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Bonnot Ruget M, Moulin P, Pagan C, Cheillan D, Marmontel O, Raverot G, Benlian P, Di Filippo M. Diagnostic challenge between a frequent polygenic hypocholesterolemia and an unusual Smith Lemli Opitz syndrome related to bi-allelic DHCR7 mutations. Clin Chem Lab Med 2024; 0:cclm-2024-0162. [PMID: 38581293 DOI: 10.1515/cclm-2024-0162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 03/28/2024] [Indexed: 04/08/2024]
Affiliation(s)
- Mathilde Bonnot Ruget
- 26900 Service de Biochimie et Biologie moléculaire, Laboratoire de Biologie Médicale Multi-sites, Hospices Civils de Lyon , Lyon Cedex, France
| | - Philippe Moulin
- CarMen Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, Pierre-Bénite, France
- 26900 Fédération d'endocrinologie, maladies métaboliques, diabète et nutrition, GHE, Hospices Civils de Lyon , Bron Cedex, France
| | - Cécile Pagan
- 26900 Service de Biochimie et Biologie moléculaire, Laboratoire de Biologie Médicale Multi-sites, Hospices Civils de Lyon , Lyon Cedex, France
| | - David Cheillan
- 26900 Service de Biochimie et Biologie moléculaire, Laboratoire de Biologie Médicale Multi-sites, Hospices Civils de Lyon , Lyon Cedex, France
- CarMen Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, Pierre-Bénite, France
| | - Oriane Marmontel
- 26900 Service de Biochimie et Biologie moléculaire, Laboratoire de Biologie Médicale Multi-sites, Hospices Civils de Lyon , Lyon Cedex, France
- CarMen Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, Pierre-Bénite, France
| | - Gerald Raverot
- Lyon 1 University, Villeurbanne, France
- Endocrinology Department, 26900 Reference Center for Rare Pituitary Diseases HYPO, "Groupement Hospitalier Est" Hospices Civils de Lyon , Bron, France
- Inserm U1052, CNRS UMR5286, Cancer Research Center of Lyon, Lyon, France
| | - Pascale Benlian
- Univ. Lille, INSERM, CNRS, CHU Lille, Institut Pasteur de Lille, UMR 1283 - EGID, Lille, France
| | - Mathilde Di Filippo
- 26900 Service de Biochimie et Biologie moléculaire, Laboratoire de Biologie Médicale Multi-sites, Hospices Civils de Lyon , Lyon Cedex, France
- CarMen Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, Pierre-Bénite, France
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KALIAPPAN A, MOTWANI R, CHANDRUPATLA M. Unusual Pattern of Coeliac Trunk and Its Branches: A Cadaveric Study of Two Cases with its Embryological and Clinical Correlation. Medeni Med J 2023; 38:291-295. [PMID: 38148727 PMCID: PMC10759946 DOI: 10.4274/mmj.galenos.2023.63993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/28/2023] [Indexed: 12/28/2023] Open
Abstract
The coeliac trunk, the first anterior branch, often originates at the level of the T12 vertebral body, right below the aortic hiatus, as the first ventral branch of the abdominal aorta. It commonly divides into the left gastric, common hepatic, and splenic arteries. We report a rare variation in the branching pattern and course of branches of the coeliac trunk in two donated female cadavers during routine abdominal dissection. It is essential to understand the coeliac trunk and the distinctions in its origin and branching pattern to perform efficient upper abdominal surgical and radiological procedures and to adopt novel interventional and treatment options for hepatic cancers. As anatomists, we are also attempting to link our study's variations to their embryological genesis.
