aneurysm. However, its incidence is low and rarely described in the literature being a generally asymptomatic pathology and incidentally discovered in routine imaging exams as presented in this patient...


Lange's cornelia syndrome: About two cases

Kh Mouaddine*; G Ismaili; M Kmari; A Ourrai; A Hassani; R Abilkassem; A Agadr

    M, N a 3-year-old M boy, term born in hospital, the third of 3 siblings, from a consanguineous marriage, admitted for dysmorphic syndrome with mental retardation. The clinical examination showed severe failure to thrive (-4DS), facial dysmorphic included hirsutism, prominent and sloping forehead, dental abnormalities, retrognatism, well-defined, arched and confluent eyebrows, long eyelashes...


Massive Splenomegaly Successfully Treated with Splenic Irradiation and Rituximab

Makoto Saito

    We report an elderly patient with massive splenomegaly in whom treatment with splenic irradiation and rituximab was successful, although the diagnosis was difficult to confirm. A 73-year-old male patient who had been followed for 6 years and who remained untreated for massive splenomegaly and cytopenia was hospitalized with severe abdominal pain. Abdominal Computed Tomography (CT) revealed worsening splenomegaly (maximum major axis diameter 38 cm) with multiple low-density areas suggestive of necrosis...


Frey's Syndrome: A Case Report

Khadija Mouaddine*; Salaheddine Seghir; Rachid Abilkassem; Aomar Agadr

    L A 05-year-old girl, from a non-consanguineous marriage, born by cesarean section with the use of forceps. She has a familial atopy: Allergic rhinitis in father and sister due to dust mites and pollen and a history of cervical poly lymphadenopathy 05 months before the onset of symptoms with spontaneous regression, the viral origin was suspected but no viral serology was done.


B Cell Lymphoblastic Lymphoma Presenting as a Paravertebral Mass in a Child: A Case Report

secSabrine Derqaoui*; Lamiae Rouas; Najat Lamalmi

    Lymphoblastic lymphomas are immature lymphoid malignancies accounting for approximately 30% of non Hodgkin lymphoma in children. Most of these neoplasms originate from T cell precursors while less than 25% of them originate from B lymphoblasts. On histology and immunohistochemistry, lymphoblasts in B Lymphoblastic Lymphoma (BLL) and B lymphoblastic leukaemia share the same features. However, they represent different diseases with distinct molecular alterations...


Comparing USA and Mexico Response to Covid as Well as Incidence and Death Toll for the First 6 Months from February 2020 to August 2020 and the Pandemic on June 1st 2021

Gabriel Miranda Nava*; Maria Preciado; Luis Gallo

    Both Mexico and United States share a border as well as Mexico being the country with the most American citizens living abroad and United States housing millions of individuals of Mexican descent, Covid 19 has impacted the world and both countries health system Mexico having to deal with the impact of a pandemic with a much lower budget and personnel compared to United States and as well United States having to deal with a pandemic occurring in a country with...


On Suicide

Paul T E Cusack

    Suicidal depression is a growing problem in our modern society, especially among the young. Our world is complex and difficult to manage. For some, it ends in self destruction. Prevention should be paramount by having a well structured and balanced lifestyle.


Solitary Plasmacytoma of the Nasal Cavity - A Rare Entity

Shivali Sehgal

    A 55 year old male presented with nasal obstruction for 2 years. On examination a polypoidal growth was seen filling the right nasal cavity which oozed out blood. Computed tomography of the paranasal sinuses revealed a polypoidal lesion involving and mildly expanding the right nasal cavity and ethmoidal sinuses, displacing the nasal septum to the left side and having a large nasopharyngeal component. Polypectomy was done and a soft tissue mass measuring 1x1x1cm was received. Serial sections from the mass showed presence of a polyp lined by pseudostratified ciliated columnar epithelium.


Bronchial Atresia and Mucous Impaction Mimicking a Solitary Pulmonary Nodule

Robert Parker

    A fifty-four year-old man was referred to the lung cancer clinic for the investigation of a left mid zone solitary pulmonary nodule seen on incidental chest radiography (Figure 1). A lifelong non-smoker, the history and clinical examination did not suggest lung cancer. The nodule was smooth, round and without calcification. Repeat radiography with skin and nipple markers had failed to clarify the diagnosis. CT scanning of the chest (Figure 2) showed atresia of the left upper lobe bronchus, predominantly affecting the anterior segment.


