Pub Date : 2013-09-01DOI: 10.13172/2052-0077-2-8-790
S. Sagar, B. Singhal, V. Kumar, C. Singh, D. Raj
Introduction Situs inversus totalis represents a rare congenital anomaly in which the thoracic and abdominal viscera are transposed to the opposite side through the sagittal plane. It often occurs concomitantly with other disorders that present a challenge for making the diagnosis and management of abdominal pathology. The relationship between situs inversus totalis and cancer remains unclear. This study reports a rare case of adenocarcinoma of the gall bladder in a patient with situs inversus totalis. Case report We report a first clinical case of a 50-year-old man with situs inversus totalis with adenocarcinoma of gall bladder, which was successfully treated with surgery and doing well with no evidence of local recurrence or metastasis during six months of follow-up. Conclusion The occurrence of gall bladder adenocarcinoma in a patient with situs inversus totalis accounts as a very rare occurrence, as no case is reported till date. In this context, when the tumour is resectable, surgical management should be considered and must be preceded by a careful preoperative staging and full adaptation to the mirror image anatomy.
{"title":"Adenocarcinoma of gall bladder in a patient with situs inversus totalis: a very rare clinical case","authors":"S. Sagar, B. Singhal, V. Kumar, C. Singh, D. Raj","doi":"10.13172/2052-0077-2-8-790","DOIUrl":"https://doi.org/10.13172/2052-0077-2-8-790","url":null,"abstract":"Introduction Situs inversus totalis represents a rare congenital anomaly in which the thoracic and abdominal viscera are transposed to the opposite side through the sagittal plane. It often occurs concomitantly with other disorders that present a challenge for making the diagnosis and management of abdominal pathology. The relationship between situs inversus totalis and cancer remains unclear. This study reports a rare case of adenocarcinoma of the gall bladder in a patient with situs inversus totalis. Case report We report a first clinical case of a 50-year-old man with situs inversus totalis with adenocarcinoma of gall bladder, which was successfully treated with surgery and doing well with no evidence of local recurrence or metastasis during six months of follow-up. Conclusion The occurrence of gall bladder adenocarcinoma in a patient with situs inversus totalis accounts as a very rare occurrence, as no case is reported till date. In this context, when the tumour is resectable, surgical management should be considered and must be preceded by a careful preoperative staging and full adaptation to the mirror image anatomy.","PeriodicalId":19393,"journal":{"name":"OA Case Reports","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78855203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-09-01DOI: 10.13172/2052-0077-2-10-804
H. Phillip, A. Okewole
Introduction As obstetricians, gynaecologists and urogynaecologists, anecdotally, we routinely see patients who complain of symptoms of urinary tract infections but have repeated clean catch urinary specimen remaining sterile, yet they respond positively to a short course of antibiotics. Sometimes, the response is sustained, on other occasions, the response is short-lived, but the response is usually satisfying to the patient. Surely, this cannot simply be the result of the known placebo effect. This paper makes a case for lowdose broad spectrum oral antibiotics in a pregnant patient with recurrent urethral pain syndrome. Case report We performed an extensive English language electronic search in the following databases: Medline, Embasse, Amed, Cinahl, Pubmed, Cochrane library and Trip; and did some search using the following search terms: urethral syndrome, urethral diseases in pregnancy, urologic diseases aetiology, presentation, treatment, outcome and therapeutics from 1951 to 2012. We found a paper by Baerheim and colleagues, who observed that there is equal symptomatic outcome after antibacterial treatment of acute lower urinary tract infection and the acute urethral syndrome in adult women. Their work did not include pregnant patients. Emboldened by the strength of the findings by Baerheim et al. and our observations in a case of a 24-yearold gravid female with recurrent episodes of urethral syndrome, which subsided when she was placed on low-dose oral co-amoxiclav, but rebounded leading to urinary retention when the antibiotic was discontinued; we make a case for low-dose oral antibiotics in a pregnant patient with recurrent urethral syndrome. Conclusion Since this is only a case report, it restricts us from making generalised statements, we would suggest that consideration be given to the use of broad-based antibiotics excreted by the kidneys in pregnant patients presenting with the urethral pain syndrome.
