A 37-year-old man with a history of post-cholecystectomy and a known case of supra renal cystic lesion was referred for contrast-enhanced computed tomography of abdomen, where a supra-renal, well-defined, thick-walled cystic lesion with intense peripheral enhancement on arterial phase measuring 7 Ã— 8.2 Ã— 7.6 cm.
Issue 9 (Sep)
Nasal dermoids are rare congenital lesions present in 1/20,000 to 1/40,000 patients. Only about 10% of these congenital lesions have an associated tract or tail with an intracranial extension. The intracranial component of the mass predisposes the child to risks of meningitis and abscess formation.
Age determination in children and adolescents of unknown age is often based on the degree of bone development (Greulich and Pile method). However, the variability of development at puberty, extrapolation to other populations and the use of invasive means make the reliability and feasibility of this method uncertain.
A 30-years-old primiparous woman with 37 weeks of amenorrhoea was admitted to the Obstetric ward with symptoms of ruptured membranes and abdominal pain. The day before she was subjected to an unsuccessful external cephalic version. Transabdominal ultrasonography revealed a breech presentation. The placenta appeared normal.
Spontaneous native aortic valve thrombosis is an unusual cause of coronary insufficiency and more common in patients with underlying coagulopathies, such as antifospholipid syndrome, valve disease or bacterial endocarditis. However in this case we want to demonstrate a case that doesnâ€™t fit above mentioned criteria. Even more, a rare condition of spontaneous native aortic valve thrombosis is combined with Chronic Thromboembolic Pulmonary Hyperthension (CTEPH).
Spontaneous intracranial hypotension often results in a new-onset headache that is worse with upright posture, along with other neurologic signs and symptoms. It is less rare than once thought and is not usually considered in the differential diagnosis of chronic daily headaches for months. We present clinical symptoms and unusual imaging findings of a case of spontaneous intracranial hypotensionin time course.
Hodgkin lymphoma is a lymphoproliferative malignancy originating from B cells of the immune system and is most commonly seen in adolescents and young adults. Hodgkin Lymphoma treatment is multimodal and includes chemotherapy, radiotherapy and stem cell transplantation. Survival in Hodgkin Lymphoma has increased due to current effective treatments, and late side effects have become more important.
Primary Mediastinal Large B-Cell Lymphoma (PMBL) is a rare neoplasm that arises in the mediastinum, and then forms a mass. A female in 50s noticed malaise of right upper limb and a firm lump in the right clavicular region. After consulting with a nearby doctor, she was introduced to our medical center. Magnetic resonance imaging showed a giant mass (12 x 7 x 6 cm) in the anterior and superior mediastinum with expansion to the right supraclavicular fossa.
Juvenile Dermatomyositis (JDM) is a rare childhood inflammatory disease. Clinical manifestations include muscle weakness and skin rashes. However, generalized edema is uncommon in JDM. Treatment is based on prolonged immunosuppressive therapy. Only few case reports of edematous JDM has been described. Here we aim to describe a case of edematous JDM with review of literature.
The aim of our study was to evaluate regional anesthesia practice trend in orthopedic surgeries during first three months of pandemic, April-June 2020 and compared with corresponding duration before it started. Tracheal intubation is considered one of the high-risk aerosols generating procedure and potential to transmit infection 6.6 times higher among those who are directly involved in airway management.
Bordetella hinzii is a primarily zoonotic organism and rarely affects immunocompetent individuals. We report the case of a healthy 45 year old male who presented with chronic cough and dyspnea and was diagnosed with Bordetella hinzii infection of the lower lungs from imaging and bronchoscopy. He was then discharged on a course of antibiotic treatment.
May-Thurner Syndrome is a left common iliac vein thrombosis caused due to its compression by right common iliac artery, an anatomical variant that is underreported. We report the case of a 52 year old female who presented with left leg swelling and was diagnosed with May-Thurner Syndrome. She underwent an iliac vein thrombectomy and was discharged on life-long anticoagulants.
Vanishing lesions of the CNS also known as Ghost lesions can be a radiological feature of various neurological disorders mainly tumoral followed by inflammatory diseases of the CNS. Vasculitis such as Behcet Disease (BD) is considered as a leading cause of demyelinating disorders with ghost lesions on brain MRI.
Stercoral ulcers resulting from damage to the intestinal lining due to chronic constipation are rarely presented as perforations. The incidence of these perforations is 3.2% of all colonic perforations. Poor diet, anatomic factors, and certain medications increase the risk of perforations. The presentation of stercoral ulcers varies widely among patients. Immediate surgical intervention is required for these patients.
