Background Dermoid cysts are developmental abnormalities occurring between the third and fifth week of embryogenesis. These lesions can initially develop as intracranial or extracranial and persist throughout the patient’s lifetime. While generally benign, their symptoms can be due to mass effect or local irritation secondary to rupture and release of contents, typically presenting as headaches and seizures. Intracranial dermoid cysts are rare and comprise less than 1% of all intracranial lesions, with rupture occurring approximately 0.18% of the time. Case presentation Our case describes a 42-year-old Hispanic female with a late-onset rupture of an intracranial dermoid cyst with associated new onset seizures. She underwent uncomplicated neurosurgical resection with mesh placement and was scheduled to follow-up as an outpatient. Conclusion To avoid rupture and associated sequelae in future patients, we recommend considering a more invasive approach as the initial strategy if internal cysts are relatively accessible.

Background: Aspergillosis is a fungal infection that can lead to development of an aspergilloma, especially in patients with a history of cavitary lung disease. It is generally managed with antifungal therapy followed by surgical intervention. There are, however, limited options for the nonsurgical patient. Microwave ablation is already an effective, minimally invasive treatment being used in some lung malignancies and may be an alternative and definitive treatment in the inoperable patient. Methods: Two patients were considered for microwave ablation following their diagnoses of aspergillosis with hemoptysis. We sought to evaluate the efficacy of CT-guided microwave ablation of an aspergilloma in these patients who were not good candidates for surgical intervention. Results: Two male patients presented with hemoptysis and were found to have an aspergilloma. Case 1 was initially treated with antifungals and did not improve. He proceeded with VATS, and the procedure was aborted intraoperatively secondary to a frozen chest cavity. The patient subsequently elected to undergo CT-guided microwave ablation. He did not experience any immediate complications but was hospitalized for hemoptysis several weeks later. He developed alveolar hemorrhage and ultimately succumbed to PEA arrest.Case 2 was without hemoptysis at follow up and chose to pursue microwave ablation for definitive treatment. Case 2 developed post ablation pneumothorax requiring chest tube placement. Follow-up CT chest imaging was consistent with resolution of the aspergilloma. Conclusion: Microwave ablation is a safe and effective therapeutic approach in the treatment of lung malignancy with no severe or death related complications. There are almost no absolute contraindications. Microwave ablation may be utilized as a therapeutic option in the treatment of an aspergilloma in the non-surgical patient. This novel application may challenge the current gold standard of surgical intervention.

INTRODUCTION AND IMPORTANCE:Herniation through the Foramen of Winslow, also known as the epiploic foramen, is an extremely rare phenomenon with less than 200 cases reported in medical literature. Internal hernias account for less than 1% of all hernias and roughly 8% of all internal hernias occur through the foramen of Winslow. We present a case of a foramen of Winslow hernia that was not detected until direct visualization with laparoscopy. PRESENTATION OF CASE:A 52 year-old healthy female with a surgical history of a Caesarean section presented to the ER with severe epigastric pain radiating to her back. Physical exam was positive for abdominal tenderness and guarding. Vital signs were within normal limits. Murphy's sign and Rovsing's sign were negative. Initial imaging studies, including a CT scan of the abdomen, and laboratory findings were unremarkable. A hepatobiliary iminodiacetic acid (HIDA) scan was performed and demonstrated non-visualization of the gallbladder suggestive of acute vs. chronic cholecystitis. Following these results the patient elected to undergo exploratory laparoscopy with potential cholecystectomy. Intra-operatively, the colon was noted to be herniated through the foramen of Winslow. The procedure was converted to an open laparotomy. The hernia was manually reduced, and a right hemicolectomy was performed to prevent recurrence of the hernia. DISCUSSION:Reports list an enlarged foramen of Winslow, excessive viscera mobility (i.e., persistent ascending mesocolon or long small bowel mesentery), and an increase in intra-abdominal pressure as potential risk factors for this particular hernia. In our case, the patient was noted to have excessive mobility of the viscera with the presence of persistent ascending mesocolon and an abnormally long right mesentery. Physical exam is usually nonspecific and laboratory findings are typically unremarkable, posing a diagnostic challenge. Additionally, radiological findings indicating presence of an internal hernia were missed in the initial CT scan read by the radiologist. Internal hernias need to be managed surgically as there is a risk of strangulation with bowel ischemia. CONCLUSION:This rare radiographic phenomenon is difficult to diagnose radiographically and warrants further workup due to the potential risk of bowel strangulation despite negative clinical and laboratory findings.

Recent advances in supercontinuum generation technology have enabled the development of lasers with higher power and broader spectral content, allowing exploitation of these light sources in a range of new and exciting application areas.

identifier (CID) number is assigned to each article at the time of publication.Utilization of CIDs allows