{"title":"Recurrent urethral pain syndrome in a pregnant patient: a case for low-dose broad spectrum oral antibiotics","authors":"H. Phillip, A. Okewole","doi":"10.13172/2052-0077-2-10-804","DOIUrl":"https://doi.org/10.13172/2052-0077-2-10-804","url":null,"abstract":"Introduction As obstetricians, gynaecologists and urogynaecologists, anecdotally, we routinely see patients who complain of symptoms of urinary tract infections but have repeated clean catch urinary specimen remaining sterile, yet they respond positively to a short course of antibiotics. Sometimes, the response is sustained, on other occasions, the response is short-lived, but the response is usually satisfying to the patient. Surely, this cannot simply be the result of the known placebo effect. This paper makes a case for lowdose broad spectrum oral antibiotics in a pregnant patient with recurrent urethral pain syndrome. Case report We performed an extensive English language electronic search in the following databases: Medline, Embasse, Amed, Cinahl, Pubmed, Cochrane library and Trip; and did some search using the following search terms: urethral syndrome, urethral diseases in pregnancy, urologic diseases aetiology, presentation, treatment, outcome and therapeutics from 1951 to 2012. We found a paper by Baerheim and colleagues, who observed that there is equal symptomatic outcome after antibacterial treatment of acute lower urinary tract infection and the acute urethral syndrome in adult women. Their work did not include pregnant patients. Emboldened by the strength of the findings by Baerheim et al. and our observations in a case of a 24-yearold gravid female with recurrent episodes of urethral syndrome, which subsided when she was placed on low-dose oral co-amoxiclav, but rebounded leading to urinary retention when the antibiotic was discontinued; we make a case for low-dose oral antibiotics in a pregnant patient with recurrent urethral syndrome. Conclusion Since this is only a case report, it restricts us from making generalised statements, we would suggest that consideration be given to the use of broad-based antibiotics excreted by the kidneys in pregnant patients presenting with the urethral pain syndrome.","PeriodicalId":19393,"journal":{"name":"OA Case Reports","volume":"114 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77143115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-09-01DOI: 10.13172/2052-0077-2-9-794
A. Jain, S. Viswanath
Introduction Infections in diabetics are common. Some infections like necrotizing fasciitis are known to affect the diabetic lower limb and rapidly spread to affect the entire limb. Gas gangrene, whether clostridial or non-clostridial, is a serious and often a limband lifethreatening infection with a very high mortality rate. Non-clostridial gas gangrene is a relatively rare entity. This article describes a rare case of non-clostridial gas gangrene of the diabetic lower limb with peripheral vascular disease. Case report A 43-year-old male presented to our emergency department with a history of pain in his left lower limb for the past 10 days. The patient was fortunate to survive but ended up in bilateral major lower-limb amputation. According to us, this is the irst rare case reported from India. Conclusion Non-clostridial gas gangrene is rare in literature and its occurrence in diabetic lower limbs with peripheral vascular disease is extremely rare.
{"title":"Non-clostridial gas gangrene in diabetic lower limbs with peripheral vascular disease","authors":"A. Jain, S. Viswanath","doi":"10.13172/2052-0077-2-9-794","DOIUrl":"https://doi.org/10.13172/2052-0077-2-9-794","url":null,"abstract":"Introduction Infections in diabetics are common. Some infections like necrotizing fasciitis are known to affect the diabetic lower limb and rapidly spread to affect the entire limb. Gas gangrene, whether clostridial or non-clostridial, is a serious and often a limband lifethreatening infection with a very high mortality rate. Non-clostridial gas gangrene is a relatively rare entity. This article describes a rare case of non-clostridial gas gangrene of the diabetic lower limb with peripheral vascular disease. Case report A 43-year-old male presented to our emergency department with a history of pain in his left lower limb for the past 10 days. The patient was fortunate to survive but ended up in bilateral major lower-limb amputation. According to us, this is the irst rare case reported from India. Conclusion Non-clostridial gas gangrene is rare in literature and its occurrence in diabetic lower limbs with peripheral vascular disease is extremely rare.","PeriodicalId":19393,"journal":{"name":"OA Case Reports","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89270431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-09-01DOI: 10.13172/2052-0077-2-11-814