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Affiliation(s)
- Ariyanachi KALIAPPAN
- All India Institute of Medical Sciences (AIIMS) Bibinagar, Department of Anatomy, Hyderabad, India
| | - Rohini MOTWANI
- All India Institute of Medical Sciences (AIIMS) Bibinagar, Department of Anatomy, Hyderabad, India
| | - Mrudula CHANDRUPATLA
- All India Institute of Medical Sciences (AIIMS) Bibinagar, Department of Anatomy, Hyderabad, India
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3
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Wilkinson ZA, Nathani A, Almeida F, Arrossi AV. All that glitters isn't gold: an unusual case of Pneumocystis jirovecii pneumonia. Histopathology 2023; 83:487-489. [PMID: 37256699 DOI: 10.1111/his.14965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/05/2023] [Accepted: 05/15/2023] [Indexed: 06/02/2023]
Affiliation(s)
| | - Avantika Nathani
- Department of Pulmonary and Critical Care Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Francisco Almeida
- Department of Pulmonary and Critical Care Medicine, Cleveland Clinic, Cleveland, OH, USA
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Luo X, Wang Y, Liu S, Guo T, Han X, Yu G. Unusual spin-orbit torque switching in perpendicular synthetic antiferromagnets with strong interlayer exchange coupling. J Phys Condens Matter 2023; 35:264004. [PMID: 36958042 DOI: 10.1088/1361-648x/acc711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 03/23/2023] [Indexed: 06/18/2023]
Abstract
Synthetic antiferromagnet (SAF) is an outstanding system for controlling magnetic coupling via tuning the layer thickness and material composition. Here, we control the interlayer exchange coupling (IEC) in a perpendicularly magnetized SAF Pt/Co/Ir/CoFeB/MgO multilayer, which is tuned by varying the nonmagnetic layer Ir thickness and the magnetic layer Co thickness. And we study the spin-orbit torque (SOT) driven magnetization switching of the SAF. In the SAF with a weak IEC, the SOT-driven switching behavior is similar to that of a single ferromagnet system, which is dominated by the external magnetic field. In contrast, in the SAF with an ultra-strong IEC, the saturation magnetic field is large than 50 kOe, and the SOT-driven switching behavior is decided by the effective magnetic field. The effective field is correlated to the external magnetic field, the IEC field, magnetic moments of CoFeB and Co, and magnetic anisotropy. These results may advance the understanding of SOT switching of perpendicular SAFs and promote the applications of SAFs with low stray fields and lower power in spintronic devices.
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Affiliation(s)
- Xuming Luo
- Beijing National Laboratory for Condensed Matter Physics, Institute of Physics, Chinese Academy of Sciences, Beijing 100190, People's Republic of China
- Center of Materials Science and Optoelectronics Engineering, University of Chinese Academy of Sciences, Beijing 100049, People's Republic of China
| | - Yuqiang Wang
- Beijing National Laboratory for Condensed Matter Physics, Institute of Physics, Chinese Academy of Sciences, Beijing 100190, People's Republic of China
- Center of Materials Science and Optoelectronics Engineering, University of Chinese Academy of Sciences, Beijing 100049, People's Republic of China
| | - Shiqiang Liu
- Beijing National Laboratory for Condensed Matter Physics, Institute of Physics, Chinese Academy of Sciences, Beijing 100190, People's Republic of China
- Center of Materials Science and Optoelectronics Engineering, University of Chinese Academy of Sciences, Beijing 100049, People's Republic of China
| | - Tengyu Guo
- Songshan Lake Materials Laboratory, Dongguan, Guangdong 523808, People's Republic of China
| | - Xiufeng Han
- Beijing National Laboratory for Condensed Matter Physics, Institute of Physics, Chinese Academy of Sciences, Beijing 100190, People's Republic of China
- Center of Materials Science and Optoelectronics Engineering, University of Chinese Academy of Sciences, Beijing 100049, People's Republic of China
- Songshan Lake Materials Laboratory, Dongguan, Guangdong 523808, People's Republic of China
| | - Guoqiang Yu
- Beijing National Laboratory for Condensed Matter Physics, Institute of Physics, Chinese Academy of Sciences, Beijing 100190, People's Republic of China
- Center of Materials Science and Optoelectronics Engineering, University of Chinese Academy of Sciences, Beijing 100049, People's Republic of China
- Songshan Lake Materials Laboratory, Dongguan, Guangdong 523808, People's Republic of China
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5
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Mathur NP, Silu M. Loosening of Teeth, an Unusual Presentation of Mucormycosis in COVID-19 Infected Patients. Indian J Otolaryngol Head Neck Surg 2023. [PMCID: PMC10031701 DOI: 10.1007/s12070-023-03697-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2023] Open
Abstract
Aim of our study was to report unusual presentation of mucormycosis in patients, who were recovered from COVID-19 infection. This was a prospective observational study, undertaken at Ravindra Nath Tagore Medical College, Udaipur, India, over a period of last 3 months (April-June 2021). All patients with maxillofacial and dental mucormycosis were included in the study. All patients either have COVID-19 infection or recovered from it. Eight (40%) patients had history of use of corticosteroids for COVID1-19 infection, fifteen patients had either known case of diabetes or newly diagnosed diabetes with uncontrolled blood sugar at the time of presentation, three (15%) patients were in pre-diabetic state with HbA1c between 6.0 and 6.5% and two patients had no diabetes. None of patients had diabetic ketoacidosis and only one patient reported complete loss of vision with dental symptoms. There was unusual presentation of mucormycosis in form of loosening of teeth in uncontrolled diabetes. Injudicious use of steroids and uncontrolled diabetes are two main risk factors, so eyes should be kept on both of these.
