Stent angioplasty of narrowed portocaval shunt in Budd Chiari syndrome: a case report

Yellow nail syndrome in anti-SSA and anti-SSB positive primary Sjögren's syndrome

Yellow nail syndrome (YNS) is a rare, acquired condition, characterised by at least two of the three clinical criteria: nail changes, respiratory tract disease and lymphoedema. Currently, the aetiology of YNS remains unknown; however, it is believed to be caused by impaired lymphatic drainage. Currently, there remain no definitive treatment options available and no prospective trials evaluating this. Management includes supportive care and symptomatic treatment. The presence of YNS has been described alongside various conditions, including autoimmune diseases, malignancies and drug exposures. To strengthen the literature on this topic, we present the case of a female patient with a history of anti-SSA and anti-SSB positive primary Sjögren's syndrome, who developed YNS in the immediate postpartum period.

Retropharyngeal abscess with mediastinal extension - A mausoleum of mumps: A case report

Introduction

Retropharyngeal abscess is a fatal infection that is uncommon, yet serious, especially in young children below 5 years. Oropharyngeal infections, in particular, can cause it as a complication of upper respiratory infections. They can also lead to respiratory depression and acute upper airway blockage and other complications.

Case presentation

The unusual case of large retropharyngeal abscess in a 2-year-old child, secondary to mumps infection who presented to us with impending airway compromise is reported.

Discussion

Retropharyngeal abscess secondary to mumps is a rare occurrence.The child initially had a bilateral parotid enlargement with fever and upper respiratory tract infection, which was diagnosed clinically as mumps by primary care physician and later confirmed by IgM antibody testing. The child was initially treated conservatively as the symptoms were mild at the beginning, however, the child worsened progressively and presented o our institute with acute retropharyngeal abscess in stridor. Emergency tracheostomy and intraoral abscess drainage were done under general anesthesia followed by appropriate intravenous antibiotics therapy.

Conclusion

A dramatic recovery was observed following the treatment approach. Although it is rare to see such a large RPA in this antibiotic era, it is imperative to maintain a high index of suspicion.

Spontaneous Coronary Sinus Thrombosis in a Patient With Pulmonary Embolism and No Prior Cardiac Instrumentation

•Spontaneous CS thrombosis is a rare condition. •High clinical suspicion is needed to diagnose spontaneous CS thrombosis. •Heart instrumentation may cause CS thrombosis.

Should asymptomatic small anteriorly located midline prostatic cyst in young adults be treated surgically or conservatively? A case report and review of the literature

Background

Prostatic cysts are uncommon, typically asymptomatic and discovered by chance during imaging. Prostatic cysts in the midline are less prevalent and primarily seen in the posterior aspect of the prostate.

Case presentation

We describe a case of a 32-year-old man with a complaint of left loin pain and a little sensation of pelvic discomfort. Ultrasound was done revealing small pelvic cystic structure related to urinary bladder base and neck with possibility to be prostatic in origin. Transrectal ultrasound and pelvic magnetic resonance imaging were done and showed an anteriorly located midline prostatic cyst protruding into the bladder lumen, with no communication with the urethra on conventional ascending urethrogram.

Conclusion

The rare relationship between the cyst, bladder neck, and prostate make this case to some extent unique and further interesting. To our best knowledge, this is the eighth documented case in the literature to describe an anteriorly located midline intraprostatic cyst projecting at the bladder neck and base with illustration of different plans of treatment.

Dermatologic Symptoms and Syndromes Associated with Headache

PURPOSE OF REVIEW

Headache disorders are often accompanied by associated symptoms involving organ systems other than the central and peripheral nervous system, including the integumentary, cardiovascular, and musculoskeletal system. However, skin changes or conditions are not commonly associated with headache disorders. Recognition of possible etiologies of headache in patients with bruising, rash, or neurocutaneous disorders can help guide workup and management. The purpose of this article is to review the various dermatologic presentations associated with headache.

RECENT FINDINGS

Multiple review articles and retrospective studies have noted the association between head pain with dermatologic changes including ecchymoses, inflammatory skin conditions, and neurocutaneous disorders. Postulated mechanisms include activation of the trigeminal autonomic system and involvement of similar pro-inflammatory molecules. In this review, we discuss three different classes of rashes including ecchymoses, inflammatory skin conditions, and neurocutaneous disorders, all of which have been associated with migraine and/or headache. We discuss the possible underlying pathophysiology and treatment options.

The management of appendicular abscesses in a Tunisian Tertiary Care Hospital

Background

This study aims to describe the epidemiological, clinical, and radiological features of appendicular abscesses, compare the different approaches, and assess the safety and utility of laparoscopy in its management.

