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  • ISSN: 2373-9819
    Body Stalk Anomaly in One of the Dichorionic Diamniotic Twins Following In vitro Fertilization and Embryo Transfer
    Authors: Krishna GR, Abdul Haium Abdul Alim, Kenneth Chang TE, Edwin Thia WH and Bhavani Sriram
    Abstract: Body stalk anomaly/Limb body wall complex (BSA/LBWC) is a sporadic, rare and severe congenital anomaly with a poor prognosis.
    A Rare Cause of Hip Pain: Primary Tuberculous Psoas Abscess. Case Report
    Authors: Carlos Cano, Roberto G. Alconada, German Borobio, Diego A. Rendon, Laura Alonso, David Pescador and Juan F. Blanco
    Abstract: Tuberculous abscesses in the iliopsoas muscle are usually secondary to Pott�s disease or spinal tuberculosis. Another possibility is direct extension from nearby structures or hematogenous spread from a distant focus.
    Latest Articles
    Case Report
    Marta Reia*, Guilherme Fialho, Jose Segurado, Hugo Capote, Eduardo Soeiro, and Ilda Barbosa
    The splenic abscess is a rare entity, frequently associated with immunosuppression syndromes, and often to less common microorganisms. Tuberculosis affects mainly the lung, but it may present as a miliary form, spreading through other organs. There are a few cases of splenic tuberculosis reported in the literature worldwide, but because of the unusual evolution and method of diagnosis in this case (after splenectomy), we reporta female patient with multiple splenic abscesses as an extrapulmonary manifestation of tuberculosis.
    Tekalign Tadesse* and Endalu Mulatu
    This report documents the clinical management of complete uterine prolapse in a cross-breed cow presented to Addis Ababa University College of Veterinary Medicine, Veterinary Teaching Hospital in October 10, 2018 with the history of normal parturition and expulsion of fetal membrane. Twelve hours after the fetal membrane expulsion, the uterine mass was everted hanging on the hock and the cow got recumbent. The clinical examination revealed that the cow was at left lateral recumbency and the everted uterine mass was soiled with feces and straws. The cow was subjected to epidural anesthesia and with a proper lubrication the prolapsed uterus was repositioned and purse string sutures were applied at vulva along with supportive therapy and cow recovered successfully without further complication of prolapse.
    Nadine Shabti*, Andressa Balbi, Taylor Avakian, Phillip Pearson, and Mohamad Aziz
    Pheochromocytoma (PCC) is the most common neuroendocrine tumor of the adrenal medulla in adults and is characterized by over-secretion of neurogenic amines resulting in the classical triad of symptoms including episodic headaches, sweating, and elevated blood pressure. In the rare case of malignant pheochromocytoma however, the clinical presentation becomes highly variable based on the targets of distant metastasis. Reported here, is a case of a 53-year-old African-American male with typical symptoms of a malignant PCC in addition to bilateral sensorineural hearing loss. This case highlights the unusual symptoms that can arise from metastasis of malignant pheochromocytoma while also considering the potential differential diagnosis of paragangliomas.
    Christopher Abdullah, Joachim Beck, Christoph Dber, Wolfram Klapper, Matthias Theobald, and Georg Hess*
    Waldenstrm's macroglobulinaemia (WM) is an indolent lymphoma characterized by bone marrow infiltration with lymphoplasmocytoid lymphocytes in conjunction with the production of monoclonal IgM. Cerebral affections of WM are a rare event but especially challenging and intensive regimen are primarily used for this difficult to treat condition
    Ibrutinib inhibits Bruton's tyrosine kinase (BTK) which is essential in signal transduction of both normal and malignant B cells and has been recently introduced in the treatment of WM. Ibrutinib, in addition, has been shown to be of promising activity in CNS-lymphoma.
    Here we report on the results of Ibrutinib treatment in a female patient with multiply relapsed WM with transformation and CNS involvement.
