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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 Potts disease or spinal tuberculosis. Another possibility is direct extension from nearby structures or hematogenous spread from a distant focus.
    Latest Articles
    Case Series
    Irene Cortes Verdasca*, Marta Rebelo, and Eduarda Carmo
    CD infection is considered when a clinical picture is associated with the presence of CD producing toxins. To characterize a set of CD cases in a sample of patients admitted to the intensive care unit. Retrospective study of 10 years. Data on demographic variables, clinical severity, ALOS and MR were collected. 33 cases of CD were found. From these, 15 cases were severe, classified as pseudo membranous colitis, with a mean age of 69 and higher prevalence in female patients. The severity scores APACHE and SAPS II, were, on average, 29.7 and 63.6 (SD of 7 and 21.9). ALOS was 21.1 (SD 19.2) with MR of 60%.
    As serious complicated infection emerged 5 cases of toxic megacolon, with higher prevalence in males and mean age of 71. APACHE and SAPS II were 25.6 and 48.4 (SD 5.5 and 13.7). ALOS was 20.1 (SD 17.9), with MR of 60%.
    The rest presented mild infection, with higher prevalence in females and mean age of 69. However, APACHE and SAPS II were 27.8 and 46.5 (SD 11.5 and 20.3). ALOS was 15.2 (SD 10.7) and MR 54%.
    Irene Cortes Verdasca*, Gabriela Almeida, and Eduarda Carmo
    Introduction: SAH is a relevant health problem. The poor prognosis might be even changed by factors influenced by therapeutic interventions and management procedures.
    Case description: 85-year-old man admitted to the ER for prostration, headache and left hemiparesis. Head CT showed right anterior SAH and CT angiography revealed aneurysm of the right posterior communicating artery. Under went aneurysm embolization and started nimodipine and NA for BP control. Head CT control showed acute hydrocephalus with midline deviation and therefore placed external ventricular drainage. At day 3 post-event presented septic shock with marked abdominal. Performed abdominal CT that revealed mesenteric ischemia. Given the irreversibility of the latest complication there was no surgical indication. Death occurred on the 4th day post-event.
    Another case of a 79-year-old woman admitted for prostration, disorientation and left hemiparesis. Head CT and angiography documented bilateral frontal acute SAH and saccular aneurysm of the anterior communicating artery, respectively. Initiated nimodipine and NA and underwent aneurysm embolization. Head CT control showed worsening of cerebral edema and frontoparietal craniotomy with subtotal drainage was performed. At day 4 post-event developed abdominal distension and increased hemodynamic instability with NA. Abdominal CT showed diffuse intestinal ischemia. Given the poor prognosis there was no surgical indication. Death occurred on the 21st day post-event.
    Discussion: The association of 2 acute events is rare and the underlying mechanism is not yet established. Prolonged use and increasing doses of NA may be considered as a contribution.
    Muhammad Ali Tariq*, Usama Nasir, Neha Waqas, Atif Ameer, Asad Ali, Saad Wasiq, and Maira Nusrat
    Chest pain is among the most common presentations in the Emergency Department. It encompasses an expansive and varied list of differentials. At initial presentation in the emergency department, our attention is mainly focused on determining if this pain is cardiac or pulmonary in origin as these are the most life-threatening scenarios that merit acute care delivery. However, once these have been ascertained and ruled out, it is very important to consider other less common causes of the chest pain. Here, we present a case of a 52 years old Intravenous drug abuser with the chief complaint of chest pain. A chest CT scan suggested underlying sternal osteomyelitis. Further investigations concluded that the gram-negative organism, Pseudomonas aeruginosa was the etiological agent implicated P. aeruginosa is a rather rare cause of sternal osteomyelitis as compared to Staphylococcus aureus.
    Thomas Busch*, Esra Bayram, Kirk Sheplay, and Mohamad Aziz
    A 69-year-old female with history of breast carcinoma presented with a large non-obstructive soft tissue mass in the small bowel radiologically suggestive of sarcoma. She also had multiple hepatic cystic lesions, bilateral adrenal masses, a blastic iliac bone lesion and a left lung mass consistent with metastases. The lung mass was biopsied and revealed a spindle cell tumor positive for vimentin, smooth muscle actin (SMA) and BCL-2. History of prior breast carcinoma was investigated and it was found to have been reported as metaplastic carcinoma with prominent spindle cell sarcomatous component. Pathological analysis of the small bowel tumor was consistent with multiple metastases. Metaplastic breast carcinoma is more aggressive than ductal carcinoma, with larger tumor size, higher grade, more distant metastases and poor prognosis. These tumors are usually negative for mucin, estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER-2), complicating diagnosis and management. It is important to distinguish metaplastic breast carcinoma and initiate an individualized treatment protocol to avoid a devastating outcome.