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Affiliation(s)
- Navneet Prasad Mathur
- Department of Otorhinolaryngology, Ravindra Nath Tagore Medical College, Udaipur, Rajasthan 313001 India
| | - Manju Silu
- Department of Otorhinolaryngology, Ravindra Nath Tagore Medical College, Udaipur, Rajasthan 313001 India
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Sawatkar GU, Sharma A, Keshavamurthy V, Mehta H, Chatterjee D, Narang T, Dogra S. Unusual clinical presentations in leprosy: a case series and review. Trans R Soc Trop Med Hyg 2023:7058784. [PMID: 36846900 DOI: 10.1093/trstmh/trad003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/25/2022] [Accepted: 02/08/2023] [Indexed: 03/01/2023] Open
Abstract
Conventionally, leprosy has been divided into various spectra of presentation ranging from the tuberculoid to the lepromatous pole, as well as histoid, pure neuritic leprosy and reactional states. This however is an oversimplification as leprosy can present in unusual clinical forms that may obfuscate the diagnosis. Our objective was to highlight unusual clinical presentations of leprosy occurring across all spectra of the disease. Our case series describes eight uncommon presentations of leprosy seen over a period of 10 y from 2011 to 2021, wherein clinical diagnosis followed by a histopathological confirmation of leprosy was performed. These include rare presentations such as psoriasiform plaques, Lazarine leprosy, verrucous plaques and hypertrophic scarring. Many of these rare presentations remain hitherto unreported, such as primary hypogonadism and annular plaques mimicking erythema annulare centrifugum and erythema gyratum repens. Sarcoidosis and syphilis have been labeled as great mimickers in dermatology. The current case series and review is an attempt to highlight a multitude of unusual presentations of leprosy that need a separate mention to make a correct and timely diagnosis and prevent the debilitating sequelae of this otherwise treatable infectious disease.
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Affiliation(s)
- Gitesh Upendra Sawatkar
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.,Department of Dermatology, Venereology and Leprology, All India Institute of Medical Sciences, Nagpur, 441108, India
| | - Apoorva Sharma
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Vinay Keshavamurthy
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Hitaishi Mehta
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Debajyoti Chatterjee
- Department of Histopathology; Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Tarun Narang
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Sunil Dogra
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
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Kansay R, Sharma AR, Singhal A, Vashisht S. An Unusual Occurrence of Scaphoid Fracture Fragment in the Volar Compartment of the Forearm: A Case Report with Review of Literature. J Orthop Case Rep 2021; 11:77-79. [PMID: 35415133 PMCID: PMC8930387 DOI: 10.13107/jocr.2021.v11.i12.2576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 10/20/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Scaphoid fractures are common wrist injuries and are commonly missed. Patients present with radial-sided wrist pain. Computed Tomography and Magnetic Resonance Imaging help in better planning, with analysis of comminution, torn ligaments, timely diagnosis, and intricate fixation prevent avascular necrosis, non-union, and carpal collapse. Case Presentation We present a rare scenario of right hand dominant 42 years male with scaphoid waist fracture, where the fracture fragment was unusually displaced 4 cm proximal to the wrist in the volar compartment of the forearm. Urgent open reduction and internal fixation with a Herbert screw was done. At 1 year follow-up, fracture united, with satisfactory range of motion and functional outcomes of the wrist. Conclusion Timely diagnosis and urgent operative intervention for unstable displaced scaphoid fractures with rigid fixation provides long-term satisfactory outcomes and prevents complications.
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Affiliation(s)
- Rajeev Kansay
- Department of Orthopaedics, Government Medical College Hospital, Chandigarh, India
| | - Atul Rai Sharma
- Department of Orthopaedics, Government Medical College Hospital, Chandigarh, India
| | - Akash Singhal
- Department of Orthopaedics, Government Medical College Hospital, Chandigarh, India,Address of Correspondence: Dr. Akash Singhal, Department of Orthopaedics, Government Medical College and Hospital, Chandigarh, India. E-mail:
| | - Saurabh Vashisht
- Department of Orthopaedics, Government Medical College Hospital, Chandigarh, India
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Neelakantan S, Kumaran SP, Viswamitra S, Ghosal N. Myriad of MR imaging phenotypes of primary central nervous system lymphoma in a cohort of immunocompetent Indian patient population. Indian J Radiol Imaging 2021; 28:296-304. [PMID: 30319205 PMCID: PMC6176660 DOI: 10.4103/ijri.ijri_23_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PCNSL (primary central nervous system lymphoma) is a chemosensitive and radiosensitive tumor, and early diagnosis has a significant impact on management. Unlike many other brain tumors, radical surgical excision of PCNSLs is not indicated because these lesions are highly infiltrative and even partial resection leads to a bad prognosis. The goal of this study is to highlight the unusual radiological presentation of PCNSLs and increase the awareness, familiarity, and global database of our observations that pose a challenge on management.
