Abstract Lumbar intradural disc herniation is rare and frequently mimics intraspinal tumors. A 58-year-old man presented with bilateral L5 radiculopathy and motor weakness. Contrast-enhanced magnetic resonance imaging (MRI) demonstrated an enhancing, cystic L4–5 intraspinal mass favoring a nerve sheath tumor. During unilateral biportal endoscopic surgery, epidural decompression revealed no extradural compression, but persistent thecal tension and absent pulsation prompted an 8-mm dorsal durotomy under reduced irrigation pressure. Sequestered disc fragments adherent to the cauda equina were resected piecemeal, while ventral defect exploration was deliberately avoided. The durotomy was closed using a sutureless inlay dural patch. Histopathology confirmed degenerative disc tissue. The patient achieved complete neurological recovery without cerebrospinal fluid leakage or pseudomeningocele on follow-up MRI. Intradural exploration is warranted when unexplained thecal tension persists, and inlay patch repair serves as an effective endoscopic alternative to primary suturing.
Abstract Burn injuries are common and carry high morbidity and mortality. Up to 40% of burn patients develop acute respiratory distress syndrome (ARDS) due to inhalational injury or infective pneumonia, and hypoxia may fail to respond to conventional therapy and ventilatory management. In this life-threatening scenario, extracorporeal membrane oxygenation (ECMO) therapy can be lifesaving, though literature on its use in burn patients with ARDS is limited. We report a case of Klebsiella pneumoniae pneumonia complicating into ARDS in a burn patient with resistant hypoxia, requiring ECMO therapy, with a favourable outcome.
Abstract Reports on Jael’s syndrome, characterized by intentionally inflicted knife wounds to the craniofacial region, are scarce. A 41-year-old man presented with a retained knife blade in the maxillofacial region 2 years after an assault. The prolonged delay in treatment resulted from his incarceration after the injury. Clinical evaluation revealed a stab wound penetrating from the right inferior orbital rim through the nasal septum into in the left maxillary sinus. Exploratory antrostomy and dacryocystorhinostomy were performed for knife blade removal with an uneventful postoperative course. This study reviewed the existing literature and examined strategies for addressing retained knife blades in the craniofacial area. Most cases involving acute knife wounds underwent urgent surgical intervention. This case underscores the importance of a comprehensive assessment for retained blades in deep stab wounds. Despite a 2-year delay in treatment, simple extraction performed in this case had no adverse effects on the outcome during 9 months of follow-up.
Abstract Destructive spondyloarthropathy (DSA) is a rare complication of long-term hemodialysis that often mimics infectious spondylitis, making diagnosis challenging. We report two patients with chronic kidney disease on long-term hemodialysis who presented with progressive neurological deficits and destructive spinal lesions suggestive of infection. In both cases, percutaneous biopsy of the lumbar destructive lesions showed no definitive evidence of infection, although occult infection could not be completely excluded. A 56-year-old woman underwent cervical reconstruction and achieved significant neurological recovery with solid fusion at 24 months. In contrast, a 62-year-old man underwent lumbar reconstruction but developed severe postoperative wound complications and died following a fatal cardiac event. These cases highlight the importance of considering DSA in the differential diagnosis of destructive spinal lesions in hemodialysis patients. Histological confirmation is essential before definitive treatment, and surgical outcomes depend not only on technical success but also on the patient's systemic condition and comorbidities.
Abstract Malignant transformation of intestinal endometriosis is rare and may closely mimic primary colorectal adenocarcinoma. A 43-year-old woman with a history of ovarian endometriosis presented with melena and a rectosigmoid tumor with uterine invasion and multiple lymph node metastases. Histopathological examination revealed moderately differentiated adenocarcinoma with intestinal endometriosis but no definitive transition between the endometriosis and the carcinoma, supporting an initial diagnosis of primary colorectal adenocarcinoma. Five years later, biopsy of a recurrent vaginal stump lesion showed an adenocarcinoma positive for estrogen receptor, paired box gene 8, and cytokeratin 7 and negative for cytokeratin 20 and caudal-type homeobox transcription factor 2. Retrospective immunohistochemical evaluation of the original tumor demonstrated a similar phenotype, supporting a Müllerian origin and malignant transformation of intestinal endometriosis. This case illustrates the difficulty of determining tumor origin based on morphology alone and highlights the diagnostic value of immunohistochemistry.