    The patient was initially diagnosed with WM in 2006 at the age of 52 years and received 6 cycles of rituximab combined with cyclophosphamide, doxorubicine, vincristine and prednisone with the achievement of a complete remission in 2007.Until 2015 the patient experienced several relapses and underwent different therapy regimens including high dose therapy followed by autologous peripheral blood stem cell transplantation and radiotherapy.
    In November 2015 the patient was admitted to the emergency unit with symptoms of increased intracranial pressure due to progressive lymphoma. Treatment with Ibrutinib was initiated and within a few days the patient's general condition improved substantially achieving almost normal quality of life. Two months later in January 2016 MRI of the brain showed a nearly complete remission which lasted for four months until the patient deceased.
    To our knowledge this is the first case reported of transformed WM with a substantial remission duration, which exceeded most responses observed in pCNS lymphoma.
    Muhammad Atif Ameer, Khansa Khalil, Arsalan Ahmad, Diego R. Torres-Russotto, and Danish Bhatti*
    Visual Hallucinations (VH) are common in Parkinson Disease (PD) and are likely related to changes in the visual pathways as shown by increased serotonergic binding and changes on structural and functional brain studies. We present a case of a retired pediatrician with PD who presented with persistent hallucinations of seeing small children in the setting of dopaminergic medication use. The content of his hallucinations was very consistent throughout. We review the literature related to visual hallucination and suggest that contents of visual hallucinations in PD are likely related to prior strong emotional visual memories including those generated through the patients profession.
    Case Report
    Irene Verdasca, Susana Franco, Luis Melo, Joo Torres, Susana Peres, Fernando Borges, and Kamal Mansinho
    Autoimmune hepatitis (AIH) remains a major diagnostic and therapeutic challenge. In addition to being a relatively rare disease, early recognition may be difficult due to its heterogeneous clinical picture and the absence of a specific laboratory finding. Female patient, 67 years old, with human immunodeficiency virus infection under antiretroviral therapy with stable immune status and suppressed viral load. Reported asthenia, yellowish mucosa and nausea for one month. Lived in a rural area with direct contact with unvaccinated animals, consumed unpasteurized food and had occasional contact with rat poison. Laboratory evaluation showed liver biochemical and function tests highly elevated and the autoimmune study positive antinuclear antibody (ANA) and anti-smooth muscle antibody (ASMA). Other causes of inflammatory liver diseases were excluded. Abdominal ultrasound showed no abnormal findings. Liver biopsy (Figure 1) was preceded and revealed chronic hepatitis with marked activity that could be compatible with autoimmune or toxic etiology (Figure 2). By the use of simplified AIH score, diagnosis of AIH was likely (7 points) and probable by using the revised original score for AIH (14 points). The patient started prednisolone 1mg / kg / day and azathioprine 25mg / day with rapid remission. The simplified diagnostic criteria have a high sensitivity and specificity for the diagnosis of AIH. Its application in clinical practice led to the diagnosis of HAI after the result of a non-definitive liver histology and the initiation of immunosuppressive therapy, in this case with remission of the disease.
    Irene Verdasca*, Miguel Ferreira, Pedro Mota, and Nuno Cardim
    A 34-year-old woman, from Argentina, with history of positive serology for Trypanosoma cruzi (T. cruzi) is referred to cardiology consultation for symptoms of palpitations. Cardiovascular assessment with chest x-ray, electrocardiogram (ECG) and 24-hour Holter monitoring was normal. Attending to the epidemiologic context of an immigrant patient from an endemic area for Chagas' disease echocardiographic evaluation was performed and documented left ventricle cavity at the upper limit for normal and inferolateral hypokinesia with decreased regional longitudinal strain. Cardiac magnetic resonance imaging (MRI) detected dilated left ventricle (LV) with segmental alterations (lower wall and apex), dilated right ventricle (RV) and increased T1 and T2 native left ventricle. These findings were suggestive of chronic Chagas' myocardiopathy, an early form (indeterminate phase).
    New imagining modalities, like strain echochardiography and MRI, helped this patient to start pharmacological treatment earlier and is now a good way to improve clinical care and follow-up of a "forgotten disease".
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