Background and Importance: Simultaneous bilateral intracerebral haemorrhages (ICH) are exceedingly rare with only a few cases reported in the literature.Identified causes include systemic arterial hypertension, amyloid angiopathy, vasculitis, diabetic ketoacidosis and cerebral mucormycosis.Only 19 cases report an association between haemorrhagic infarct and preceding carbon monoxide (CO) poisoning.Clinical Presentation: We describe a case in which recent CO poisoning may have been a significant predisposing factor to the development of bilateral basal ganglia haemorrhages.When maximum medical management failed to control raised intracranial pressure, bilateral decompressive craniectomies were undertaken.Conclusion: To our knowledge there have been no reported cases of CO poisoning causing spontaneous bilateral basal ganglia haemorrhage, managed with decompressive craniectomy.
Wernicke's encephalopathy(WE) is an uncommon, yet, treatable and acute neuropsychiatric manifestation of thiamine deficiency which may often go undiagnosed .We report this case of a previously healthy 30 year old, non drinker, pregnant woman with hyperemesis gravidarum (HG) and gestational thyrotoxicosis(GT) who presented with a combination of WE, polyneuropathy and dysautonomia.This case is unique in many respects.(WE) is a rare but serious known complication of hyperemesis gravidarum.More so, WE occurring in association with hyperemesis gravidarum and gestational thyrotoxicosis, which are both hypermetabolic states and may predispose to WE, has been rarely reported in literature.Association of polyneuropathy causing generalized weakness and autonomic dysfunction in the same patient as part of the thiamine deficient state, with a good treatment outcome further adds to the complex yet interesting clinical presentation of this case.
With the increasing use of assisted reproduction technology, more women with endometriosis
Behçet's disease (BD) is a chronic multisystemic inflammatory disease with chronic wax and waning course.Eosinophilic pustular folliculitis (EPF) is characterized by pruritic follicular papules and pustules that may involve the face, trunk, and upper arms.The precise etiopathogenesis of EPF is not yet elucidated.Immunological aberrations have been suggested to play pivotal roles, as the most common type of EPF is associated with HIV infection.Herein, we describe a patient with BD who presented with multiple vesicopustular lesions that were pathologically proven to represent EPF, and further postulate that EPF may be considered as cutaneous lesions of BD, although further studies are necessitated.
Background: Recognition of Cytomegalovirus related primary adrenal insufficiency in patients with Acquired Immunodeficiency Syndrome (AIDS) requires a high clinical suspicion in patients already on glucocorticoids, especially if the glucocorticoids are to be withdrawn.Case Presentation: We report the case of a 67 year old man with a new diagnosis of Human immunodeficiency virus and multiple AIDS defining illnesses including disseminated Cytomegalovirus infection.The use of six weeks of prednisone therapy for an exacerbation of chronic obstructive pulmonary disease resulted in a delay in the diagnosis of primary adrenal insufficiency from Cytomegalovirus in this patient resulting in marked hypoadrenal symptoms when prednisone therapy was stopped.Conclusion: Our case highlights the importance of investigating for adrenal insufficiency in patients with Cytomegalovirus adrenalitis, regardless of prior or concurrent treatment with glucocorticoids, particularly if glucocorticoids are to be withdrawn.
Objective: Sitagliptin is a new oral glucose-loweri ng medication that acts via the incretin hormone system. The most common side-effects are headache and pharyngitis. Acute pancreatitis are rarely described in literature.
The objective of this study is to present a patient with hypopharyngeal epithelioid malignant schwannoma as a secondary malignant neoplasm following treatment with MOPP and radiotherapy. The patient, presently a 43 year-old man, was diagnosed at clinical stage III Hodgkin’s lymphoma (HL) with mixed cellularity histopathology at the age of thirteen. He had received 40 Gy radiotherapy to the neck region and MOPP + maintenance MOPP (a total 10 cycles), while malignant schwannoma developed 30 years after the treatment. Although the patient further received four cycles of ifosfamide + adriamycin combination chemotherapy, he died with progression of his malignant schwannoma six months after diagnosis.
Embolization of cholesterol material from atherosclerotic plaques lining the walls of major arteries causes different types of cholesterol embolization syndromes (CES), depending on the organs being involved.CES is most frequently found after cardiovascular procedures and less common after carotid surgery.We describe a case of a 65 -year old heavily smoker male patient of Caucasian origin with high grade symptomatic carotid stenosis.Duplex Doppler examination and angio-CT showed more than 90% unstable plaque in the right carotid artery.Clinically, he presented three transient ischemic attacks (TIA) in the past 2 years, the last one two months before surgical procedure.Carotid endarterectomy (CEA) was performed in local anaesthesia without using shunt and primary closure.Postoperative period was complicated in the second day by important visual deterioration in the right eye and the patient was referred to the Ophthalmological Department.In the indirect ophthalmoscopy of the right eye, a whitening of the superior retinal artery area and many cholesterol plaques was noted.Additionally, performed OCT and fluorescein angiography confirmed a diagnosis of retinal embolization syndrome.The present case report shows that there is a rare possibility of embolic retinal arteries occlusion (RAO) due to CES as a complication of the surgical restoration of internal carotid artery.
Carotid sinus syndrome is an exaggerated response to carotid sinus baroreceptor stimulation and has been reported in patients with cancer.Here we present a 22-year-old man diagnosed with Hodgkin's lymphoma and admitted with pulmonary sepsis.He evolved with hypotension, bradycardia and syncope after infection control.A CT scan of neck revealed nodal compression of the right common carotid artery.The patient improves after transvenous cardiac pacing and chemotherapy.