Comparison between Bone Graft Surgery and Computer-Aided Implant Surgery for Implant Placement in the Maxillary Posterior Area: A Two-Year Randomized Prospective Trial

Ghazwan Almahrous*; Sandra David-Tchouda; Nathalie rancon; Jean-Luc Bosson; Thomas Fortin*

    Objective: The aim of this study is to compare between two implant placement techniques, that is, Bone Graft Surgery (BGS) prior to freehand implant placement and Computer-Aided Implant Surgery (CAIS), in patients with maxillary atrophy.
Materials and methods: Patients with partial edentulous in the posterior atrophic maxilla were selected for a randomized controlled clinical trial, which was designed to compare implants in the posterior partially edentulous maxilla.


A Clinician's Eyes in Hemoperitoneum: Cullen's and Grey Turner Sign

Harikrishnan P*; Divya Kochhar; Shacha Wangmo

    Cullen's and Grey turner signs are both dermatological manifestations of retroperitoneal or intraperitoneal haemorrhages. Cullen's sign is characterised by periumbilical ecchymosis while in Grey Turner sign there is involvement of the flanks. Cullen’s sign, first described in 1918 by Thomas Stephen Cullen a Gynaecologist, as a bluish discoloration of periumbilical skin in patients of ruptured ectopic pregnancy due to retroperitoneal blood that tracks along the gastrohepatic and falciform ligament to the umbilicus


Neck Localisation of Castelman’s Disease Mimicking A Metastatic Lymph Node: A Case Report and Review of Literature

Chafai houda; Haidar Maojil; Alaoui Mahdaoui Sihame; Kamal Dounia; Amarti Afaf; El Alami Mohammed Nourredine

    A 75-year-old man presented with a soft, non-tender right subcostal mass of 6 months evolution. His medical history was remarkable for a non-penetrating thoracic trauma 30 years before. Physical exam revealed no pain or respiratory distress and vital signs were normal. A CT-scan showed protrusion of lung tissue (arrows) through a chest wall intercostal defect in axial (Figure 1A-B) and coronal (Figure 1C-D) views, images consistent with lung hernia.


Lung Hernia 30 Years After Thoracic Trauma

Jose Gabriel Solis*; Luis Fernando Zavala-Jonguitud; Guillermo Flores-Padilla

    A 75-year-old man presented with a soft, non-tender right subcostal mass of 6 months evolution. His medical history was remarkable for a non-penetrating thoracic trauma 30 years before. Physical exam revealed no pain or respiratory distress and vital signs were normal. A CT-scan showed protrusion of lung tissue (arrows) through a chest wall intercostal defect in axial (Figure 1A-B) and coronal (Figure 1C-D) views, images consistent with lung hernia.


Severe Pain Resulting from the Impingement between Patella and Tibia Secondary to Melorheostosis: A Case Report

Zijie Xu; Jiaxing Chen; Wenlong Yan; Aiguo Zhou*

    Melorheostosis is a rare sclerosing bone dysplasia. We report a unique case of melorheostosis with involvements of femur, tibia, and patella, resulting in pain, limited range of motion and impingement between patella and tibia. An arthroscopic assisted open surgery approach was performed to debride the damaged cartilage, soft tissue, and removal of the lesion on patella. This procedure led to an improvement of knee function and remission of pain.


The other Face of Amiodarone

Tamer Shalaby*

    The risk of Amiodarone-associated TdP is not common but possible and often underestimated. We present a case of a patient who had a history of AF that was converted to sinus rhythm by Amiodarone. However, the patient developed TdP few days after loading and on maintenance Amiodarone treatment. We documented a sudden significant increase in QTc interval by 400 ms within 24 hours which led to the presentation of patient to Emergency Department (ED) with pulseless polymorphic ventricular tachycardia...


Surgical Management of Mandibular Odontogenic Myxoma Utilizing CAD/CAM Technology: A Case Report

Orvokki Helinko*; Alexandria L Irace, BA; Anni Suomalainen; Jaana Hagström; Karri Mesimäki

    Background: Odontogenic myxoma (OM) is a benign intraosseous tumour of the jaw usually treated by surgery. Computer-aided design and manufacturing (CAD/CAM) technology may optimize preoperative planning of the resection and jaw reconstruction.
Case Report: A 29-year-old female was diagnosed with mandibular odontogenic myxoma. A large, benign but potentially infiltrating, and locally aggressive tumour required radical surgical treatment.