Andoulo Ankouane, Medjo Olinga, H. Hadja, R. Djapa, N. Ndjitoyap
Abstract Introduction To the best of our knowledge, other than tuberculosis, tracheo-oesophageal fistula complicates oesophageal ulcers and has been rarely reported. Tracheo-oesophageal fistula, secondary to AIDS-defining infectious diseases and neoplasia, is regressing since the introduction of highly active antiretroviral therapy. It occurs as a complication of tuberculosis of the digestive tract and airways. Other infections causing deep oesophageal ulcers include cytomegalovirus, herpes simplex virus type 2 and HIV. Several studies have reported resistances of HIV1 to many antiretroviral drugs, making the occurrence of opportunistic gastrointestinal disease possible in patients treated with such drugs, particularly in the severely immunodepressed. The outcome is generally poor in the absence of treatment with an average survival rate of one to six weeks. This paper reports a case of tracheo-oesophageal fistula in a highly active antiretroviral therapy patient with AIDS. Case report We are reporting the case of a 43-year-old Cameroonian man, who was type 1 HIV-infected, classified CDC stage C3. He has been on treatment for about 10 years and on combination therapy for about six months. He presented with cough during swallowing, odynophagia and weight loss, complicating a medically treated tracheo-oesophageal fistula, whose outcome was poor. Conclusion Despite the various antiretroviral regimens available in developing countries, HIV-related digestive diseases remain a challenge with poor prognosis due to other limited therapeutic options. The diagnosis of tracheo-oesophageal fistula should be considered in the context of persistent cough during swallowing in patients with AIDS.
{"title":"Tracheo-esophageal fistula in highly active antiretroviral therapy patient with AIDS","authors":"Andoulo Ankouane, Medjo Olinga, H. Hadja, R. Djapa, N. Ndjitoyap","doi":"10.13172/2052-0077-2-11-814","DOIUrl":"https://doi.org/10.13172/2052-0077-2-11-814","url":null,"abstract":"Abstract Introduction To the best of our knowledge, other than tuberculosis, tracheo-oesophageal fistula complicates oesophageal ulcers and has been rarely reported. Tracheo-oesophageal fistula, secondary to AIDS-defining infectious diseases and neoplasia, is regressing since the introduction of highly active antiretroviral therapy. It occurs as a complication of tuberculosis of the digestive tract and airways. Other infections causing deep oesophageal ulcers include cytomegalovirus, herpes simplex virus type 2 and HIV. Several studies have reported resistances of HIV1 to many antiretroviral drugs, making the occurrence of opportunistic gastrointestinal disease possible in patients treated with such drugs, particularly in the severely immunodepressed. The outcome is generally poor in the absence of treatment with an average survival rate of one to six weeks. This paper reports a case of tracheo-oesophageal fistula in a highly active antiretroviral therapy patient with AIDS. Case report We are reporting the case of a 43-year-old Cameroonian man, who was type 1 HIV-infected, classified CDC stage C3. He has been on treatment for about 10 years and on combination therapy for about six months. He presented with cough during swallowing, odynophagia and weight loss, complicating a medically treated tracheo-oesophageal fistula, whose outcome was poor. Conclusion Despite the various antiretroviral regimens available in developing countries, HIV-related digestive diseases remain a challenge with poor prognosis due to other limited therapeutic options. The diagnosis of tracheo-oesophageal fistula should be considered in the context of persistent cough during swallowing in patients with AIDS.","PeriodicalId":19393,"journal":{"name":"OA Case Reports","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81876965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-09-01DOI: 10.13172/2052-0077-2-10-806
Nayak B Satheesha, N. Kumar, R. Srinivasa, D. Reghunathan, J. Patil, R. Swamy
Introduction Ligamentum teres hepatis, an embryological remnant derived from the obliterated left umbilical vein is lodged on the fissure for the ligamentum teres on the inferior surface of the liver. We report here an anomalous case where the ligament passed through a tunnel instead of a fissure. Case report The fissure for ligamentum teres was obliterated by bridging of liver tissue across the quadrate and left lobes. This bridging converted the fissure into a tunnel through which ligamentum teres coursed to its destination. A small fissure extended from the left end of porta hepatis to this tunnel. Lack of separation of lobes, in the early embryonic period might have led to this variation. Conclusion Anomalies like this can often mislead the radiologists or surgeons either in diagnosis or interpretations of liver diseases.