Methods

This descriptive retrospective study was carried out over 3 years extending from January 2017 to December 2019, reporting 150 appendicular abscesses cases. Data were collected from the register of the general surgery department B of the Rabta hospital. Cases with appendicular abscess were included. Files concerning patients with early appendicitis, non-appendicular abscesses or generalized appendicular peritonitis were excluded. Data were analysed with Statistical Package for the Social Sciences (SPSS) software. In univariate analysis, we used the chi² test, the Fischer test, the Student t test. The factors retained by the univariate analysis were introduced into a logistic regression model. The significance level was set to 0.05.

Results

The mean age was 40.51 years. The gender ratio in patients with appendicular abscesses was M:F 1.94:1. Pain in the right iliac fossa associated with fever was the most common symptom (78% of cases). Clinical examination showed tenderness in the right iliac fossa in 38% of cases, rebound and guarding were found in 77 patients (51.3%), and a palpable mass was noted in 4 cases (4.2%). Imaging was done to confirm diagnosis; 46 patients underwent ultrasonogram and this confirmed the diagnosis in 26 patients (56%), while among the 71 patients who underwent CT abdomen confirmatory diagnosis was made in 65 patients (91.55%). An appendectomy was performed in 148 patients (98.6%) via laparoscopic approach in 94 patients, open Mac burney procedure in 32 cases (21.3%) and midline incision in 24 cases (16%). Two patients had an ileocecal resection. The appendix was most commonly located retrocecally (55.3%) in our cohort. The laparoscopic approach was performed in 94 patients (62.6%), and we had to convert in 44 patients due to dissection difficulties (46.8%). Among patients who underwent laparascopic approach 7 had developed peritonitis.. There were only 2 deaths. The mortality rate was 0,013%. The median duration of outpatient followup was 6 months (4–24 weeks) and was uneventful.

Conclusion

Appendicular abscess is a disease of young adults more common in men. Location of the appendix in our case series was mostly retroceacal. Laparoscopy was associated with good outcomes; peritonitis was uncommon and mortality was rare. The laparoscopic approach is a safe surgical technique for treating appendicular abscess and it can be considered as the routine approach for this condition In developing countries with limited technical resources, laparoscopy guarantees the absence of recurrence, reduces healthcare costs and decreases the risk of treating a severe disease conservatively.

Morphological Modification of Carbon Nanoparticles after Interacting with Methotrexate as a Potential Anticancer Agent

PURPOSE

Production of highly penetrable and targetable drug delivery particles is mainly focused by current therapy and such focus is achieved in our present study. The carbon nanoparticle (CNP) prepared from purely natural source was modified from spherical shape to cylindrical floral like structure after treatment with the anticancer drug methotrexate (CM).

METHODS

The physiochemical properties of the CNP and CM was characterized using FT-IR/Raman Spectrometer, XRD, SEM, AFM, particle size analyzer and its biological evaluation using haemolysis and MTT assay.

RESULTS

The shift in FT-IR peaks at 1592, 1120 cm^-1 and peaks of raman spectra observed at 1303, 1300 cm^-1 represents ordered carbon nanotubes. The morphological change from spherical to cylindrical floral like structure was observed using SEM and AFM and its particle size distribution analysis shows an average diameter of 269 nm for CM. XRD peak at 2θ = 23.86° (002) indicates the presence of large amount of amorphous material that corresponds to multi-walled carbon nanotubes. Haemocompatibility studies proved the safety level usage as 100 μg/ml and MTT assay shows viability rate of 85-98% with mouse embryonic fibroblast (NIH/3 T3) and 30-45% with pancreatic carcinoma (MIA PaCa-2) and gastric cancer cell lines (SNU- 484) respectively.These results are also supported by phase contrast microscope images observed after staining with calcein AM and EthD-1.

CONCLUSIONS

The morphologically modified CNPs has shown good anticancer, biocompatibility and haemocompatibility property which is an important criterion to be satisfied by a biomedical product.

Bilateral rectal sheath hematomas after low-molecular weight heparin treatment in uremia

Rectus sheath hematomas (RSHs) are uncommon. They are usually unilateral and rarely bilateral. In this paper, we report the first case of spontaneous bilateral RSHs in a uremic patient after the administration of the first dose of low-molecular weight heparin during hemodialysis. The most interesting aspect of this case is that the main symptom of RSH in our patient was urinary bladder irritation. We highlight the importance of the prompt diagnosis and management of this medical emergency.

Unusual diagnosis in a patient with minor ankle trauma

We present the case of a 23 year-old male who sustained an anterior tibial artery pseudoaneurysm after an apparently innocuous soccer injury. The patient presented with sudden onset severe pain and swelling one week after the injury. The diagnosis was made using duplex ultrasound, and confirmed with CT angiography. Definitive management consisted of endovascular platinum microcoiling. One year later, the patient is asymptomatic and remains active. A review of the epidemiology, diagnosis, and treatment of arterial pseudoaneurysm is presented. Bedside ultrasound in the emergency department may be a useful adjunct in the early identification of pseudoaneurysms.