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  • ISSN: 2373-9819
    Volume 2, Issue 6
    Editorial
    Evan L. Hardegree1,2 and Rajiv Gupta1*
    Although coronary angiography is considered the gold standard for diagnosis of coronary artery disease, it has many limitations. In standard angiography, the operator acquires multiple views of the coronary arteries in 4-6 projections for the left coronary artery and 2-3 for the right coronary artery to find the diseased area for diagnosis and subsequent treatment of coronary artery disease.
    Clinical Image
    Yuh-Ming Chang*
    A 56-year-old woman presented at the emergency department with progressive dysarthria, dysphagia, and general weakness for 5 days. She had a 20-year history of alcohol abuse and a new-onset type-2 diabetes mellitus.
    Osman Kostek*, Mumtaz Takır, Yusuf Yılmaz and Alihan Oral
    A fifty-eight years old female patient admitted to our hospital with diabetic ketoacidosis (DKA) that caused by urinary tract infection. Her medical history was unremarkable,...
    Yew Toong Liew1*, Elizabeth Lim2 and Prepageran N3
    Abstract: A 22 year old gentleman presented with right neck swelling since 6 months of age. It progressively enlarged until it involved the right face. There were no compressive symptoms, bleeding or cardiac symptoms. There was no trauma.
    Anetta Lasek-Bal1, Mike Smertka2, Małgorzata Piwkowska3, Małgorzata Cisowska- Babraj1 and Michał Holecki2*
    We present a 28 year old male patient with a primary neurosarcoidosis. His initial symptoms found on physical exam include acute onset of sensorimotor aphasia on the right side (central nerve paresis) of the face, as well as the right upper extremity, with pain localized in the occipital region.
    Letter
    Patrick Richard Fraser*
    In recent years, one of the more potentially devastating issues facing medical education is the idea of replacing human cadaver dissection and anatomy labs with that of clay models, previously prosected portions such as the axilla, and in some of the most low-rent cases clay models.
    Research Article
    Patrick R. Fraser*, Victor Taylor II, Rustin E Reeves and Geoffrey D. Guttmann
    Abstract:
    Introduction: As part of a series of dissections geared towards an improved anatomical understanding of Greater Trochanteric Pain Syndrome (GTPS), several pathologies of the greater trochanter were observed. Case studies of two pathologies are presented.
    Method: The experiment was performed on two partially dissected, embalmed hips from cadavers donated through the Willed Body Program at the University of North Texas Health Science Center. The gluteus maximus muscle belly was detached from the iliac crest. In addition, the iliotibial band was cut from the origin (ilium) and reflected to gain access to the gluteus maximus tendon. The tissue in the area around the greater trochanter was cleaned to expose the greater trochanter and the gluteus maximus tendon.
    Results: Of the two hips observed, both had discoloration of the greater trochanter. In case 1, the pathology of the greater trochanter was identified as hemosiderin. It presented as a yellowish color, possibly be due to hemorrhage. Probing the area revealed the bone to be softer than the other areas of the greater trochanter. In case 2, the pathology was identified as exostosis. Multiple osteophytes were observed on the surface of the greater trochanter, and parts of the gluteus maximus tendon were calcified. This may be due to repetitive use of the hip while damaged.
    Conclusion: Multiple pathologies were observed in this study. Further studies will be conducted to determine which pathologies are linked to GTPS.
    Patrick R. Fraser*, Arthur C. Bredeweg and Armando A Rosales
    Abstract: A 31-year-old female with a 19-year history of chronic urinary tract infections, intermittent hematuria, and associated flank pain was referred to our service for evaluation and treatment. Increasing frequency and severity of the infections prompted the following diagnostic studies to elucidate the etiology of the patient's condition: abdominal and pelvic computed tomography scans, intravenous pyelography, voiding cystourethrography, kidney ureter and bladder x-rays, flexible cystoscopy, bilateral renal ultrasonographies, cystourethroscopy with sounding, bilateral retrograde pyelographies with fluoroscopy, and ureteroscopy. Our studies revealed an uncommon, bilateral duplication of the urinary collecting systems. Upper and lower pole collecting systems, each with their own ureter, were discovered bilaterally. Chronic changes of the upper pole collecting system of the left kidney were observed, including hydroureter, caliectasis, and renal calculi. Furthermore, a large ureterocele, measuring 4 cm in length x 2 cm maximum transverse diameter, was observed in the distal portion of the left upper pole ureter. This ureter inserted into the proximal portion of the external sphincter muscle of the female urethra. These findings are consistent with an obstructive process that resulted in chronic damage to the left upper pole collecting system, and presents a difficult clinical scenario to manage. The duplicated collecting system on the right showed normal function despite its anatomical variation. Based on this finding, we believe that the location where the duplicated ureter inserts into the bladder is more predictive of chronic renal insult and associated pathology versus the presence of the variant alone causing problems.
    Research Article
    Kiran Kumar KR1* and Giju Baby George2
    Abstract: Cleidocranial dysplasia is an autosomal dominant condition caused by mutation of RUNX2, involving the skeleton and the teeth. It presents with a major finding of the hypoplasia or aplasia of clavicles along with late closure of the fontanels, presence of open skull sutures and multiple wormian bones. Although not frequent it can present to the dentist commonly with significant retention of multiple deciduous teeth, impaction or delay in eruption of permanent teeth and often with the presence of supernumerary teeth. Here we report a case of Cleidocranial dysplasia in a 30 year old male.
