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  • ISSN: 2373-9819
    Volume 8, Issue 2
    Case Report
    Amy Storfa, Sherif Said and AugustinAttwell*
    In this case report we describe the case of a patient with cirrhosis who presented with jaundice and initial labs and imaging suggestive of biliary obstruction. The diagnosis of HCC was then made during ERCP with blood clot extraction followed by pathologic analysis of the thrombus. Making the diagnosis promptly and safely permitted the patient to be discharged days later and pursue palliative care measures while avoiding risky and expensive tests. Such an unusual presentation and style of diagnosis has been described only once in the literature to our knowledge, in an image-based report that did not include a discussion or literature review.
    Nikhil Jain*, Saurabh Rawall and Pramod Saini
    Intraoperative neurophysiological monitoring is an implicit aid, used to prevent unwanted neurological complications in spine deformity correction procedures. From the available armamentarium, Tc MEP and SSEP are most sensitive and most specific techniques respectively1. Loss of intraoperative signals is alarming and indicates either a temporary or a permanent neurologic injury2. Here we present a case of a young female with adolescent idiopathic scoliosis who developed unilateral intraoperative SSEP and Tc MEP signal loss but had intact post-operative neurology.
    Papa Dasar* and Haritha Sagil
    Background: Hypoxic ischemic encephalopathy (HIE) most commonly results due to Cardiac arrest secondary to Cardiac diseases. Global ischemia occurs due to a drop in cerebral perfusion pressure and if the insult is for a brief period it results in selective neuronal damage and not brain death. Persistent Vegetative state develops due to diffuse cortical, thalamic or combined neuronal loss with intact brain stem. This is rarely encountered in Obstetrics. It is important to diagnose HIE early and there is a great role for imaging in arriving the diagnosis so that prognosis can be explained to the family members.
    Case Series: The 3 women with HIE were in their 3rd decade of life and all 3 suffered from hypertension during pregnancy and developed complications that led to cardiac arrest and were successfully revived. Though advances in resuscitation resulted in survival, persistent vegetative state occurred due to the resultant hypoxia to the brain. CT was normal but MRI -FLAIR showed the insult as evidenced by bilateral diffuse hyper-intensity of cerebral cortex and hyper-intensities along head of bilateral caudate nucleus, putamen and occipital lobes. Delayed termination of Pregnancy is the preventable factor identified. Mortality occurred due to secondary reasons in 2 of them after prolonged ICU stay.
    Conclusion: Early decision for termination of Pregnancy is the key for prevention of morbidity and mortality in women with severe hypertension developing complications. MRI (DWI) should be the neuroimaging of choice to find out the extent of brain damage and prognosticate.
    Verlyn Yang*, Sandeep Bhuta, and Aditi Kirpalani
    In this case report, we present an unusual case of a 7-year-old female who came to the attention of the Ophthalmology department for reduced vision in the right eye 6/18 (LogMAR 0.4) with normal vision in the left eye. Fundoscopic examination revealed signs of an optic disc coloboma associated with an optic disc pit with adjacent sub-retinal fluid extending to the macula. She was born with a left multi-cystic kidney. Further work-up in the form of MRI and USG Orbits demonstrated a well-defined optic pit at the optic nerve head and a tubular channel extending to a 6-7mm multi-cystic lesion.
    Fatima Meraj*, Sumaira Sheikh, and Hafsa Muhammad Hanif
    Secondary hyperparathyroidism is a known complication of chronic renal disease. Excessive parathyroid hormone induces a form of renal osteodystrophy characterized by bony remodeling (by stimulating osteoblastic and osteoclastic activities) and myelofibrosis. We report the case of a 22-year-old lady with end-stage-renal disease and marked hyperparathyroidism (1140.90pg/ml; reference range: 15-68pg/ml) who developed pancytopenia despite nutritional supplements and weekly erythropoietin injections. Bone marrow examination revealed findings consistent with renal osteodystrophy.
    Michael Mortellaro*, Daniela Pereira*, Nichole Allen, MD*, Stefanie Grewe, Gregory Lauwers, Kun Jiang
    Gastric adenosquamous carcinomas are challenging entities due to their rarity, aggressive behavior, and frequently missed clinical and pathologic identification and diagnosis. Adding to the challenges is the current unclear knowledge of its etiology, presentation, molecular mechanism(s) and ideal therapeutic strategy remains unclear. Defects in mismatch repair, also known as microsatellite instability, impact the clinical course and prognosis of many types of human cancers. To our knowledge there has been no report in the literature fully illustrating microsatellite instability and the associated molecular profile in gastric adenosquamous carcinoma. Here we report an aggressive, 5-fluorouracil-resistant gastric cancer that underwent surgery due to stomach outlet obstruction. Ancillary studies were significant for identifying an originally missed adenosquamous phenotype and mismatch repair-deficiency (MSH2/MSH6-absent); subsequent next generation sequencing detected multiple carcinogenic mutations. These findings led to pembrolizumab-based management with the patient remaining disease-free 30-months later. This unique case suggests that microsatellite and/or mismatch repair testing and squamous differentiation should be considered in gastric poorly differentiated cancers that fail conventional managements.
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