Elevated level of CA19.9 is usually associated with malignancies of the hepatobiliary and the pancreatic system. It not only helps to diagnose the malignancy, but also ever high levels can indicate advanced or metastatic diseases. However in rare instances elevated CA19.9 has been found in patients with adnexal masses.
F wave is one of the most sensitive electrodiagnostic parameters to verify the diabetic neuropathy even in absent or mild clinical symptoms. In our prospective study, we determined the best cut-off point measures of tibial and peroneal Minimal F-Waves Latency (MFL), in 100 diabetic patients using Receiver Operating Characteristic (ROC) curves.
The present review summarizes current knowledge on the possible mechanisms of Whey Protein (WP) action on appetite. Due to the high prevalence of obesity worldwide and the relationship between obesity and Non communicable diseases (e.g., diabetes mellitus, cancer, and cardiovascular diseases), as the main cause of mortality, strategies for weight loss such as appetite reduction is important for increment of life expectancy and mortality reduction.
A 50-year-old farmer presented with dysphagia and chest tightness following foot trauma for the last three days. On examination, he had nuchal rigidity, trismus, and hypertonia. A characteristic â€˜Risus Sardonicusâ€™ face was noticed (Figure 1). The patient also developed generalized painful spasms and respiratory distress with stridor, following which an urgent tracheostomy was done.
A 8-year-old male child was referred to the Dermatologic clinic for a protruding growth on the glans penis that had appeared and started growing rapidly over a period of past 7 days since the child underwent the angioembolisation procedure for Penile Arteriovenous (AV) malformation. There was a history of intermittent bleeding from the well-established lesion.
Teriflunomide is one of the first-line treatment in Multiple Sclerosis (MS). Cessation of medications can cause increased MS-related disease activity which has been characterized as rebound syndrome (RS). Rebound syndrome is not an expected syndrome when the drug is discontinued especially in first-line treatments.
Left Ventricular Assist Devices (LVADs) have become an established therapy in end-stage heart failure patients as a bridge to transplant, a bridge to candidacy or as destination therapy, resulting in improved prognosis in this group of patients. However, LVAD patients often suffer from complications, which can result in severe morbidity and mortality.
Hyperhomocysteinemia (HHcy) has been recognized as a risk factor of several chronic disease. It is noteworthy that HHcy prevalence appeared to be rising in recent years. Many patients have good curative effect after treatment, but some HHcy caused by gene mutations remains difficult to treat. Here, we present a case of hyperhomocysteinemia type II with poor effect of conventional treatment. We report it in order to provide a basis for follow-up studies.
En plaque meningioma is a type of tumor that causes infiltrates into the bony tissue and forms a lamellar structure. The symptoms and prognosis are significantly related to the severity of bone involvement and involved areas. Given the limited information from the basic knowledge of these patients, we aimed to determine the characteristics and post-surgical outcomes of patients operated via pterional approach surgery.
A 25- year-old systemically healthy female patient reported with an aesthetic complaint due to a growth in the corner of right upper lip present for 2 months. Clinical examination revealed a solitary spherical-shaped bright red fibrous overgrowth measuring 4 x 4 mm involving the mucocutaneous line of upper lip. On palpation, it was non tender, smooth in texture, and soft in consistency.
Since May 2022, there is an ongoing Monkeypox (MPX) outbreak that has been declared as a public health emergency of international concern by WHO. Most of the cases are men who have sex with men, frequently presenting to the clinic with one or more Sexually Transmitted Diseases (STDs). We present one of the first cases admitted to our hospital ward with a clinical image of multiple painful peri anal lesions.
Femoral hernias account for 10% of all groin hernias. Females have a 4:1 incidence of abdominal hernias, while males have a 5% incidence. A spontaneous enterocutaneous fistula is rare due to a small bowel loop perforation in an incarcerated femoral hernia. Patientsâ€™ ignorance and late presentation cause these fistulas. This case report discusses the presentation of spontaneous enterocutaneous fistula due to femoral hernia, as very little literature describes this phenomenon.
Covid-19 influence on QT prolongation is mainly caused by antiviral medications. However, there is some evidence of independent effect of disease on QT interval in association with cardiac injury and on the other hand as previously demonstrated, acquired long QT has potential negative impact on the outcome of Covid-19 infection. We are presenting a case of QT prolongation in an ambulatory patient with a pre-existing borderline QT interval who was on no antiviral medications.
Dasatinib, a second-generation tyrosine kinas inhibitoris effective against most cases of imatinib-resistant Chronic Myelogenous Leukemia (CML), and this drug has also shown significant glucose-lowering effects. Here, we report two diabetes patients with sudden onset of CML. In Case 1, dasatinib produced mild but clear improvement of hyperglycemia with the same anti-diabetic regimen together with rapid control of CML.