    Case Report
    Necial Marcelin Marta Pérez*, Diego Enjuto, Soraya Sánchez Molero, Norberto Herrera Merino, Rosa Serrano García, Rafael Sánchez Estella, Javier Martin Ramiro, Fernández Merino Javier, Mariano Salvador Fernández and Jorge De Luis Yanes
    Abstract: We present a case of intrathyroid hemorrhage of a thyroid no-dule which presented as a progressive cervical mass asso-ciated with anterior neck discomfort, anterior neck malaise, dysphagia and mild dyspnea which was controlled with rest. Ultrasound and CT scan allowed diagnosis and staging.
    Le Calloch R1*, Ianotto JC1, Guillerm G1, Bailly P2, Tissot V3, Imbeault B4, Eveillard JR1, Berthou C1 and Timsit S2
    Abstract: The Posterior Reversible Encephalopathy Syndrome (PRES) is a serious complication of treatment with cyclosporine with an incidence of 8% in patients with bone marrow transplantation. PRES is a hypertensive encephalopathy with a various clinical presentations (twitching, convulsions, blindness and coma). Cyclosporine is an immunosuppressant used in the prevention of graft rejection in solid organ transplantation and prevention of Graft Versus Host Disease (GVH) during allogeneic bone marrow transplantation. We present 3 cases of patients that we have took care in our unit who presented severe neurological complications in the aftermath of their bone marrow transplant and after receiving cyclosporine.
    Imaging performed by emergency, using MRI and measurement of Apparent Diffusion Coefficient (ADC) is an important consideration during the management of these patients. In case of a high ADC, reflecting vasogenic edema, patients might have a favorable prognosis and the use of corticosteroids may decrease edema while a decreased ADC may represent an irreversible damage with a poor outcome.
    Early and appropriate care of PRES, taking in account ADC index, may improve prognosis of this potentially mortal syndrome.
    Shokouh Taghipour Zahir*
    Abstract: Rhino-cerebral fungal infection is rare in immunocompetent patients without a history of underlying predisposing risk factors. Signs of this infection can mimic other diseases such as vasculitis or intracranial tumors. We present a 14-year-old male patient with diplopia, headache, and strabismus after blunt facial trauma. The first clinical impression was that of vasculitis such as Wegener's granulomatosis,but histopathological examination of abiopsied specimen confirmed the presence of rhino-cerebral mucormycosis.
    Rocco Luca Emanuele Liardo*, Corrado Spatola, Roberta Bevilacqua and Giuseppe Privitera
    Abstract: The Extramedullary Plasmacytomas (EP) are rare tumors originating from plasmacells of the soft tissues outside of the bone. For a correct diagnosis biopsy is mandatory and CT or MRI is necessary.
    We report a case of a 62 year-old man, who underwent to otolaryngologist visit for nose bleeding. A peduncolated right palatine tonsillar lesion was diagnosed. The nasopharyngeal examination revealed another mass extending inferiorly from the left fossa of Rosenmuller, confirmed by a facial and neck CT. An excisional biopsy was performed in both sites and the histological examination diagnosed a moderately differentiated extramedullary plasmocytoma.
    Patient was referred to hematologist, which requires a 18F-FDG PET-CT that shows tracer accumulation only in the tonsillar region bilaterally. Bone scintigraphy and bone marrow biopsy were negative.
    Finally, the patient was referred to our Department and submitted to radiation treatment. Therapy was performed with 3-D conformal technique. The total dose administered was 45 Gy in 25 fractions.
    The EP is a radiosensitive disease. Several studies show an excellent local control and a long-term disease-free survival after radiotherapy, but there are still not standardized doses and volumes of radiation.
    All retrospective reviews support radiation doses of 40-50 Gy, supporting irradiation of involved lymph nodes. Higher doses are indicated for high dimensions tumors (> 5 cm) or patients with high risk of recurrence. Studies on the role of surgery are conflicting and there is no evidence on the efficacy of adjuvant chemotherapy.
    Patient was free from recurrence 30 months after the end of radiation treatment.
    Sefa Kelekci, Serpil Aydogmus, Serenat Eris*, Zeynep Çetinkaya Şeyhanlı, Hüseyin Aydogmus and Mustafa Şengul
    Abstract: Placentation abnormalities are more common today as a result of the spread of the use of assisted reproductive techniques and increasing the incidence of cesarean delivery. Early diagnosis of these conditions that can lead to serious perinatal complications can contribute to the prevention of perinatal morbidity and mortality. Here we present a case of vasa previa who prenatally diagnosed in second trimester routine sonographic evaluation and managed successfully with elective sectio abdominalis at 36th week of pregnancy.
    Elcin Telli1*, Omer Tarık Yalcin1, Tufan Oge1 and Sare Kabukcuoglu2
    Abstract: Hereby, we present a rare case of 22 year-old pregnant woman with a suspicious adnexal mass coexisting multiple nodules on ovary, peritoneum and omentum diagnosed as disseminated peritoneal leiomyomatosis.
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