Intracranial chondrosarcoma is a rare entity with little consensus regarding surgical and adjuvant management options.The treatment approach to a 27 year old female with a clival chondrosarcoma displacing the basilar artery is described.This was surgically resected via an extended endoscopic endonasal approach (EEA) and the skull base was reconstructed using a vascularised nasoseptal flap.The patient had an uncomplicated recovery.This case details the feasibility and success of EEA for clival tumours and the effectiveness of local mucosal flaps as a reconstructive option.
We report on a 11 year old boy who was treated for bilateral vesicoureteral reflux grade II at our department by the age of 12 months by bilateral endoscopic injection with dextranomer / hyaluronic acid (Deflux). Because of reflux persistence on the right side an open antireflux surgery (Lich Gregoir) was performed. 10 years after initial treatment he developed serious deterioration of the left kidney function after three febrile urinary tract infections within one month. Diagnostic re-evaluation revealed bilateral recurrence of grade II reflux, which was corrected consequently by open bilateral ureteral reimplantation (Cohen technique). We discuss the available literature as to renal scarring in older children and adults after initial reflux therapy in childhood and conclude that there is no age limit to possible scar formation and that there are possible implications on follow up after “curative” therapy of vesicoureteral reflux in childhood. key words: paediatric urology, vesicoureteral reflux, endoscopic reflux therapy, Deflux, renal scarring
We describe a rare case of an epiphrenic esophageal diverticulum, complicated by perforation and leakage below the diaphragm, in a patient with known benign esophageal stricture and esophagitis.
Brachytherapy was employed as curative treatment modality for localized prostate cancer early in the 20 th century.Transperineal implantation of prostatic radioactive seeds is generally safe, however serious complications may occur.Although the half -life of the I 125 is about 60 days, literature review showed that Solitary Rectal Ulcer tends to occur months to years after the initial treatment.We present a case of 72 year-old man, who complained of "seeds" anal discharge 7 years after prostate brachytherapy.Paraclinical investigations showed Solitary Ulcer of the Rectum with extra urethral prostatic-rectal fistula.Laparoscopic Loop colostomy was performed.The 4 months follow-up period was uneventful, and the symptoms had resolved.Currently the patient is awaiting colostomy reversal.
Chorioangiomas are the most common benign tumors of placenta with reported prevalence of approximately 0.5% -1%.Large tumors are rare but those exceeding 5 cm in diameter may be associated with adverse effects on both mother and fetus.The larger the size of the tumor the more is the chance of developing complications.However, it is not necessary that complications would always ensue.Here, we present a case with a large asymptomatic placental chorioangioma that was found incidentally at term and led to a successful outcome.Despite the large size, it was not associated with the maternal or fetal complications expected with a chorioangioma of that size.
Extrapancreatic somatostatinomas are uncommon neuroendocrine tumours. Information related to its long-term prognosis is scarce. The prognosis of patients with advanced somatostatinoma is expected to be poor, but some tumours show low malignant potential and long-term survival rates have been described, even in the presence of metastases. We present a case of a 30-year-old patient, diagnosed with jejunal somatostatinoma. Multiple liver metastases were present at diagnosis. The primary tumour was removed and somatostatin analogues were prescribed. The patient survived for 12 years, with acceptable quality of life, although he suffered from repeated episodes of abdominal pain, diarrhea and vomiting along with severe hyperglycaemia followed by hypoglycaemia. Finally, he died because of severe ascitis and dyspnea due to tumour progression.
Perforation of Meckel's diverticulum following blunt abdominal trauma is quite rare.Only 4 cases have been reported in literature of Meckel's diverticulum perforation following blunt abdominal trauma .Here we report a case of Meckel's diverticulum perforation in a 10 yr old male child who presented in emergency with history of blunt abdominal trauma with bicycle handle.The patient had generalized tenderness and guarding all over abdomen and X-ray abdomen showed pneumoperitoneum.On exploration, there was perforated Meckel's diverticulum for which wedge resection and primary suturing was done.
Gastritis cystica profunda is described as gastric glands covered with normal gastric mucosa that locate submucosally and form cystic expansion. Its etiology is not clear, but the most important cause is prior gastric surgery. There is no agreed treatment because of its rarity. A 44-year-old female patient was admitted to hospital with complaints of abdominal pain and vomiting. We found a 2-cm mass in the wall of the stomach as a result of investigations. The patient was operated on with a preliminary diagnosis of gastric cancer. Surgeon performed excision of the total mass only. Pathological examination of the mass revealed that it was gastritis cystica profunda. Gastritis cystica profunda is a rare lesion of the stomach, and can be confused with other gastric pathologies. Preoperative diagnosis is important because it can prevent unnecessary resections. Gastritis cystica profunda should be kept in mind in the differential diagnosis of gastric submucosal masses.
Sensorineural hearing loss is common in patients with chronic kidney disease (CKD), occurring in 29% of children with end-stage renal disease and in 47% after renal transplantation1. CKD leads to immunosuppression, which has been reported to be associated with poor wound healing and/or infection. These issues are leading causes of morbidity in patients receiving solid organ transplantation2. For cochlear implantation, the common cause of morbidity is wound complication and meningitis. Due to these risks, cochlear implantation is rarely undertaken in a patient who underwent a renal transplant. Case
We report the case of a 60-year-old man undergone an aortic valve replacement with a SmeloffCutter prosthesis 40 years ago. The patient underwent a redo aortic valve and ascending aorta replacement for ascending aorta aneurysm that intraoperatively appeared as a chronic Type A aortic dissection. The Smeloff-Cutter prosthesis looked intact and functionally normal. The ascending portion of the aorta appeared dissected two centimeters above the sino-tubular junction, between the non-coronary and the left coronary valsalva sinuses: we speculate that Smeloff-Cutter prosthesis may contribute, due to its rheology and features, to the determinism of aortic dilatation and subsequently dissection.