Pseudoaneurysms are a well described complication of peripheral arteries. They often develop post-traumatically and/or iatrogenically. Prompt recognition with appropriate management is paramount in preventing limb-threatening complications. Surgeons must maintain a high index of suspicion for pseudoaneurysms of peripheral arteries in patients with recent history of trauma and/or surgery of the area.
Thyroid nodules are one of the frequently seen presentations in the clinic. Thyroid nodules are present in almost 5% of females and 1% males in iodine-sufficient regions. On the other hand it can incidentally be found in as high as 67% of the patients on ultrasound neck. Among all the thyroid nodules, 5-15% come out to be malignant on final histopathology.
Bronchial atresia is a rare congenital lung abnormality characterized by the focal obliteration of the bronchial lumen, on a lobar, segmental or subsegmental level, usually associated with peripheral mucus impaction (bronchocele or mucocele). It presents with adjacent segmental or subsegmental hyperinflation, and reduction of vascularization of the involved segment or lobe.
Aesthetics is a major concern for patients suffering from cleft lip-palate, and equally challenging to a dentist when approached at a later stage for rehabilitation. Regenerative procedure involving use of bone grafts is advocated at a younger age, due to higher regenerative capacity and greater acceptance rate.
Mammary Analogue Secretory Carcinomas (MASCs) are rare slow growing salivary gland tumors that mimic the histological and genetic features of secretory carcinoma, a rare tumor of the breast. In this article, we present the case of a 24-year-old woman diagnosed as a case of mammary analogue secretory carcinoma.
Cervical lymphadenopathy usually represents lymphomas or metastasis from head and neck primary tumors, but it can also occasionally be a manifestation of a remote primary site. PET-CT has improved identification of the location of such unknown primaries, particularly when they are distant in location.
Apical or periapical cysts are the most common type of cyst, affecting the local and systemic health of patients. This pathology can manifest as an inflammatory condition in periodontal tissues due to the stimulation and proliferation of the epithelial cell rests of Malassez and it can be identified in clinical visits and imaging exams of routine. Apical cysts do not cause facial pain and/or swelling and appear as a well-defined radiolucent region when analyzed radiographically.
Spontaneous Intracranial Hypotension (SIH) results from a decrease in cerebrospinal fluid volume without any iatrogenic cause and presents most commonly with orthostatic headache. Cervical dural tears are an uncommon cause of SIH. Cervical epidural blood patch has been successfully used in many developed countries for the treatment of spontaneous intracranial hypotension after failure of conservative management.
Postpartum hemorrhage is the leading world cause of maternal mortality in low-and-middle income countries. Puerperal hematomas are auncommon cause of postpartum hemorrhage. Their adequate management requires a particular skill and technical platform to surgically assure hemostasis. This case allows us to draw the attention of practitioners to the seriousness and singularity of this highly morbid pathology.
Residents are the backbone of every large medical center that aims to strengthen and nourish the upcoming crop of medical personal. The professional prospect of a resident is largely based on their core subject knowledge, the tenacity to practice these core principles and their ability to add to it by academic activities and didactic thinking.
Cervical lymphadenopathy is a common finding in the everyday life of an ORL physician. The diagnostic steps range from laboratory and microbiological examinations to removing lymph nodes for histopathological processing. The differential diagnoses include infectious, chronic and malignant diseases. In rare cases, lymph node biopsy may diag-nose a chronic lung disease like sarcoidosis or silicosis.
The effect of aspirin therapy in patients with nonobstructive Coronary Artery Disease (CAD) remains controversial. This study aimed to investigate the association between aspirin therapy and prognosis in nonobstructive CAD. We searched for observational cohort studies on Pubmed, Embase, the Cochrane Library and Web of Science. Studies were included that compared the endpoint differences in patients with nonobstructive CAD who were treated with aspirin or not.
The study of aerosol deposition and bronchial tube flows in the human respiratory system can assistance improve an understanding of the damaging or beneficial effects of the inhalation of lung aerosols. In this study, we propose a strategy for segmenting the decomposition of particles inside the respiratory system.
Glucocorticoids are among the most commonly prescribed medications owing to their generic anti-inflammatory and immunosuppressive effects. Adrenal insufficiency and adrenal crisis are among the major serious adverse effects of long course glucocorticoid treatment. Patient education on sick day rules and the use of steroid treatment identifiers are some of the strategies.