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Affiliation(s)
- Sankar Neelakantan
- Department of Radiology, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, Karnataka, India
| | - Sunitha P Kumaran
- Department of Radiology, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, Karnataka, India
| | - Sanjaya Viswamitra
- Department of Radiology, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, Karnataka, India
| | - Nandita Ghosal
- Department of Pathology, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, Karnataka, India
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Abstract
Over the years the nomenclature of thymomas has been debated regarding the best manner in which these tumors should be grouped. In every schema presented thus far, the main issue has been the presence or lack of lymphocytes and accordingly, the tumors have been place into a specific category. However, even though this concept applies for most of the cases, there are numerous tumors that do not necessarily fit into those categories as either the thymomas show another cellular proliferation associated with the epithelial cells or the epithelial cell themselves are arranged in a pattern that departs from the conventional features of the classic thymoma. Herein we will emphasize those features, which in some circumstances, mainly with small mediastinoscopic biopsies may pose a considerable problem in interpretation. We do consider that the most important issue is to be familiar with the different growth pattern that these tumors may show in order to avoid misdiagnosis. In addition, we consider that regardless of the growth pattern or cellular composition of the tumor, it is highly recommended that these tumors just like any other be carefully sampled and properly stage. Although we are fully aware of the different growth pattern and specific cellular details that thymoma may show, the discussion of each one of those tumors is beyond the scope of this review. Therefore, we have placed more emphasis in those, which in our judgment are more commonly encountered in the daily practice.
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Affiliation(s)
- Diana M Oramas
- Department of Pathology, The University of Texas, M D Anderson Cancer Center, Houston, TX, USA
| | - Cesar A Moran
- Department of Pathology, The University of Texas, M D Anderson Cancer Center, Houston, TX, USA.
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Radhi AS. Uncommon Presentation of COVID-19 With Long Incubation Period and Only Gastrointestinal Symptoms in a Fully Vaccinated Patient: Is There a Relation? Cureus 2021; 13:e16028. [PMID: 34336515 PMCID: PMC8320968 DOI: 10.7759/cureus.16028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 11/29/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a respiratory infectious disease that caused a worldwide pandemic in December 2019. It affected millions of people across the world and forced nations to lockdown their borders and implement curfews to control the spread of the disease. Unusual manifestations of the disease should be reported and be kept in mind among physicians. We report a case of a 33-year-old man who was fully vaccinated with two doses of Pfizer vaccine and presented with fever, epigastric pain, and diarrhea without any respiratory symptoms. The patient had a longer than usual incubation period of 16 days without reporting any signs of respiratory infection for the period of his infection. His laboratory investigations and chest X-ray were all normal. The patient did not require any treatment and his COVID-19 infection lasted for 10 days. Clinicians should understand that post-vaccination COVID-19 cases might present with a longer incubation period than usual and might present with gastrointestinal symptoms as the sole complaint.
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Affiliation(s)
- Ahmed S Radhi
- Internal Medicine, Faculty of Medicine, King Abdulaziz University, Rabigh, SAU
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Shah T, Shakya A. An unusual cause of large bowel obstruction: To keep an open mind. Clin Case Rep 2020; 8:3592-3593. [PMID: 33363993 PMCID: PMC7752416 DOI: 10.1002/ccr3.3292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 08/12/2020] [Indexed: 11/29/2022] Open
Abstract
Enterolithiasis or formation of gastrointestinal concretions is an uncommon medical condition that develops in the setting of intestinal stasis due to various pathologies. Its prevalence ranges upto 10% and can present in different clinical pictures to challenge a clinician.
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Affiliation(s)
- Tuhin Shah
- Department of SurgeryAsia Pacific Medical CollegeBirgunjNepal
| | - Arjana Shakya
- Department of OphthalmologyAsia Pacific Medical CollegeBirgunjNepal
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Douba Z, Sinno JA, Jawish H, Hakim N, Mouselli A, Shihade MB, Abdullah MA, Alhames S. Unusual localizations of hydatid cysts: a rare case report from Syria. J Surg Case Rep 2020; 2020:rjaa438. [PMID: 33133511 PMCID: PMC7588311 DOI: 10.1093/jscr/rjaa438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 09/28/2020] [Indexed: 11/17/2022] Open
Abstract
Hydatid disease (HD) is an infection with the metacestode stage of the tapeworm Echinococcus. It is commonly seen in South America, The Middle East, Eastern Mediterranean, Africa and China. Hydatid cysts usually affect the liver followed by the lungs. Involvement in other organs has been reported. However, in the majority of the cases, cysts are localized in one organ or one region. We report a rare case of a 36-year-old woman who presented to the hospital in Syria with long-standing history of non-specific abdominal pain. Computerized tomography showed several hydatid cysts in the liver, spleen, left lung, mediastinum (adjacent to the aortic arch), both breasts and above the right gluteal muscles.