HIV Screening in Transgender Women in Western Population: Missed Opportunities?

CG Daans; MAM Huson; I de Nie; CAM Schurink; EJG Peters; EB Conemans; M den Heijer; E Hoornenborg

    Studies in selected transgender populations demonstrate a high HIV-prevalence, but data on this subject in the Dutch transgender population are lacking. In this report we illustrate the importance of a timely HIV diagnosis to prevent complications. Routine HIV testing should be considered as part of the work-up for people attending Dutch gender-identity clinics.


More than Meets the Eye

Eimear O’Connell*, Susanna Felsenstein

    A 15-year old, presented with five days of bilateral eyelid swelling, fatigue, cervical lymphadenopathy and fever. There was no associated pruritis, conjunctivitis or eye pain. There was mild pharyngitis on examination. C-Reactive Protein (CRP) was mildly elevated (24.3mg/L), full blood count and albumin were normal, transaminases were raised (AST 230 U/mL, ALT 218 U/mL), proteinuria was absent. Ebstein Barr Virus (EBV) serology was diagnostic of acute Infectious Mononucleosis (IM).


Lytic Lesions in Thalassemia Major

William LiPera Maryann Fragola

    A 62-year-old Female with Beta-Thalassemia Major, complicated by transfusion dependence, hypocalcemia, and ironoverload requiring chelation therapy. Cat scan after skull injury, revealed multiple lytic lesions scattered throughout the calvarium some which demonstrated cortical disruption and concern for neoplasms such as multiple myeloma or metastatic disease. (Figure A).


A Young Female Patient Develops a Dark Spot in Her Vision

Gregory Sovinski; Colleen M Cebulla; Siri Hiremath*

    Over the last two decades the incidence of syphilis has increased. Ocular syphilis can occur during any stage of syphilitic infection and Acute Syphilitic Posterior Placoid Chorioretinopathy (ASPPC) is a rare but pathognomonic manifestation of ocular syphilis. Key ophthalmologic findings of this disease can be demonstrated on dilated retinal exam and optical coherence tomography with supplemental findings seen on fundus auto fluorescence imaging and intravenous fluorescein angiography...


A Huge Myoepithelial Carcinoma of Parotid Gland in 99 Years Old Patient

Matteo Gualtieri*; Vincenzo Antonio Marcelli; Bruno Andrea Pesucci; Flavio Andrea Govoni; Francesca Stella; Pietro Felice; Lucio Montebugnoli; Roberto Pistilli

    Myoepithelial carcinoma, also named malignant myoepithelioma or epithelial – myoepithelial carcinoma, is an unusual neoplasm arising from neoplastic myoepithelial cells. This tumor accounts for 0, 1–0, 45% of all salivary tumors; these neoplasms can involve both major and minor salivary glands. Myoepithelial carcinomas generally occur in adults or elderly. The described cases in literature have an average age of 52, 5 years, with a range from 7 to 81 years...


Neurosyphilis and COVID-19: Symptom Overlap, Impact on Management and Further Implications for Management of Sexually Transmitted Infections During a Pandemic

Jonathan McGrath*; Tara McGinty; Maureen Lynch; Edel O’Regan; Peter O’Gorman; John S Lambert

    Background: The Coronavirus Disease 2019 (COVID-19) pandemic, caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) has had a significant impact on healthcare provision, both in acute inpatient management of critically-ill COVID-19 patients and also in regard to health services which have been curtailed in an effort to maximise resources in tackling the virus. The clinical manifestations of COVID-19 are highly varied and those of syphilis are notoriously protean...


A Case of Good Clinical Outcome after Panitumumab-Related Interstitial Lung Disease

Panebianco Martina; Ierino Debora; Milano Annalisa; Mazzuca Federica

    Background: In Metastatic Colorectal Cancer (mCRC) patients, mutational analysis of KRAS and NRAS genes is mandatory for therapeutic programming as in wild type patients anti-EGFR monoclonal antibodies (panitumumab/cetuximab) demonstrated clinical efficacy.
Case report: We report here-by a case of a 63-years-old woman, no smoker, with mCRC that involved lung, liver and abdominal lymphadenopathies. Molecular analysis revealed NRAS, KRAS and BRAF wild-type adenocarcinoma.