Langerhans cell histiocytosis is a group of diseases characterized by an inflammatory neoplasia of myeloid precursor cells driven by mutations in the mitogen-activated protein kinase pathway leading to the proliferation and accumulation of Langerhans cells. Clinical manifestations range from isolated disease to multifocal lesions and systemic involvement with a worse prognosis
At present, the treatment of internal carotid artery stenosis has been extensively modified, passing from endarterectomy to balloon plasty and stent placement, generating a significant reduction in surgical risk. In-stent stenosis is reported in up to 30% of cases and patients generally present with a transient ischemic attack or stroke.
Various studies have suggested a correlation between Fas Cell Surface Death Receptor/Fas Ligand (FAS/FASL) variants and multiple types of cancers. The present study aimed to investigate the association between FAS-670A/G and FASL-844C/T and the synergistic effects of both variants on the risk of Gastric Cancer (GC) in the Kurdish population of West of Iran.
A 41-year-old female presented to emergency with complaints of recurrent vomiting, pain abdomen since last 24 hours. She is known case of diabetes, non-compliant to her medication. On examination, she was confused, GCS 11/15, and vitals were pulse rate 102/min, blood pressure 130/70 mmHg, respiratory rate 26/min, and random blood sugar 439 mg/dl.
Sub-Saharan Africa is currently having a dual burden of HIV and Non-communicable diseases. HIV is regarded as a chronic condition regardless of HIV being infectious, due to the absence of a cure. However, these patients have achieved a substantial increase in survival after receiving Antiretroviral Therapy (ART). An increase in survival puts HIV patients at risk of developing Non-Communicable Diseases (NCD).
A middle-aged male, coming from a remote hilly village of Northern India, presented to the outpatient department for optimization of his anti-diabetic medications. On routine general examination innumerable soft to firm, asymptomatic subcutaneous nodular swellings were noted over his trunk and limbs which varied from 1-4 cm in size.
A 21 year female patient reported with the chief complaint of pain and difficulty while eating and swallowing food from past 15-20 days. Her mother complained about her silent mode most of the time. Patient revealed that she is having pain while speaking, therefore she avoid speaking from past few days. Patient was systemically healthy.
A 24-year-old immune-competent man, with no significant past medical history, presented a Streptococcus viridans Infective Endocarditis (IE). Work-up for IE showed on post-contrast brain CT-scan a ring- enhancing lesion suggesting a cerebral abscess, with a contiguous nodular enhancing lesion. Given this radiological aspect, and because immediate cardiac surgery was indicated, a cerebral angiography was performed.
DIVC may play a role as a confounding factor in imaging diagnostic tests and also may represent a hazard for inadvertent injury and bleeding during surgery. Careful interpretation Radiological investigations help to define such anomalies and avoid significant morbidity during surgical exploration. We present a case of renal cell carcinoma involving Right kidney with tumor thrombus extending into both venae cava.
To describe our experience with TSCPC with diode laser for refractory glaucoma in a single centre in southern Italy. This retrospective descriptive study included 134 eyes with refractory glaucoma. Patients underwent TSCPC using a Cyclo-G6 laser method with a G-probe delivery system. Intraocular Pressure (IOP) and the number of Antiglaucoma Medications (AGM) were recorded at baseline and at 1-, 7-, 30-, 60-, 90- and 180-days post-treatment.
We present a case of a radiocarpal fracture dislocation. The injury of the distal radioulnar joint was initially underestimated and only fixed with screws and a K-wire without addressing the radiocarpal instability. In the further course, the patient developed a painful radiocarpal dislocation and an impaired Range Of Motion (ROM) of the affected wrist.
Libman Sacks Endocarditis is rare, nonbacterial vegetation of the heart valves. Most commonly seen in association with solid cancers and autoimmune diseases. A 64-year-old male came in with sudden onset left upper arm numbness, pain and pallor which worsened with movement. On examination, he had feeble pulses of the left upper extremity and an aortic diastolic murmur of the heart.
Aneurysmal bone cysts are primarily benign neoplastic lesions, often occurring in childhood and adolescent age group. A 27 year old male with neoplastic lesion arising from the posterior end of right third rib, underwent resection without thoracotomy or use of thoracoscopy. In this technique we used posterior midline transpedicular approach and resected with the help of neuronavigation system.
IgE-mediated food allergies can cause life-threatening anaphylaxis. Management of these allergies is based on a strict avoidance diet in relation to foods that may contain the allergen. The European regulations issued by the INCO (consumer information) provide a list of 14 allergens subject to mandatory declaration.
Pneumonia is common in neurocritical care patients. Non-bronchoscopic bronchoalveolar lavage (NB-BAL) is a generally safe, well-tolerated procedure with similar sensitivity to bronchoscopic bronchoalveolar lavage. This procedure is most often performed by non-physicians, particularly nursing and respiratory therapy, often without advanced training regarding the procedure.