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Affiliation(s)
- Zain Douba
- Faculty of Medicine, University of Aleppo, Aleppo 15310, Syria
| | - Judy A Sinno
- Department of Dermatology & Venereology, Aleppo University Hospital, Aleppo 15310, Syria
| | - Haya Jawish
- Faculty of Medicine, University of Aleppo, Aleppo 15310, Syria
| | - Nour Hakim
- Faculty of Medicine, University of Aleppo, Aleppo 15310, Syria
| | | | - Mohamad B Shihade
- Department of Thoracic Surgery, Al-Razi Hospital, Aleppo 15310, Syria
| | | | - Samer Alhames
- Department of Thoracic Surgery, St Louis Hospital, Aleppo 15310, Syria
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Kuruvilla N, Rajendran R, Thomas SS, Ali Km I, Kurian S. An Unusual Presentation of Adult-Onset Still's Disease as Hemophagocytic Lymphohistiocytosis in a Male Patient. Cureus 2020; 12:e11139. [PMID: 33240728 PMCID: PMC7682946 DOI: 10.7759/cureus.11139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is an aggressive and potentially fatal condition characterized by immune activation and multi-organ dysfunction. HLH can be inherited in an autosomal recessive fashion, but can also be secondary to infections, malignancy, immunosuppression, and autoimmune conditions. Adult-onset Still’s disease (AOSD) is an autoimmune disorder that can predispose patients to HLH. AOSD, similar to other autoimmune conditions, is more common in females than males. However, the occurrence of AOSD in males and subsequent predisposition to HLH is rarely reported. We report the case of a 23-year-old male patient who presented with fever, joint pain, and rash for 20 days. On evaluation, he fulfilled the diagnostic criteria for AOSD and HLH, and a diagnosis of HLH secondary to AOSD was made. He was treated with pulse dose steroids and gradually tapered. AOSD and HLH have overlapping clinical and laboratory features and hence their co-occurrence poses diagnostic challenges. The mortality rate of HLH is high and hence prompt initiation of treatment is of utmost importance.
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Affiliation(s)
- Neenu Kuruvilla
- Department of Internal Medicine, Government Medical College, Kottayam, IND
| | - Rahul Rajendran
- Department of Internal Medicine, Government Medical College, Kottayam, IND
| | - Shilpa S Thomas
- Department of Internal Medicine, Government Medical College, Kottayam, IND
| | - Irshad Ali Km
- Department of Internal Medicine, Government Medical College, Kottayam, IND
| | - Sheela Kurian
- Department of Internal Medicine, Government Medical College, Kottayam, IND
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14
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Ryan MP, Nguyen AV, Hay MJ, Kelly BC, Raimer SS. Multiple subcutaneous juvenile xanthogranulomas with a blue hue in a neonate: An atypical presentation. JAAD Case Rep 2020; 6:521-3. [PMID: 32490115 DOI: 10.1016/j.jdcr.2020.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Abstract
Intracranial dermoids are rare congenital lesions of the brain that account for < 1% of all intracranial tumors. Even though they are rare, typical computed tomography (CT) scan and magnetic resonance imaging (MRI) features along with location allow radiological diagnosis in the majority of patients. Radiologically, dermoid cysts typically appear as nonenhancing low-density masses on CT scan and are hyperintense on T1-weighted (T1-W) MRI sequences with variable signal on T2-W sequences. We describe two cases of dermoid with unusual imaging appearance with the presence of mural nodule in both the cases. The recognition of atypical radiological features can avoid diagnostic pitfalls and is clinically relevant for overall surgical management.
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Affiliation(s)
| | - Rakshith Srinivasa
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, Karnataka, India
| | - Nandita Ghosal
- Department of Pathology, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, Karnataka, India
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16
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Rajapakse S, Wattegama M, Weeratunga P, Sigera PC, Fernando SD. Beyond thrombocytopaenia, haemorrhage and shock: the expanded dengue syndrome. Pathog Glob Health 2018; 112:404-414. [PMID: 30507366 DOI: 10.1080/20477724.2018.1552645] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Dengue infection classically presents with fever, thrombocytopaenia, and varying degrees of plasma leakage, giving rise to shock. However, a myriad of other manifestations, involving the cardiovascular system, the nervous system, the liver, the kidneys, the gut and the haematological system have been reported in dengue. This review summarizes these varied presentations.