Systemic Lupus Erythematosus Onset in a Young Woman with Human Papilloma Virus Infection

Claudia Canofari*; Gian Domenico Sebastiani

    Nowadays the exact pathophysiological processes underlying Systemic Lupus Erythematosus (SLE) development remain unknown. Factors, which seem to contribute to disease onset is a strong genetic predisposition but also an environmental influence. Among environmental factors, viral infection may play an important role, leading to immune system dysfunction in several ways.


Anti-Taliglucerase Alpha Antibodies Associated with Lower Efficacy of ERT and Onset of Autoimmune Thyroiditis in a Patient with Type 1 Gaucher Disease

Cullufi P; Gjikopulli A; Tomori S*; Velmishi V; Dervishi E; Zimran A; Revel-Vilk S

   Treatment of patients with Gaucher disease type 1 with enzyme replacement therapy might be associated with development of anti-drug antibodies. As we know, the literature is lacking reports demonstrating the development of ADAs in patients with GD1 and association with a decreased efficacy, as was shown in other LSDs.


Rotator Cuff Repair using Focused Ultrasound Energy in Three Individuals

Petrofsky JS*; Donatelli R; Laymon M

   Rotator cuff injuries are common, especially in older individuals. These injuries can be partial or complete thickness tears and can require either therapy or surgical intervention and therapy. Three patients were treated with extracorporeal shock wave or FOCUS wave therapy to see if this would cause healing of supraspinatus tears.


A Catheter-Related Bloodstream Infection Caused by Chryseobacterium Indologenes in a Hemodialysis Patient: A Case Report

Sadagah LF*; Almalki AH

   Catheter Related Blood Stream Infection (CRBSI) is associated with significant morbidity and mortality in Hemodialysis patient, and it’s a leading cause of hospitalization. Gram-negative organism is increasingly reported as a cause of CRBSI in hemodialysis patients. Recently, primary and catheter related bacteremia caused by Chryseobacterium indologenes is identified more frequently.


Selective Surgical Treatment of the Intraneural Perineurioma of the Femoral Nerve by Tumor Resection and Graft Repair

Ronald Lutzenberg; Doris Burg; Daniela Grimm; Markus Wehland; Manfred Infanger*

   The perineurioma is a rare nerve tumor. The etiology is unknown and only a small number of case reports can be found in the literature, which includes proposals of conservative as well as surgical means of treatment. The current objective is to present an effective therapeutic strategy in treating this disease, which led to complete recovery.


Successful Treatment of Primary Vulvar Extra Mammary Paget Disease with Topical Imiquimod Cream- Report of Three Cases

Rama Padma Namuduri*; Lim Yong Kuei; Yeo Yen Ching; Gudi Mihir Ananta

   Extramammary Paget Disease (EMPD) is a rare cutaneous neoplasm that most frequently affects the vulva. Wide local excision remains the preferred treatment, which may need vulvar reconstruction. However, it is associated with high recurrence rates. Frequently women with Paget’s disease of the vulva who are elderly with associated co-morbidities and are not suitable for surgery.


Vertebral Bone Infarction in Sickle Cell Disease

Catarina Brito

   A 9-year-old girl with history of sickle cell anemia presented to our hospital with severe low back pain with 8 days duration, not relieved with analgesics. She had previous episodes of vaso-occlusive crisis and a basal hemoglobin level of 4,9 mmol/L. Spinal magnetic resonance imaging revealed multiple recent bone infarcts in the lumbar vertebral bodies


Mastoiditis with Concomitant Pneumocephalus, Meningitis, and Frontoparietal Ischemic Infarction

Eyas Mukhtar, MD, MBA*; Jahinover Mazo, MD; Michael T Mantello, MD; Yuliya Mazo

   Otogenic pneumocephalus describes intracranial free air as a consequence of mastoid effusion secondary to complicated otitis media. While the incidence of intracranial complications related to middle ear disease is low, the associated mortality rates remain particularly high. Clinical manifestations vary from asymptomatic to an acute neurosurgical emergency.


Case Report: Morel-Lavallee Lesion

Johnson SM*; Kowalchuk RM

   The Morel-Lavallée lesion is a traumatic soft tissue degloving injury [1]. The injury is characterized by a separation between the fascia and overlying hypodermis, and a collection of fluid often ensues in the created space. The soft tissue injury disrupts vascular or lymphatic flow in the area of local trauma resulting in a hemolymphatic fluid collection.