{"title":"Tunnel for ligamentum teres: a rare variation of the liver","authors":"Nayak B Satheesha, N. Kumar, R. Srinivasa, D. Reghunathan, J. Patil, R. Swamy","doi":"10.13172/2052-0077-2-10-806","DOIUrl":"https://doi.org/10.13172/2052-0077-2-10-806","url":null,"abstract":"Introduction Ligamentum teres hepatis, an embryological remnant derived from the obliterated left umbilical vein is lodged on the fissure for the ligamentum teres on the inferior surface of the liver. We report here an anomalous case where the ligament passed through a tunnel instead of a fissure. Case report The fissure for ligamentum teres was obliterated by bridging of liver tissue across the quadrate and left lobes. This bridging converted the fissure into a tunnel through which ligamentum teres coursed to its destination. A small fissure extended from the left end of porta hepatis to this tunnel. Lack of separation of lobes, in the early embryonic period might have led to this variation. Conclusion Anomalies like this can often mislead the radiologists or surgeons either in diagnosis or interpretations of liver diseases.","PeriodicalId":19393,"journal":{"name":"OA Case Reports","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86209312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-09-01DOI: 10.13172/2052-0077-2-9-800
F. Caobelli, F. Magli, C. Pizzocaro, F. Terragnoli, U. Guerra
Introduction An osteomyelitis may be difficult to diagnose by conventional imaging methods; nuclear medicine imaging can detect a lesion in the very early stages, highlighting the metabolic changes preceding structural ones. We present a case of Salmonella os- teomyelitis in a 26-year-old woman, involving the distal epiphysis of the right femur. Case report The involvement usually affects a single joint, but also vertebrae or any other bones can be involved; frequently, an osteomyelitis caused by Salmonella is associated with par- ticular pathological conditions like immunodepression due to corticos- teroid treatment, systemic lupus ery- thematosus, renal transplantation, sickle cell disease or pre-existing joint disease 4 . The pathology in im- munocompetent adults is usually due to the ingestion of contaminated food products 2 . The onset of such pathology in young patients, in the absence of sig- nificant anamnestic data, can hardly be recognised, although a prompt and correct diagnosis is absolutely necessary. Conventional imaging suffers from lack of specificity, especially at the ear- ly stage of the disease. Conversely, nu- clear medicine imaging can be useful for diagnosing and monitoring Salmo- nella bone lesions, giving more infor- mation than conventional imaging 5,6 .
{"title":"Nuclear medicine techniques: a better weapon in detecting a rare case of epiphyseal osteomyelitis caused by Salmonella in a patient without sickle cell disease","authors":"F. Caobelli, F. Magli, C. Pizzocaro, F. Terragnoli, U. Guerra","doi":"10.13172/2052-0077-2-9-800","DOIUrl":"https://doi.org/10.13172/2052-0077-2-9-800","url":null,"abstract":"Introduction An osteomyelitis may be difficult to diagnose by conventional imaging methods; nuclear medicine imaging can detect a lesion in the very early stages, highlighting the metabolic changes preceding structural ones. We present a case of Salmonella os- teomyelitis in a 26-year-old woman, involving the distal epiphysis of the right femur. Case report The involvement usually affects a single joint, but also vertebrae or any other bones can be involved; frequently, an osteomyelitis caused by Salmonella is associated with par- ticular pathological conditions like immunodepression due to corticos- teroid treatment, systemic lupus ery- thematosus, renal transplantation, sickle cell disease or pre-existing joint disease 4 . The pathology in im- munocompetent adults is usually due to the ingestion of contaminated food products 2 . The onset of such pathology in young patients, in the absence of sig- nificant anamnestic data, can hardly be recognised, although a prompt and correct diagnosis is absolutely necessary. Conventional imaging suffers from lack of specificity, especially at the ear- ly stage of the disease. Conversely, nu- clear medicine imaging can be useful for diagnosing and monitoring Salmo- nella bone lesions, giving more infor- mation than conventional imaging 5,6 .","PeriodicalId":19393,"journal":{"name":"OA Case Reports","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75382453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-09-01DOI: 10.13172/2052-0077-2-10-810
P. Shetty, Nayak B Satheesha, D'souza, R. Thangarajan, Gayathri S Prabhu
Introduction The arch of the aorta is situated in the superior mediastinum and it normally branches into three: the brachiocephalic trunk, left common carotid artery, and the left subclavian artery. Variations in its morphology and branching pattern are mainly due to the errors in its embryologic development. Here, we report concurrent variation in the morphology and branching pattern of the aortic arch. Case report The first branch of the aortic arch was a common trunk which divided into the brachiocephalic trunk and the left common carotid artery. There was a constriction in the aortic arch immediately to the left of this common trunk. The left vertebral artery arose from the aortic arch, dorsolateral to the origin of the left subclavian artery. At the root of the neck, the left vertebral artery passed behind the first thoracic and inferior cervical sympathetic ganglia. Conclusion Knowledge of these variations may be very useful to surgeons involved in the cervical and thoracic sympathectomies, vascular surgeries, and cardiac catheterization procedures.