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Affiliation(s)
- Senaka Rajapakse
- a Department of Clinical Medicine, Faculty of medicine , University of Colombo , Colombo , Sri Lanka
| | - Milanka Wattegama
- b Department of Endocrinology , North Colombo Teaching Hospital , Ragama , Sri Lanka
| | - Praveen Weeratunga
- a Department of Clinical Medicine, Faculty of medicine , University of Colombo , Colombo , Sri Lanka
| | - P Chathurani Sigera
- c Department of Parasitology, Faculty of medicine , University of Colombo , Colombo , Sri Lanka
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Boronat S, Barber I. Less common manifestations in TSC. Am J Med Genet C Semin Med Genet 2018; 178:348-354. [PMID: 30156054 DOI: 10.1002/ajmg.c.31648] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/10/2018] [Accepted: 07/17/2018] [Indexed: 12/19/2022]
Abstract
Tuberous sclerosis complex (TSC) is due to pathogenic variants in TSC1 or TSC2 genes resulting in hyperactivation of the mTOR pathway. Many organ systems can be affected, such as brain, skin, eye, heart, bone, kidney, or lung. Typical lesions of TSC usually are those included as major criteria, including angiofibromas, hypomelanotic macules, tubers, subependymal nodules, angiomyolipomas, cardiac rhabdomyomas, and lymphangioleiomyomatosis. However, there are many other manifestations less frequent and/or less well known, many of them not included as clinical diagnostic criteria that are part of the clinical spectrum of TSC. The focus of this review will be on these less common and less well-known manifestations of TSC. Among the rare manifestations, we will discuss some clinical findings including arteriopathy, arachnoid cysts, lymphatic involvement, chordomas, gynecological, endocrine, and gastrointestinal findings. Among the manifestations that are very frequent but much less well known, we find the sclerotic bone lesions. Although they are very frequent in TSC they have been largely overlooked and not considered diagnostic criteria, mainly because they are asymptomatic. However, it is important to know their typical characteristics to avoid misdiagnosing them as metastasis.
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Affiliation(s)
- Susana Boronat
- Department of Clinical Genetics, Hospital Universitari Sagrat Cor, Barcelona, Spain.,Department of Pediatric Neurology, Hospital Quirónsalud Vallès, Sabadell, Spain
| | - Ignasi Barber
- Department of Pediatric Radiology, Hospital San Joan de Déu, Barcelona
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18
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Chakraborty R, Budoo MS, Kerai S. A Case of Unusual Occurrence of Nasogastric Tube Feed Coming Through the Chest Tube in a 27-Year-Old Polytrauma Patient. Indian J Crit Care Med 2018. [PMID: 30111934 DOI: 10.3969/j.issn.2095-252x.2018.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
The provision of early and adequate nutritional support is vital for the successful recovery from the trauma in any form. Nutritional support is enteral unless specified otherwise as dictated by various benefits of the former. Nasogastric tubes provide effective and common mode of enteral feed due to the ease of placement and maintenance. To our knowledge, the late presentation of diaphragmatic hernia with gastric perforation in a trauma patient leading to feed coming through chest tube is very rare of the complications.
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Affiliation(s)
- Raunaq Chakraborty
- Department of Anaesthesiology and Critical Care, Maulana Azad Medical College, New Delhi, India
| | - Mohd Shoaib Budoo
- Department of Anaesthesiology and Critical Care, Maulana Azad Medical College, New Delhi, India
| | - Sukhyanti Kerai
- Department of Anaesthesiology and Critical Care, Maulana Azad Medical College, New Delhi, India
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19
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Chakraborty R, Budoo MS, Kerai S. A Case of Unusual Occurrence of Nasogastric Tube Feed Coming Through the Chest Tube in a 27-Year-Old Polytrauma Patient. Indian J Crit Care Med 2018; 22:547-551. [PMID: 30111934 PMCID: PMC6069308 DOI: 10.4103/ijccm.ijccm_11_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The provision of early and adequate nutritional support is vital for the successful recovery from the trauma in any form. Nutritional support is enteral unless specified otherwise as dictated by various benefits of the former. Nasogastric tubes provide effective and common mode of enteral feed due to the ease of placement and maintenance. To our knowledge, the late presentation of diaphragmatic hernia with gastric perforation in a trauma patient leading to feed coming through chest tube is very rare of the complications.
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Affiliation(s)
- Raunaq Chakraborty
- Department of Anaesthesiology and Critical Care, Maulana Azad Medical College, New Delhi, India
| | - Mohd Shoaib Budoo
- Department of Anaesthesiology and Critical Care, Maulana Azad Medical College, New Delhi, India
| | - Sukhyanti Kerai
- Department of Anaesthesiology and Critical Care, Maulana Azad Medical College, New Delhi, India
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20
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Banda FM, Mutapanduwa MG, Goutam C, Steenhoff A, Joel D. An unusual surgical cause of pyloric stenosis in an 8-month-old infant. Afr J Paediatr Surg 2017; 14:79-82. [PMID: 30688283 PMCID: PMC6369598 DOI: 10.4103/ajps.ajps_118_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Infantile hypertrophic pyloric stenosis (IHPS) is the most common surgical cause of nonbilious, projectile vomiting in children. Its incidence is estimated to be 2-5/1000 live births and has been noted to be quite rare in African-Americans, Asians, and Indians. It is more common in infants under 6 months of age and is quite rare in older infants. While IHPS is invariably intrinsic in nature, extrinsic pyloric stenosis is very rare. Children who present with nonbilious, projectile vomiting after the age of 6 months should, therefore, be thoroughly investigated for causes other than IHPS. This is a case report of an 8-month-old child who had a band of tissue constricting the pylorus which mimicked IHPS.
