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  • ISSN: 2373-9819
    Volume 3, Issue 1
    Case Report
    Laren Tan1,2*, Charles Poon1,2 and Richart Harper1,2
    Abstract Malignant pleural effusions often appear at the late stages of disease and can vary in severity of symptoms and volume. Timely diagnosis and etiology of pleural effusions are essential in achieving a favorable outcome; however there are instances when obtaining both are problematic. We report a case where immediate gross inspection of pleural fluid can allude to a diagnosis of malignancy.
    A 68 year old male with HIV presented with2-3 weeks of weight loss, shortness of breath and productive cough. Chest X-ray was consistent for bilateral patchy opacities with worsening adenopathy, Computed Tomography (CT) was positive for cavitating nodules, hilaradenopathy and bilateral pleural effusions. A right thoracentesis was performed revealing blood-tinged serosanguinous fluid with white, grainy specks of tissue. Cytologic analysis of the pleural fluid revealed the white grainy specks of tissue to be clusters of lung squamous cell carcinoma. This case is unique in the extent of the tumor spread at presentation and high degree of tumor burden that could be visualized on gross inspection of the pleural fluid. To the best of our knowledge, the presence of gross malignant clumps in the pleural fluid has not been described in literature. The cause of this unique pattern of pleural metastasis, which we have coined the "snow-globe effect", is unclear.
    Y T Liew*, DJ Yong, Somasundran M and Ong CA
    Objective: We report an extremely rare case of massive tracheosophageal fistula which can be a reference for physicians and surgeons in the prevention of the disease.
    Method: A case report and literature review of aetiologies, clinical features, management and prevention of acquired Tracheoesophageal Fistula (TOF) secondary to oesophageal stent are presented.
    Results: A young gentleman developed TOF at post oesophageal stenting day 14 for benign proximal oesophageal stricture (secondary to irradiation for Diffuse Large B cell lymphoma of mediatinum). After insertion of self-expanding oesophageal stenting, he developed severe respiratory distress and stridor where he needed a tracheostomy. Presence of tracheostomy, oesophageal stent, previous irradiation and malnutrition put him at deem high risk of TOF. He passed away due to failure of pulmonary oxygenation before surgical correction of the fistula.
    Conclusion: Proper selection of candidate with least risk factors is important prior oesophageal stenting.
    Sheikh Irfan Bashir*
    Fractures of the Proximal tibial epiphysis are rare. We report a case of proximal tibial epiphyseal fracture with completely separated and displaced physis . The injury was a result of high speed road traffic accident. The fracture displacement was such that it was difficult to put it in any existing classification system except poland type 4. The injury has a high risk of neurovascular compromise. The patient had a feeble anterior and posterior tibial pulses on admission .We managed the case on emergency basis and went for closed reduction and internal fixation by smooth krishner wires .The results were good in both immediate and early follow-up despite the gross injury to physis.
    Tatsuhito Miyamoto1, Toshihiko Nakatani2*, Tatsuya Hashimoto3 and Yoji Saito4
    Abstract Although spinal epidural hematoma is rare, it can have critical consequences. We experienced a case of spinal epidural hematoma after bolus injection of local anesthetics during patient-controlled epidural analgesia (PCEA). A female patient was presented for management of herpes zoster related pain. An epidural catheter was placed at the thoracic level for PCEA. On day 6 after epidural catheterization, after bolus injection, she complained of bilateral lower extremity motor deficits, and vesicorectal disturbance. A spinal MRI demonstrated spinal epidural hematoma at the T6 level. The hematoma spontaneously disappeared without invasive treatment and the patient recovered completely without any neurological sequelae.
    Krishna GR1, Abdul Haium Abdul Alim1*, Kenneth Chang TE2, Edwin Thia WH3 and Bhavani Sriram1
    Abstract Body stalk anomaly/Limb body wall complex (BSA/LBWC) is a sporadic, rare and severe congenital anomaly with a poor prognosis. Association of this lethal malformation in multiple gestations following assisted reproduction techniques is even more uncommon and had been reported in case reports only. In-vitro fertilization embryo transfer (IVF-ET) is an effective treatment for various types of infertility and there is increased incidence of congenital anomalies when compared to natural pregnancy. We report a case of body stalk anomaly in one of the dichorionic diamniotic twins conceived after IVF-ET.
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