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[Relationship between designated hyperferritinemia and hemophagocytic lymphohistiocytosis].
Tibial tuberosity fractures are usually seen in the adolescent age group and are very rare in adults. Here we describe a case of knee injury following a road traffic accident. The patient had tibial tuberosity avulsion along with tibial plateau fracture. He was treated with open surgical reduction and internal fixation. His rehabilitation was quite successful, resulting in a good range of motion and functional outcome. This study aims to present this unusual case of tibial tuberosity avulsion fracture associated with tibial plateau fracture and its appropriate management.Splenic injury is an uncommon complication following a colonoscopy procedure. Splenic laceration typically presents with post-procedural abdominal pain. We present a case of non-specific shoulder pain, following an uneventful routine colonoscopy and highlight the importance of maintaining a high degree of clinical suspicion for the general gastroenterologist.Meningiomas are the most common benign intracranial tumors. They often require surgical resection and postoperative radiation/chemotherapy based on their histologic grade. While necrosis caused by preoperative embolization and spontaneous tumor infarction is appreciated by pathologists when staging meningiomas, intraoperative events including large bore artery occlusion may also alter the histopathologic picture of a benign meningioma. Hence, they should be considered when signs of unexpected ischemia and necrosis are found, as these same phenotypes are also hallmarks of a higher-grade disease. We describe a case of a man with a large ventral foramen magnum meningioma who underwent temporary intraoperative occlusion of the vertebral artery, leading to ischemic tumor necrosis with abundant neutrophil invasion when the tumor was eventually examined histologically.Non-functional, extra-adrenal, retroperitoneal paraganglioma is a rare, neuroendocrine, and potentially malignant tumor. Its diagnosis and treatment may be challenging. A 69-year-old female patient was admitted because of a left para-aortic, solid, 4.4-cm mass, incidentally discovered during abdominal ultrasonography for screening purposes. Her clinical examination was unremarkable. Preoperative differential diagnosis based on cross-sectional imaging included tumor of neuroendocrine or mesenchymal origin. Hormonal investigation with 24-hour urinary catecholamines and metanephrines and plasma-fractionated metanephrines was in the normal range. Following consultation with the endocrinologist and anesthesiologist, the tumor was removed by using the three-dimensional (3D) laparoscopic transperitoneal surgical approach. The perioperative course was uneventful and the patient was discharged on the third postoperative day. Histopathologic findings were consistent with the diagnosis of retroperitoneal extra-adrenal paraganglioma of 5 cm in maximum diameter.Introduction To determine the spectrum of diseases and the level of clinicopathological concordance in skin biopsies received over a period of one year. Methods A total of 2216 skin biopsy cases received over a period of one year at a tertiary care center were retrospectively analyzed. The cases were further divided into further categories in levels of concordance based on the agreement between the clinical and histopathological diagnosis rendered. Results Of the cases, 61.01% showed clinicopathological concordance. Cases with a descriptive pathological diagnosis, not matching the clinical diagnosis, constituted 31.54%, whereas 4.02% of cases had a definitive pathological diagnosis, which was discordant with the clinical differentials; 3.29% biopsies were inadequate. Conclusion This study highlights the clinicopathological concordance in all the biopsies received from dermatology. It emphasizes the importance of skin biopsies in arriving at the diagnosis. However, it is a tool that must be used judiciously. Skin biopsies are also pivotal in flagging malignancies that may mimic benign lesions.Lung ultrasound (LUS) is a dynamic, real-time, non-invasive bedside tool that offers increased sensitivity over standard imaging modalities in identifying pulmonary edema. This case highlights acute post-operative hypoxia secondary to pulmonary edema that was initially missed by chest radiography (CXR) and chest computed tomography (CT). The edema was diagnosed first on same day by bedside LUS, later seen on next day follow-up CXR and resolved with diuresis. LUS has demonstrated superior accuracy compared to CXR, but scant evidence compares it to CT. This case presentation serves to increase awareness of LUS as a highly sensitive and easy-to-use diagnostic tool for hospital providers in the evaluation of acute hypoxia.Transarterial chemoembolization (TACE) is a generally well-tolerated and safe procedure that is increasingly being used in the management of intermediate-stage hepatocellular carcinoma (HCC). Tumor rupture is a rare major complication of TACE. Predisposing factors for tumor rupture include large tumor size and peripherally located tumors; in cases of HCC in cirrhosis secondary to autoimmune hepatitis (AIH), tumor rupture may occur more frequently because of the phenomenon of peliosis that occurs in AIH leading to higher propensity to rupture. Management of tumor rupture can be surgical or conservative depending on the individual case. We describe the first documented case of tumor rupture post-TACE in a patient with AIH cirrhosis and HCC.Identifying drugs that can mitigate dispersal of glioblastoma cells, particularly after patients undergo radiotherapy and concomitant chemotherapy, may increase the length of time to recurrence and improve overall survival. Previous studies have shown that dexamethasone (Dex), a drug currently used to treat brain tumor-related edema, which is tapered immediately after the edema has resolved, induces fibronectin matrix assembly (FNMA) and reduces dispersal of primary