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Affiliation(s)
- Francis Msume Banda
- Department of Paediatrics and Adolescent Health, Princess Marina Hospital, Gaborone, Botswana
| | - M G Mutapanduwa
- Department of Paediatrics and Adolescent Health, Princess Marina Hospital, Gaborone, Botswana
| | - C Goutam
- Department of Surgery, Princess Marina Hospital, Gaborone, Botswana
| | - A Steenhoff
- Department of Paediatrics and Adolescent Health, Princess Marina Hospital, Gaborone, Botswana
| | - Dipesalema Joel
- Department of Paediatrics and Adolescent Health, Princess Marina Hospital, Gaborone, Botswana
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21
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Albandar HJ, Roberto ES, See JRH, Sabiers JH. Arteriovenous malformation and thyroid metastasis from underlying renal cell carcinoma, an unusual presentation of malignancy: A case report. Oncol Lett 2017; 13:3323-3327. [PMID: 28521439 PMCID: PMC5431183 DOI: 10.3892/ol.2017.5822] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 11/17/2016] [Indexed: 12/21/2022] Open
Abstract
Renal Clear Cell Carcinoma (RCC) comprises over 80% of renal malignancies in adults. Thyroid gland metastasis is rare in RCC. Few studies have described cases of RCC mistaken for benign arteriovenous malformation (AVM). To the best of our knowledge, an AVM arising from underlying RCC metastasis to the brain has not yet been reported. The current study presents a case of RCC metastasis to the thyroid gland, with an AVM identified to be a result of metastatic involvement in the brain. A 45-year-old African-American female presented with left-sided weakness, slurred speech, facial droop and seizure. The patient's medical history was notable for a diagnosis of RCC, 2010 American Joint Committee on Cancer Tumor-Node-Metastasis Stage 1B (T1B, N0, M0) grade III status post-right partial nephrectomy. Computed tomography (CT) imaging revealed a soft-tissue mass, suspected to be metastasis, in the left lobe of the thyroid, in addition to a 1.9 cm right intracranial mass in the parietal lobe. Positron emission tomography/computed tomography revealed a hypermetabolic area in the thyroid. Fine needle aspiration of the thyroid, and subsequent histopathological analysis, suggested a diagnosis of RCC metastasis. Subsequent immunohistochemical analysis of the thyroid tumor confirmed RCC metastasis. The patient also underwent a right partial craniotomy with resection of the intra-axial mass. Initial pathology was suggestive of an AVM. After several months, the patient was readmitted with headache, nausea and vomiting. Repeat imaging revealed recurrence of a 3.9 cm mass that was negative for AVM on biopsy; however, the immunostaining markers were positive for RCC. Recent literature suggests a link between AVMs and RCC as each exhibit highly vascular characteristics. RCC is a particularly vascular tumor that has been demonstrated to lead to the abnormal expression of various angiogenesis-promoting growth factors, including vascular endothelial growth factor. These angiogenic factors are vital to the pathophysiological pathway involved in the tumorigenesis and progression of RCC, and may explain the development of AVMs within these neoplasms, as demonstrated in the case presented in the current study.
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Affiliation(s)
- H J Albandar
- Department of Internal Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH 45409, USA
| | - E S Roberto
- Department of Internal Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH 45409, USA
| | - J R H See
- Division of Hematology Oncology, Wright State University Boonshoft School of Medicine, Dayton, OH 45409, USA
| | - J H Sabiers
- Division of Hematology Oncology, Wright State University Boonshoft School of Medicine, Dayton, OH 45409, USA
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22
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Doering S, Boulet C, Shahabpour M, De Mey J, Demaeseneer M. Unusual CT Appearance of Bony Metastases from Malignant Peripheral Nerve Sheath Tumor. J Belg Soc Radiol 2016; 100:110. [PMID: 30151498 DOI: 10.5334/jbr-btr.1089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We present a case of bone metastases from a malignant peripheral nerve sheath tumor (MPNST). While multiple bone lesions typically are suggestive of metastatic disease, especially in combination with a primary tumor and positive PET, the appearance of lesions in this patient was quite atypical. We are not aware of any case of metastatic disease with such atypical doughnut appearance as in our case.