Porcelain Gallbladder or A Special Type Stone? A Case Report and Literature Review

Linlin Qu*; Jinyu Pei; Peng Liu; Guanghua Cao; Dongxia Yang; Cong Wang; Dongdong Dai; Jingyu Cao

   We reported a 60-year-old patient with porcelain gallbladder was performed abdominal CT scan which showed the calcification of gallbladder wall disappeared. The specimens showed the gallbladder mucosa was attached to white jelly-like substances which were not calcified. In our opinion, the while jelly-like substance may be a special manifestation of stones.


Pure Sensory Stroke due to Putamen Bleed: A Case Report

I V Nagesh*; Manoj Gopinath

   Pure Sensory Stroke (PSS) is a well-defined clinical entity in which hemisensory symptoms predominate without other major neurological signs. Pure sensory stroke without involving other features is uncommon. Most commonly it is caused by a lacunar syndrome, either infarction or hemorrhage. The literature rarely describes putaminal haemorrhage producing pure spinothalamic sensory deficit.


Intrahepatic Cholestasis Following Spontaneous Subcapsular Rupture of Hepatic Hemangioma; A Case Report

Madhushanka Ekanayaka

    Hepatic hemangiomas are the commonest benign mesenchymal hepatic tumors. Majority of the cases are asymptomatic and do not need interventions. Few presents with wide variety of symptoms. Of these, spontaneous or traumatic rupture is rare but most dramatic complication. They may present with sudden abdominal pain, anemia and hemoperitoneum.


Endoscopic Treatment of Cystic Duodenal Duplication

Mouna Medhioub; Mahdi Bouassida; Amal khsiba; Khaled Bouzaidi; Moufida Mahmoudi; Asma Ben Mohamed; Lamine Hamzaoui; Mohamed Moussadek Azouz

    Duodenal duplication cyst is a rare congenital entity. The treatment has classically involved surgical resection.We report the case of a 61 year old women who presented with upper abdominal pain and vomiting related to a cystic duodenal duplication. She was treated with endoscopic marsupialization in the cyst roof. The patient remained asymptomatic during 4 years follow-up.


Lung and Diaphragm Ultrasonography During Weaning from Mechanical Ventilation in a Patient with COVID-19 Pneumonia

Funda Gok*; Aysel Mercan; Korhan Kollu; Alper Yosunkaya

    Mechanical ventilation is the main therapy used as the support live therapy performed in Intensive Care Units (ICU) for the patient swith COVID-19. The failure in weaning the patient from mechanical Ventilation (MV) can result in such air way manipulations as deep tracheal aspiration and tracheostomy, where there are the high risks of rein tubation and aerosol generation. It is the most important point to decide to weaning the mechanically-ventilated patients from the device at the right time.


A Case Report of Cerebellar Glioblastoma

Ting Chen; Xiao Qi Xie; Wei Min Li*; Xin Wu; Qing Ding; Xue Yang; Ping Ai; Feng Wang*; Chen Yi; Yong Luo; Deng Bing Wu; Yuan Zhao Liu; Jing Bo Kang; Ruo Yu Wang; Bao Lin Qu; Xian Feng Li; Jun Jie Wang; Dong Cun Jing; Fu Quan Zhang

    The patient, male 50 years old, was admitted to hospital for 20 days due to headache and vomiting. The CT and MRI of the external hospital head suggest intracranial space occupying, considering the possibility of tumor. Admission examination: clear mind, no abnormal cranial nerve examination; no deformity of spine and limbs; normal muscle strength of limbs.


Radiographic Signs of Trauma from Occlusion at the Level of the Periodontal Ligament and Articulation Structures

Ilma Robo*; Saimir Heta

    The periodontal ligament faces even greater occlusal forces within a limit, presenting with trauma changes from occlusion locally to the tooth where it operates. Subsequently, the whole pathology is followed at the level of articulation, to present there the distinct radiographic signs of occlusion trauma.


Mucinous Ovarian Adenocarcinoma and CHD1 Germline Mutation: A Case Report

Christa Aubrey*; Valerie Capstick; Soufiane El Hallani; Carol Ewanowich

    Background: CDH1 mutation is a rare autosomal dominant mutation in the gene encoding for E-cadherin, and a known familial cancer syndrome associated with hereditary diffuse gastric carcinoma and lobular breast carcinoma. Case: A 21 year old with a known CDH1 mutation and history of diffuse hereditary gastric cancer with a prior total gastrectomy presented seven years later with a pelvic mass. Pathology was consistent with a FIGO stage IA1 mucinous adenocarcinoma, (intestinal type, expansile pattern) of the left ovary.