{"title":"Variation in the morphology and branching pattern of the aortic arch: A case report","authors":"P. Shetty, Nayak B Satheesha, D'souza, R. Thangarajan, Gayathri S Prabhu","doi":"10.13172/2052-0077-2-10-810","DOIUrl":"https://doi.org/10.13172/2052-0077-2-10-810","url":null,"abstract":"Introduction The arch of the aorta is situated in the superior mediastinum and it normally branches into three: the brachiocephalic trunk, left common carotid artery, and the left subclavian artery. Variations in its morphology and branching pattern are mainly due to the errors in its embryologic development. Here, we report concurrent variation in the morphology and branching pattern of the aortic arch. Case report The first branch of the aortic arch was a common trunk which divided into the brachiocephalic trunk and the left common carotid artery. There was a constriction in the aortic arch immediately to the left of this common trunk. The left vertebral artery arose from the aortic arch, dorsolateral to the origin of the left subclavian artery. At the root of the neck, the left vertebral artery passed behind the first thoracic and inferior cervical sympathetic ganglia. Conclusion Knowledge of these variations may be very useful to surgeons involved in the cervical and thoracic sympathectomies, vascular surgeries, and cardiac catheterization procedures.","PeriodicalId":19393,"journal":{"name":"OA Case Reports","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72946967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-09-01DOI: 10.13172/2052-0077-2-10-809
Nayak B Satheesha, S. Shetty, Sirasanagandla Srinivasa Rao, R. Swamy, N. Kumar, R. Jetti, P. Abhinitha
Introduction The left kidney is supplied by the left renal artery, which is a branch of the abdominal aorta and drained by left renal vein, which is a tributary of the inferior vena cava. This article reports a case of morphological and vascular variations of the left kidney. Case report During dissection classes for medical undergraduates, we observed morphological and vascular variations of the left kidney in a male cadaver aged approximately 65 years. Hilum of the left kidney was situated on the medial half of its anterior surface. The left renal artery made a prominent downward curve at its origin and then coursed upward and to the left. It divided into two major branches before entering the kidney. The left renal vein had two divisions: an upper and a lower. The upper division was formed by a union of two veins, and the lower division was a single vein. The upper division and lower division had a crisscross arrangement before they united to form a single vein. Conclusion Knowledge of the morphological and vascular variations of the kidney reported here is of importance to urologists, radiologists, endocrinologists and surgeons.