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Koné S, Gbané-Koné M, Bana A, Touré SA, Kouassi AN, Koffi AG, Eti E, Kouakou NM. [ Unusual multifocal osteoarthritis tuberculosis in an immunocompetent patient]. Pan Afr Med J 2015; 20:212. [PMID: 26113943 PMCID: PMC4470444 DOI: 10.11604/pamj.2015.20.212.6015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 03/03/2015] [Indexed: 12/02/2022] Open
Abstract
Les formes multifocales de la tuberculose, surviennent habituellement chez des sujets immunodéprimés. Dans les formes multifocales, certaines localisations osseuses sont rares. Les auteurs rapportent le cas d'une patiente de 58 ans, immunocompétente qui présentait une tuberculose multifocale associant une atteinte pulmonaire et des localisations osseuses et articulaires inhabituelles (l’épaule, la cheville et le pied homolatéral, la branche illio-pubienne). Le diagnostic a été histologique (biopsie ostéo-articulaire) et bactériologique (mise en évidence des BAAR dans les crachats). Le traitement a été médico-chirurgical.
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Affiliation(s)
- Samba Koné
- Service de Traumato-Orthopédie CHU de Cocody, Abidjan, Côte d'Ivoire
| | | | - Abdoulaye Bana
- Service de Traumato-Orthopédie CHU de Cocody, Abidjan, Côte d'Ivoire
| | | | | | - Akué Gérard Koffi
- Service de Traumato-Orthopédie CHU de Cocody, Abidjan, Côte d'Ivoire
| | - Edmond Eti
- Service de Rhumatologie CHU de Cocody, Abidjan, Côte d'Ivoire
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Shrestha B, Omran A, Rong P, Wang W. Report of a Fatal Pediatric Case of Hemophagocytic Lymphohistiocytosis Associated with Pandemic Influenza A (H1N1) Infection in 2009. Pediatr Neonatol 2015; 56:189-92. [PMID: 23602384 DOI: 10.1016/j.pedneo.2013.03.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 12/08/2012] [Accepted: 03/12/2013] [Indexed: 11/17/2022] Open
Abstract
An acute viral infection may lead to death, as seen in the recent novel 2009 influenza A (H1N1) virus pandemic that rapidly spread worldwide. Hemophagocytic lymphohistiocytosis (HLH) is a systemic disorder with high mortality rates and can be triggered by various etiological agents, including viral infections. H1N1-associated HLH is a very rare condition that may cause extremely severe complications leading to multiple organ failure (MOF) and death. We report an unusual case of a rapidly progressive and fatal H1N1 infection that was complicated with HLH and MOF in a previously healthy 8-year-old Asian female who initially presented with fever and abdominal pain. To enable early recognition and proper treatment, physicians should be aware of the possibility of this fatal complication, which may present with unusual initial symptoms.
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Affiliation(s)
- Biswas Shrestha
- Department of Imaging and Interventional Radiology, The Third Xiang Ya Hospital of Central South University, Changsha, Hunan, China
| | - Ahmed Omran
- Department of Pediatrics, Xiangya Hospital of Central South University, Changsha, Hunan, China; Department of Pediatrics and Neonatology, Suez Canal University, Ismailia, Egypt
| | - Pengfei Rong
- Department of Imaging and Interventional Radiology, The Third Xiang Ya Hospital of Central South University, Changsha, Hunan, China
| | - Wei Wang
- Department of Imaging and Interventional Radiology, The Third Xiang Ya Hospital of Central South University, Changsha, Hunan, China.
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Abstract
Headaches presented with unusual manner like cough, exertion, and sex, poses a diagnostic challenge in the emergency room or primary care provider's office. The majority of these patients have no underlying intracranial pathologic condition and have a good prognosis. Since the pathophysiology is poorly understood, treatment choices are limited. Further research is needed to elucidate the pathophysiologic mechanisms of these uncommon headaches and to assess the cost-effectiveness of various diagnostic and follow-up strategies. This article focuses on eleven unusual headache syndromes, all of which are associated with significant morbidity and mortality.
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26
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Olivier T, Gastaud L, Maschi C, Caujolle JP, Cupissol D, Thariat J. [Metastasis to unusual sites]. Bull Cancer 2014; 101:203-10. [PMID: 24556000 DOI: 10.1684/bdc.2014.1889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Metastases are responsible for the majority of deaths from solid cancers. Metastatic phenomenon, complex, is a multi-step process where interactions between cells and with the microenvironment are essential. The organ tropism, that is the propensity of a cancer to metastasize to specific organs, can be explained by several mechanisms that we have described. Apart from the usual metastases, unusual sites can appear with heterogeneous clinical presentations. We describe known to date mechanisms that can explain these unusual metastasis. A summary of these locations has been realized. A rare location should always be considered in front of any atypical symptom.
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