Posterior Reversible Encephalopathy and Cavernous Sinus Thrombosis in a Child with Nephrotic Syndrome using Cyclosporine; Causationor Coincidence?

Mehtap Ezel Celakil*; Burcu Bozkaya YUcel; Kenan Bek

    Cyclosporine A (CyA) is the initial immunosupressive in Steroid Resistant Nephrotic Syndrome (SRNS). Hypertension is one of its adverse effects but Posterior Reversible Encephalopathy Syndrome (PRES) is rare. Nephrotic syndrome is a hypercoagulable state with thromboembolic events in 2-3% of the cases rarely involving cerebral vessels.


Intrauterine Bony Fragment, A Cause of Secondary Infertility

Santosh Minhas; Aditi Jindal*; Chitra Chaudhary; Himanshu Chaudhary

    Here we discuss the case of a 37 year old gentleman found collapsed and unresponsive at home. He was subsequently diagnosed with a Cerebral Venous Thrombosis. Successful treatment with therapeutic Low Molecular Weight Heparin was achieved. Cerebral Venous Thromboses arise in the draining dural sinuses. Annual incidence is between 0.22 and 1.57 per 100,000 population


An empty delta sign: Pathognomonic of cerebral venous thrombosis

L Kavanagh

    Here we discuss the case of a 37 year old gentleman found collapsed and unresponsive at home. He was subsequently diagnosed with a Cerebral Venous Thrombosis. Successful treatment with therapeutic Low Molecular Weight Heparin was achieved. Cerebral Venous Thromboses arise in the draining dural sinuses. Annual incidence is between 0.22 and 1.57 per 100,000 population


Isolated right superior pulmonary vein fibrillation during catheter ablation in the left atrium

Marco Galeazzi*; Maurizio Russo; Carlo Lavalle; Sabina Ficili; Claudio Pandozi; Furio Colivicchi

    We performed a radiofrequency catheter ablation of atrial fibrillation by means of high-density electroanatomical mapping of the left atrium. During radiofrequency delivery into the Right Superior Pulmonary Vein (RSPV), we observed restoring of sinus rhythm. Post-ablation re-mapping of the left atrium in sinus rhythm evidenced isolated fibrillatory activity confined to the RSPV.


A complication prevented by the primary aetiology: A case report of LA thrombus in an RVD patient with mitral stenosis

Huzairi Sani*; Nada Syazana; Vijayendran R; Amirul Asyraf; Sazzli Kasim

    The aim of this paper was to present a case report in which prothombic or hypercoagulable states had caused a large mobilizing thrombus to developed in the Left Atrium (LA). This is perhaps due to delay in primary management. If it is not due to narrowing of the mitral valve as a result from mitral stenosis, the LA thrombus could have cause a catastrophic complications.


Magnetic resonance angiography and high resolution MRI of giant cell arteritis: A case report

Hui-Qin Zhang; Ming-Li Li*

    It is a case of giant cell arteritis diagnosed firstly by Combined MRA and High Resolution MRI (HRMRI), the lesion site and inflammatory degree can be easily evaluated by MRA and HRMRI. It can be predicted that temporal artery biopsy may be avoided in patients with typical features accompanied by characteristic HRMRI findings for GCA.


Gait recovery by recovery of an injured corticospinal tract in a patient with a cerebral infarct

You Sung Seo; Sung Ho Jang*

    A 81-year-old, right-handed female presented with complete weakness of the left upper and lower extremities due to infarcts in the right anterior and middle cerebral artery territories. She was transferred to the rehabilitation department of a university hospital at 3 weeks after onset.


Carpal giant cell tumour

Sonal Saran*; Venkata Subbaih Arunachalam

    A 18 year old female presented with pain of insidious onset associated with swelling over the right wrist joint for 6 months. Swelling and pain gradually increased over the duration of 6 months. She came to the Orthopedician’s out-patient clinic when her symptoms affected her day to day activities.


Chlorhexidine contact vasculitis

Selma Benkirane*; Mounia Bennani; Zakia Douhi; Sara Elloudi; Hanane Baybay; Fatima Zahra Mernissi

    Chlorhexidine contact vasculitis in a 72-year-old patient with cutaneous herpes (Figure 1) for whom he was put on local care with chlorhexidine, the evolution was marked by the installation of an erythematous and purpuric plaque at the level of the left flank (Figure 2) appeared 4 days after the application of chlorhexidine that the patient did not rinse with water after use. Dermoscopy showed an erythema that did not fade at the vitropression corresponding to purpura (Figure 3)...


