Seyed Farshad Allameh
Vol 6 No 5 (2021): September-October
Adult intussusception is a rare disease with various clinical presentations and can cause grave surgical problems. The condition is associated with malignant and benign leading points in adults, unlike in children who mostly experience the latter. The colonic intussusception type can be more malignant than the enteric type, especially in distal parts of the colon. Sigmoidorectal intussusception is less common in adults; it usually presents as bowel obstruction or lower gastrointestinal bleeding. We reported a case of a middle-aged woman with sigmoidorectal intussusception who was treated by transrectal endoscopic surgery.
A 41-year-old female with retractable epigastric pain due to an invasive neuroendocrine tumor of the pancreas was treated with blockage and radiofrequency ablation of the celiac and splanchnic plexuses. Then, the patient developed back pain, and a bone scan revealed abnormal uptake in the lower thoracic vertebrae despite a normal CT scan. The findings were interpreted as a local invasion of the tumor or iatrogenic post-manipulation inflammation or infection. MRI data presented the destruction of the thoracic 11th and 12th vertebrae, and pathology examination of the open biopsy sample favored inflammatory changes.
This case report discusses A 6-year-old boy, a known case of Cri-du-chat (cat's cry) syndrome, who was referred to the epilepsy clinic of Imam Khomeini hospital for further evaluation and performing video EEG monitoring. Video EEG monitoring showed two stereotypical ictal clinical habitual events during sleep. These episodes were sudden and showed hyper motor movements in the left lower extremity. Electrographically, a definite ictal pattern evolved to rhythmic slow activity in the left centroparietal region. Brain MRI with epilepsy protocol was unremarkable. Due to the sudden onset of movements depicting hyper motor activity during sleep and abnormal EEG and the fact that the patient is a known case of the cri-du-chat syndrome, this is reported as having a motor seizure is extremely rare in cat cry syndrome. To our knowledge, this is the first report of motor seizure in cat cry syndrome.
Volvulus of the gallbladder is among infrequent diseases ranked among acute abdomen conditions. The disease presents with acute biliary ailments, often reminiscent of acute cholecystitis. It is more common in frail elderly women. Its preoperative diagnosis is complicated; therefore, this finding is intraoperatively encountered in most cases. In our case report, we present the case of a female patient where the volvulus of the gallbladder was found as a surprising discovery during surgery. Gallbladder volvulus is a rare disease that presents as acute abdomen. It is most often diagnosed intraoperatively. Cholecystectomy is the most appropriate therapeutic method for this condition.
We reported a case of corneal perforation due to longstanding exposure keratopathy treated successfully with lamellar corneal patch graft, conjunctival flap, and lateral tarsorrhaphy. A 75-year-old male presented with ocular pain and decreased visual acuity in his right eye since 2 weeks ago. On external examination, lagophthalmos in the right eye was evident. Visual acuity was hand motion on slit-lamp examination. 2×3 mm perforated area in the right cornea accompanied by adjacent corneal melting and diffuse punctate epithelial keratopathy were observed. The anterior chamber was flat. Intraoperatively, a 7×2.5 mm-diameter corneal patch graft was fashioned manually; its thickness was reduced and placed over the perforated area, successfully sealed the cornea, a partial bipedicle conjunctival flap was also applied over the graft, and lateral tarsorrhaphy was performed. Four weeks after surgery, Corrected Distance Visual Acuity (CDVA) improved to Counting Finger (CF) 20 cm. The lamellar corneal patch graft was intact without a leak, and the conjunctival flap was partially removed retracted. Corneal perforation can occur in patients with severe exposure to keratopathy, and corneal patch graft is a good option when a sizeable corneal perforation (≥3 mm diameter) is not amenable to corneal gluing.
Evaluating the anatomic variations and location of the mental foramen is essential for preventing damages to the branches of the mental nerve during dental implants placement and other surgical procedures. The mental foramen commonly lies at the apices of the mandibular premolars. This foramen may lie in the canine anterior segment or the posterior first molar area in only 1-2% of cases. This report presents a case with a rare mental foramen position identified in cone beam computed tomography (CBCT).
Posterior Cortical Atrophy (PCA) is a rare neuropsychiatric syndrome characterized by the dominancy of visuospatial impairments due to bilateral parieto-occipital divesting with the most common pathological changes presented in typical Alzheimer’s Disease (AD). We reported 3 cases with similar diagnoses and interesting manifestations in this study. Gradual onset and progression of visual deficits without underlying ophthalmologic disease accompanied by intact memory and fluent speech and also the presence of simultagnosia, optic ataxia, oculomotor apraxia, dyscalculia, finger agnosia, and environmental disorientation, and the absence of any history of related diseases; all of them strongly suggesting posterior cortical atrophy.
Myeloid Sarcoma (MS) or extramedullary myeloid tumor is a rare tumor affecting the skin, lymph node, and any part of the body except the bone marrow. MS may present differently depending on the site of involvement. A 61-year-old male with a known case of chronic myeloid leukemia presented to the emergency department of a district hospital with per rectal bleeding for two days. Examination revealed haematochezia with no evidence of rectal tumor. Hyperleukocytosis was noted from the blood investigation. Colonoscopy was performed, which revealed the rectosigmoid tumor. Histopathological examination confirmed the diagnosis of myeloid sarcoma. The patient was subsequently referred to a hematologist in a tertiary hospital for further care. MS may present a diagnostic challenge as it may present nonspecific symptoms depending on the site of involvement. Awareness of this condition is essential; thus, diagnosis and treatment can be initiated earlier.
Tracheal injuries are relatively rare; however, their mortality rate is relatively high. Complete disruption of the trachea is extremely rare, and a systematic approach is required for early diagnosis and favorable outcomes. This is a case report of a 17-year-old male admitted to the emergency room after a motor vehicle accident. He was agitated and in respiratory distress with labored breathing and urgently intubated orotracheally. In the first flexible bronchoscopy, the diagnosis of the tracheal transaction was missed. Due to saturation drop and high peak ventilator pressures on the seventh day, the flexible bronchoscopy examination was performed in the operating room. This measure revealed complete tracheal transection in midportion. Neck exploration demonstrated complete tracheal transection. The area was debrided, and primary end-to-end anastomosis was performed. The patient was extubated at the end of the surgery.
Primary Malignant Melanoma of the Esophagus (PMME) is an aggressive tumor with a median survival of about 13 months. Surgical extirpation is the only treatment for PMME. The most common clinical presentation is the onset of progressive dysphagia. Endoscopy presents a polypoid lesion occasionally in the middle and lower third of the esophagus. Definitive diagnoses are based on pathology and immunohistochemical examination with positive results for S-100, Human Melanoma Black (HMB)-45, and Melanoma-specific Antigen (Melan-A) proteins. We presented a 46-year-old man complaining of dysphagia and melena from the past two months. Gasteroesophagoscopy demonstrated a large polypoid in the lower third of the esophagus extending to the cardia. Histopathology of the biopsy specimen from the esophagus revealed positive staining for S-100, Human Melanoma Black (HMB)-45, and Melanoma-specific Antigen (Melan A) proteins that were all compatible with malignant melanoma of the esophagus. The patient underwent surgery followed by radiotherapy and Immunotherapy. The postoperative period was uneventful. No metastasis and recurrence was observed after more than 6 months of initial treatment. PMME is a rare but highly aggressive tumor. The diagnosis of PMME should be made by clinical symptoms, auxiliary examination, pathological examination, and immunohistochemistry markers. The problem of exact diagnosis at the early stages of the disease and effective treatment is still a challenge.
Seyed Farshad Allameh
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