    Ioannis Stamatatos*, Georgios Meimaris, Dimitrios Lioumpas, and Isaak Dimitriadis
    Background-Aim: Femoral artery pseudoaneurysms (PSA) typically result from percutaneous access for the purpose of angiography and other interventions. PSAs can be asymptomatic or manifest as a pulsatile mass or thrill. Rarely, they rupture leading to a life-threatening shock. We report the case of a 98 year-old woman who suffered a life-threatening superficial femoral artery pseudoaneurysm rupture after an extra-capsular fracture osteosynthesis that was treated with thrombin injection.
    Methods: We have received written consent from the patient and the institution review committee to present this case for scientific purposes.
    Results: Although uncomplicated femoral PSA can be treated with ultrasound-guided compression with 70-100% efficacy, thrombin injections guided by ultrasound have become the treatment of choice with the success rates ranging from 93-100%. This is the first case to our knowledge of ruptured iatrogenic femoral pseudoaneurysm treated with thrombin infusion.
    Conclusions: Rupture of the pseudoaneurysm comprises a vascular emergency while clinical suspicion and imaging techniques are the cornerstones of timely diagnosis and appropriate management of the condition. Ultrasound-guided thrombin injection should always be considered after the diagnosis of a ruptured femoral pseudoaneurysm, before emergency surgery is performed.
    Case Report
    Dylan M. Johnson*, Levi J. White, Brenda Cruciani, and Stephen V. Gordon
    Pseudoepitheliomatous hyperplasia (PEH) is a benign skin disease associated with reactivity to chronic inflammation. The diagnosis is based upon histologic characteristics and thus requires a formal biopsy. Due to its ambiguity, particularly the range of other conditions in which it is associated, a report of PEH instills much difficultly upon the receiving clinician in deciding further management, especially if malignancy had not been discounted prior to the biopsy. The risk of causing unnecessary iatrogensis by obtaining additional biopsies must be weighed with the potential consequence of anchoring to a diagnosis of PEH that reveals it to have been falsely reassuring. If one finds themselves in such a situation when caring for a patient, due diligence is warranted. Determining whether or not additional studies are appropriate should not be taken lightly with a diagnosis of PEH, as the decision may result in significant consequences.
    Sakshi Nayar*, Minu Keshkar, Aparna Arya, and Manju Puri
    Gestational gigantomastia is a rare condition of unknown etiology with psy-chological and physical adverse effects on the mother. Our case presented as an unbooked case at 37 weeks of gestation and was managed conservatively till delivery followed by spontaneous resolution post delivery.
    Usama Nasir*, Muhammad Ali Tariq, Haris Chaudhry, Cesar Figueroa, Maira Nusrat and Saher Aslam
    Insulin replacement therapy is one of many treatment options that can help to bring about near normoglycemia in patients with type 2 diabetes mellitus (T2DM).Adverse effects of human insulin and its analogs are common and are a significant issue in current diabetes care. However, polyarthralgias on long acting insulin, especially Insulin Glargine is a side effect that has previously never been reported. Here, we present an interesting case of a 61-year-old male patient, who was diagnosed with type two diabetes at the age of 41. The patient was compliant with basal-bolus insulin therapy and his basal insulin was recently changed to Insulin Glargine. In the immediate follow up after this change, the patient reported progressively worsening polyarthralgias necessitating Insulin Glargine to be discontinued. It was assumed that the new Insulin was the cause since the patient returned to his normal state of health upon its discontinuation. This is the first documented case of polyarthralgias on Insulin Glargine therapy in an adult patient. The literature does not have much to offer regarding this paradox and so the exact pathophysiology remains unknown.
    Michael Schmidt*, Alec Raniwsky, Abigail Sebald, Eason Balakrishnan, and Mohamed Aziz
    Leiomyosarcoma of the testis is extremely rare. We present the case of a 42-year-old male with a firm right para-testicular mass who underwent a radical wide margin orchiectomy. Histological examination revealed a high-grade leiomyosarcoma.