Parathyroid carcinoma and secondary hyperparathyroidism: A case report

Rachida Bouatay; Khaled Harrathi; Manel Njima; Jamel Koubaa

    Parathyroid carcinoma is a rare form of endocrine malignancy which occurs most commonly in patients with primary hyperparathyroidism. Here we report an unusual case of parathyroid carcinoma developing on secondary hyperparathyroidism in a 53-year-old man, with a chronic renal insufficiency on hemodialysis, operated 10 years ago of subtotal parathyroidectomy for secondary hyperparathyroidism with favorable outcome, was hospitalized for bone pain with hypercalcaemia and elevated serum Para Thyroid Hormone (PTH).


An unusual clinical sign of right-sided Heart Failure

seIshay Yuva*; Lahav Ziv; Mowaswes Mohammad; Abu Remeilh Ayman

    Dislocation of the fourth and fifth carpometacarpal (CMC) joint associated with a fracture of the hamate is a rare injury. Literature shows no consensus regarding optimal treatment of this injury. We present three cases that will discuss this specific injury and all have been treated according to the same philosophy; reconstruction of the hamate to get a stable joint.


Treatment of CMC dislocation associated with hamate fracture; Case report of three cases

Ragna C Jonker*; Hugo D Ammerlaan; Eric E J Raven

    Dislocation of the fourth and fifth carpometacarpal (CMC) joint associated with a fracture of the hamate is a rare injury. Literature shows no consensus regarding optimal treatment of this injury. We present three cases that will discuss this specific injury and all have been treated according to the same philosophy; reconstruction of the hamate to get a stable joint...


Intra-abdominal desmoid tumor on the background of lynch syndrome. An unusual association mimicking recurrent colon cancer

Abdulmohsin Aldilaijan*; Mohammed Tahtouh; Hassan Alzahrani; Deena T Boqari; Antonio Privitera

    Desmoid tumors are rare benign tumors that tend to be locally invasive rather than metastatic, and have a high recurrence rate despite complete excision [1]. Intra-abdominal desmoids are sporadic in most cases with only 20% associated with familial syndromes, in particular Familial Adenomatous Polyposis (FAP). Sporadic cases seem to be less aggressive and associated with a lower mortality and recurrence rate than FAP-associated desmoids [2]. The etiology is unknown, however, a history of previous trauma is sometimes identified [3]...


Spontaneous nasal septal perforation due to Bevacizumab

Yasemin Benderli Cihan

    Bevacizumab is a growing monoclonal antibody agent in oncology. Nasal septum perforation due to bevacizumab is rare. It is generally more common in patients receiving high doses of bevacizumab and who are using taxane. In the treatment of nasal septal perforation, bevacizumab treatment interruption, nasal hygiene, antibiotics, local irrigation or observation are recommended...


Glomus tumor of uncertain malignant potential in upper extremity: Case report and review of literature

Dominguez Gonzalez Jose Javier*; Martín Davila Francisco Jose; Banegas Illescas Maria Eugenia; Arregui Lopez Elena

    Malignant glomus tumors are a extremely rare soft tissue sarcomas, supposed originated from a benign glomus tumor. We report a case of glomus tumor of uncertain malignant potential occurring on the skin of volar area of arm of a 56-year-old woman...


Longitudinally extensive transverse myelitis with unknown etiology presenting with sensory ataxia

Athena Sharifi Razavi*; Narges Karimi

    Longitudinally Extensive Transverse Myelitis (LETM) is an inflammatory lesion of spinal cord that extending over three or more spinal segments. A number of conditions may be associated with LETM such as autoimmune central nervous system disease, infective, neoplastic, and connective tissue disorders...


Exophthalmia grade III unilateral secondary to a mucocele ethmoido-frontal

Seydou Diallo; Rodrigue R Elien GY; Jean M Mbaikoua; Japhet P Thera

    Mucoceles are benign, pseudo-cystic, expansive tumors, due to an accumulation of mucus in a cavity whose orifice is obstructed. This accumulation may occur in the tear sac or sinus. Mucocele can be maxillary, sphenoidal, ethmoidal, frontal and ethmoido-frontal.


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