{"title":"Morphological and vascular variations of the left kidney: a case report","authors":"Nayak B Satheesha, S. Shetty, Sirasanagandla Srinivasa Rao, R. Swamy, N. Kumar, R. Jetti, P. Abhinitha","doi":"10.13172/2052-0077-2-10-809","DOIUrl":"https://doi.org/10.13172/2052-0077-2-10-809","url":null,"abstract":"Introduction The left kidney is supplied by the left renal artery, which is a branch of the abdominal aorta and drained by left renal vein, which is a tributary of the inferior vena cava. This article reports a case of morphological and vascular variations of the left kidney. Case report During dissection classes for medical undergraduates, we observed morphological and vascular variations of the left kidney in a male cadaver aged approximately 65 years. Hilum of the left kidney was situated on the medial half of its anterior surface. The left renal artery made a prominent downward curve at its origin and then coursed upward and to the left. It divided into two major branches before entering the kidney. The left renal vein had two divisions: an upper and a lower. The upper division was formed by a union of two veins, and the lower division was a single vein. The upper division and lower division had a crisscross arrangement before they united to form a single vein. Conclusion Knowledge of the morphological and vascular variations of the kidney reported here is of importance to urologists, radiologists, endocrinologists and surgeons.","PeriodicalId":19393,"journal":{"name":"OA Case Reports","volume":"80 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85585751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-09-01DOI: 10.13172/2052-0077-2-8-791
B. Douraiswami, S. Thanigai
Introduction Monoarticular presentation of rheumatoid arthritis is infrequent and it usually occurs in the hip and knee joints. We report such a case in a 70-year-old male with monoarticular rheumatoid arthritis of the left wrist. Case report A 70-year-old male patient presented with pain and restriction of movements of his left wrist. Radiographs showed lytic lesions in distal radius and carpal bones, concentric reduction of wrist joint space and periarticular osteoporosis. Erythrocyte sedimentation rate and C-reactive protein were elevated. Rheumatoid factor was negative. Uric acid levels were normal. Joint aspirate culture was negative. Anti-citrullinated cyclic peptide was strongly positive. Following treatment using diseasemodifying anti-rheumatic drugs, patient improved signi icantly. Conclusion Our case did not have the classical features of rheumatoid arthritis. Monoarticular presentation of rheumatoid arthritis is rare, of which isolated wrist involvement is even rarer. Rheumatoid arthritis should be considered in the differential diagnoses of monoarticular arthritis, and anticitrullinated cyclic peptide should be used more frequently to diagnose rheumatoid arthritis in doubtful cases.
{"title":"Monoarticular rheumatoid arthritis of the wrist: a rare entity","authors":"B. Douraiswami, S. Thanigai","doi":"10.13172/2052-0077-2-8-791","DOIUrl":"https://doi.org/10.13172/2052-0077-2-8-791","url":null,"abstract":"Introduction Monoarticular presentation of rheumatoid arthritis is infrequent and it usually occurs in the hip and knee joints. We report such a case in a 70-year-old male with monoarticular rheumatoid arthritis of the left wrist. Case report A 70-year-old male patient presented with pain and restriction of movements of his left wrist. Radiographs showed lytic lesions in distal radius and carpal bones, concentric reduction of wrist joint space and periarticular osteoporosis. Erythrocyte sedimentation rate and C-reactive protein were elevated. Rheumatoid factor was negative. Uric acid levels were normal. Joint aspirate culture was negative. Anti-citrullinated cyclic peptide was strongly positive. Following treatment using diseasemodifying anti-rheumatic drugs, patient improved signi icantly. Conclusion Our case did not have the classical features of rheumatoid arthritis. Monoarticular presentation of rheumatoid arthritis is rare, of which isolated wrist involvement is even rarer. Rheumatoid arthritis should be considered in the differential diagnoses of monoarticular arthritis, and anticitrullinated cyclic peptide should be used more frequently to diagnose rheumatoid arthritis in doubtful cases.","PeriodicalId":19393,"journal":{"name":"OA Case Reports","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91085746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-09-01DOI: 10.13172/2052-0077-2-10-811
P. Shetty, Nayak B Satheesha, D'souza, R. Thangarajan, Gayathri S Prabhu
Introduction Intrinsic and extrinsic muscles of the hand show frequent variations. Knowledge of these muscle variations is important during diagnosis and treatment of carpal tunnel syndrome, hand surgery and some plastic surgery procedures. We report here the presence of an anomalous muscle in the hand between the first and second lumbricals. Case report The flexor digitorum superficialis had five tendons and the two lateral-most tendons among them gave origin to this abnormal muscle of the hand. The fleshy belly of the muscle was supplied by a branch of the median nerve. Distally the tendon of the anomalous muscle and most of the lateral tendon of the flexor digitorum superficialis muscle merged with the second tendon of the flexor digitorum superficialis muscle. The common tendon was inserted to the base of the middle phalanx of the index finger. Further, the first lumbrical had two heads: a lateral head and a medial head. The lateral head took its origin from the lateral-most tendon of the flexor digitorum profundus muscle and the medial head took origin from the lateral part of the fleshy belly of the abnormal muscle. Its insertion and nerve supply were normal. Conclusion The abnormal muscle can produce a bulge in the palm and it might compress the median nerve in the carpal tunnel, resulting in carpal tunnel syndrome.
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