human glioblastoma multiforme (GBM) cells in vitro and ex vivo. Here, we utilized an in vivo mouse retina dispersal assay to demonstrate that Dex also inhibits dispersal in vivo. We show that 1) Dex significantly reduces z-axis penetration of glioblastoma cells into mouse retina; 2) treatment alters the morphology of dispersal; 3) without Dex, the presence of fibronectin increases dispersal; 4) treatment activates in vivo FNMA by glioblastoma cells, leading to the containment of the tumor mass; and 5) Dex-mediated activation of FNMA is fibronectin dose-dependent. Dispersal inhibition could be achieved at human equivalent doses as low as 1 mg/day, a dose significantly lower than currently used to reduce edema. This is the first step towards future studies in which patients can be potentially maintained on low-dose dexamethasone therapy with the aim of increasing the time between initial resection and recurrence.Cryptococcosis is an opportunistic fungal infection found in both immunocompromised and non-immunocompromised patients; however, it is particularly prevalent in those with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS). Patients with isolated pulmonary cryptococcosis can present with heterogeneous symptoms. The rarity of this entity makes it difficult to recognize and diagnose. We present a case of a 54-year-old female with poorly controlled HIV and seizure disorder, who presented with suspected seizures. Her CD4 count was 7. Due to fever and headache, cryptococcal meningitis was suspected, and she was empirically started on liposomal amphotericin and flucytosine. Computed tomography (CT) of the head was negative for any acute intracranial process. Serum cryptococcal antigen was positive; however cerebrospinal fluid (CSF) studies from lumbar puncture (LP) were entirely negative, including CSF cryptococcal antigen. CT thorax demonstrated interval development of two solid pulmonary nodules in the right upper lobe (RUL). There was no other evidence of disseminated cryptococcal disease. CT-guided biopsy of the larger RUL was compatible with Cryptococcus species. Fungal cultures of sputum and blood were negative. The patient improved, and therapy was de-escalated from liposomal amphotericin and flucytosine to oral fluconazole, with a plan to complete a six- to twelve-month course of therapy. This case illustrates that in rare cases, Cryptococcal disease may still be localized despite having a positive serum Cryptococcal antigen. Alexidine It also emphasizes the importance of a thorough investigation with multimodal diagnostic tools to evaluate for disseminated Cryptococcal disease, especially in those with a history of immunocompromise.Aneurysmal subarachnoid hemorrhage is a life-threatening event that can cause permanent disability. This life-threatening event can be further complicated by subsequent cardiac and pulmonary disability. The presence of a neurogenic cardiomyopathy and pulmonary edema increases the morbidity and mortality of patients who suffer from aneurysmal subarachnoid hemorrhage. In this paper, we discuss a 39-year-old woman who presented to the emergency department (ED) with a chief complaint of a pounding headache with associated nausea and vomiting for the past three days. She had a past medical history significant only for migraines. During her stay in the ED, she began to exhibit signs of altered consciousness, hemoptysis, and respiratory compromise. Neuroimaging showed evidence of subarachnoid hemorrhage. The exact source of her subarachnoid hemorrhage could not be located with neuroimaging or angiography. Her clinical course was complicated by pulmonary edema and neurogenic stunned myocardium, and is still ongoing.Introduction The aim of this study is to evaluate whether pregnancy rates or semen parameters are affected due to male or female age after microsurgical varicocelectomy. Methods A total of 293 infertile men who underwent microsurgical inguinal varicocelectomy were divided into three groups according to age group 1, patients and their spouses ≥35 years old (n = 46); group 2, patients ≥35 years old and their spouses less then 35 years old (n = 34); and group 3, patients and their spouses less then 35 years old (n = 213). Preoperative and postoperative semen parameters and pregnancy rates were compared. Results The median ages of the patients in groups 1, 2, and 3 were 41, 35.50, and 28 years, respectively. The median ages of the spouses were 36 (35-38 years), 30 (21-34 years), and 25 (18-32 years) years, in groups 1, 2, and 3, respectively. Total motile sperm count (TMC) significantly increased in all groups after varicocelectomy (P less then 0.05). Pregnancy rates after varicocelectomy was higher in group 3 compared to groups 2 and 3, but the differences were not significant (P = 0.133). Conclusions According to these results we can say that male and female ages were not negative factors in terms of pregnancy rates.In recent literature, mucoceles have been discovered to be in the appendix vermiformis or in the nasal sinuses. Although rare, colonic mucoceles, as well as rectal mucoceles, have also been encountered. Furthermore, colonic mucoceles arising from a diverticulum is an even more unusual occurrence, and to date, there has been only one reported case. We present a 48-year-old male with a past medical history of multiple episodes of diverticulitis who presented to the emergency department complaining of bilateral lower quadrant abdominal pain for three days. Upon arrival to the emergency department, the patient had a CT scan of the abdomen and pelvis, which showed an annular constricting 65 mm mass in the proximal sigmoid causing large bowel obstruction. The patient underwent unsuccessful endoscopies and inevitably underwent a hand-assisted laparoscopic sigmoid resection. The following days, the biopsy returned and resulted to be a mucocele arising from a sigmoid diverticulum. We encountered the very first benign colonic mucocele arising from a sigmoid diverticulum.
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