    Ricardo Villasmil*, Nicole Asher, Amy Town, and Mohamed Aziz
    Malignant mesothelioma (MM) is a rare and highly aggressive neoplasm primarily of the pleura with a poor prognosis principally due to its late presentation. Differentiation of malignant cells from reactive benign cells in ascitic and pleural effusions can be challenging and may lead to diagnostic errors. Even after malignant cells are identified, it is equally challenging to differentiate malignant mesothelial from malignant epithelial cells. Diagnosis should be based on cytological evaluation and confirmation utilizing immunohistochemistry studies. We report the case of a 44-year-old patient diagnosed with malignant mesothelioma. Initial cytomorphology assessment was suggestive of adenocarcinoma (clusters with community border). However, with utility of immunohistochemistry studies for confirmation, the final diagnosis proved to be malignant mesothelioma and not adenocarcinoma. The diagnosis was confirmed using immunohistochemical studies even in the presence of strong cytomorphological features.
    Case Report
    Martins P. Vieira* and Iriart JA. Bernstein
    Leprosy is a disease caused by Mycobacterium leprae and etiologic agent is transmitted from person to person through prolonged contact, and through patients in the form of multibacillary (lepromatous or borderline) without treatment. It remains a serious public health problem in Brazil, and in the northeast it is especially common. This study aims to understand how patients diagnosed with leprosy feel during the treatment in the city of Salvador, Bahia. From an anthropological perspective the objective of this study is to understand how patients felt during the diagnosis, changes in the body and the social impact of the disease in their lives. Eighteen narrative interviews were conducted with patients receiving treatment for leprosy in Salvador. The results highlight the social impact of the disease on peoples lives causing unemployment, family conflicts and exclusion. In some cases, changes in the body have implied identity transformations caused by the fact that the person is no longer able to recognize themselves. We also noted that the individuals themselves often feel a sense of guilt or the need to find out who is responsible sought for their contamination. Therefore, infected individuals clearly demonstrated a lack of support for social and 33 professional integration, which still exists today.
    Arguelles-Ambriz JA*, Murillo-Barrios IE, Carbajal-Contreras G, Lara-Perez MA, Cabrera-Mendoza F, and Ruiz-Mercado H
    Introduction: The reappearance after the removal of a carotid paraganglioma is very uncommon. It represents a surgical challenge due to difficulties caused by its high vascularity, proximity and possible infiltration of the carotid division.
    Objective: Case report and a review of this pathology, discarding cancer and the complexity of surgical management.
    Case description: 70-year-old male with previous resection of right carotid paraganglioma also common carotid artery ligation at the same intervention. After 15 years, he started to present progressive dysphagia, non pulsatile mass in neck, Kocher sign, non-palpable carotid pulse, for over one year. Imaging studies were performed, demonstrating adequate cerebral vascular compensation.
    An incision was made to the neck, the fore border of the sternocleidomastoid muscle. The tumor was removed by blocks and the internal and external carotid artery was ligated without evidence of cerebral ischemia. It was wrapping nerves and arteries. He presented coughs after surgery due to swallowing and infiltration of the superior laryngeal nerve.
    Postsurgical findings: Histopathological report: the paraganglioma is confirmed and negative to cancer. With satisfactory evolution after resection.
    Conclusion: We recommend the paraganglioma removal, when tumor reappearance, due to risk of potential cancer.
    Agathe Nallatamby, Julie Tronche, Ali Abdeh, and Nicolas Pichon*
    76 years-old woman, with a medical history of thyroidectomy and no significant medical history of thromboembolic disease, presented to emergency department with severe dyspnea and chest pain.
    Iraj Z. Afzal*, Dominik Dabrowski, David Haddock, Andrea Batshon, and Mohamad Aziz
    Microcystic adnexal carcinomas (MAC) are a very rare form of locally invading neoplasms. This paper reports a case of a 74-year-old female diagnosed with a MAC neoplasm localized to the left upper cheek; she was treated with both surgery and radiotherapy. The patient had two recurrences after surgical excisions with the second excision being coupled with radiotherapy. This report asses the rarity of this disease, which may lead to misdiagnosis, and the optimal treatment to minimize the possibility of known high recurrence rates. MAC is not considered a highly metastatic neoplasm; however, potential for metastasis exists, as discussed in this case.
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