Pub Date : 2013-05-01DOI: 10.13172/2052-0077-2-4-557
I. Wani
Introduction Though adult intussusception is rare, but it is a well-recognised condition in adults. In adults, intussusception is commonly associated with underlying pathology. While the condition is clinically non-specific, the intestinal obstruction is found to be a common presentation. Ileal lipoma demonstrates as an underlying pathological lead point is thus found to be a rare condition. In this case report, a case of ileo-ileal intussusception, with ileal lipoma demonstrating an underlying pathological lead point, in a 60-year-old female patient is reported. Case Report We present a case of a 60-yearold female patient with pain in her right lower abdomen and nausea that lasted for 2 days. Contrastenhanced computed tomography scan confirmed the diagnosis of intussusception in the patient. Ileal lipoma was the lead point for intussusception that was diagnosed at laparotomy, which is a surgical incision into the abdominal cavity. Conclusion The results show that intussusception in adult is a rare condition. Lipoma, which acts as an underlying pathological lead point, is rarely found. Introduction Intussusception is defined as the invagination of one portion of the bowel into an immediately adjacent portion; the proximal segment of the gastrointestinal tract, or the intussusceptum, is carried within the lumen of an adjacent segment known as the intussuscipiens1. Intussusceptions may be classified as ileocolic, ileocecal, colo-colic and ileo-ileal2. Adult intussusception is relatively a rare and is substantially a different clinical entity from paediatric intussusception3. Most adult intussusceptions are benign and represents 1% of all bowel obstructions, 5% of all intussusceptions and 0.003%–0.02% of all hospital admissions4,5. Adult patients mostly complain of obscure abdominal pain only6. In adults, there is a lack of classical triad of abdominal pain, palpable abdominal mass and passage of ‘red currant jelly’ stools, but these are commonly found in children7. Intestinal lipoma is an uncommon causation of adult intussusception and some lipoma may cause intussusception by acting as the lead point located in the ileum8,9. The diagnosis of intussusception is readily suggested because of its pathognomonic appearance on computed tomography10. This report discusses ileo-ileal intussusception in an adult by lipoma. Case Report We present a case of a 60-year-old female patient with pain in her right lower abdomen and nausea that lasted for 2 days. While the general physical examination was unremarkable, the systemic examination was found to be normal. A vague abdominal mass was palpable in the right lower abdomen as found in individual abdominal examination. There was a slight increase in bowel sounds. On digital rectal examination, the rectum was found to be empty with the presence of rectal ballooning. Plain X-ray abdomen findings showed multiple levels of air fluid. Ultrasound sonography abdomen scans revealed doughnut sign. Contrastenhanced comput
{"title":"Ileo-ileal intussusception in an adult by lipoma","authors":"I. Wani","doi":"10.13172/2052-0077-2-4-557","DOIUrl":"https://doi.org/10.13172/2052-0077-2-4-557","url":null,"abstract":"Introduction Though adult intussusception is rare, but it is a well-recognised condition in adults. In adults, intussusception is commonly associated with underlying pathology. While the condition is clinically non-specific, the intestinal obstruction is found to be a common presentation. Ileal lipoma demonstrates as an underlying pathological lead point is thus found to be a rare condition. In this case report, a case of ileo-ileal intussusception, with ileal lipoma demonstrating an underlying pathological lead point, in a 60-year-old female patient is reported. Case Report We present a case of a 60-yearold female patient with pain in her right lower abdomen and nausea that lasted for 2 days. Contrastenhanced computed tomography scan confirmed the diagnosis of intussusception in the patient. Ileal lipoma was the lead point for intussusception that was diagnosed at laparotomy, which is a surgical incision into the abdominal cavity. Conclusion The results show that intussusception in adult is a rare condition. Lipoma, which acts as an underlying pathological lead point, is rarely found. Introduction Intussusception is defined as the invagination of one portion of the bowel into an immediately adjacent portion; the proximal segment of the gastrointestinal tract, or the intussusceptum, is carried within the lumen of an adjacent segment known as the intussuscipiens1. Intussusceptions may be classified as ileocolic, ileocecal, colo-colic and ileo-ileal2. Adult intussusception is relatively a rare and is substantially a different clinical entity from paediatric intussusception3. Most adult intussusceptions are benign and represents 1% of all bowel obstructions, 5% of all intussusceptions and 0.003%–0.02% of all hospital admissions4,5. Adult patients mostly complain of obscure abdominal pain only6. In adults, there is a lack of classical triad of abdominal pain, palpable abdominal mass and passage of ‘red currant jelly’ stools, but these are commonly found in children7. Intestinal lipoma is an uncommon causation of adult intussusception and some lipoma may cause intussusception by acting as the lead point located in the ileum8,9. The diagnosis of intussusception is readily suggested because of its pathognomonic appearance on computed tomography10. This report discusses ileo-ileal intussusception in an adult by lipoma. Case Report We present a case of a 60-year-old female patient with pain in her right lower abdomen and nausea that lasted for 2 days. While the general physical examination was unremarkable, the systemic examination was found to be normal. A vague abdominal mass was palpable in the right lower abdomen as found in individual abdominal examination. There was a slight increase in bowel sounds. On digital rectal examination, the rectum was found to be empty with the presence of rectal ballooning. Plain X-ray abdomen findings showed multiple levels of air fluid. Ultrasound sonography abdomen scans revealed doughnut sign. Contrastenhanced comput","PeriodicalId":19393,"journal":{"name":"OA Case Reports","volume":"42 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79100293","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 : 2013-05-01DOI: 10.13172/2052-0077-2-4-563
M. Singh, L. Kumar, U. Prashanth, A. Gupta, A. Rao
{"title":"Hepatogastric fistula following amoebic liver abscess: an extremely rare and difficult situation","authors":"M. Singh, L. Kumar, U. Prashanth, A. Gupta, A. Rao","doi":"10.13172/2052-0077-2-4-563","DOIUrl":"https://doi.org/10.13172/2052-0077-2-4-563","url":null,"abstract":"","PeriodicalId":19393,"journal":{"name":"OA Case Reports","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73898504","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 : 2013-05-01DOI: 10.13172/2052-0077-2-4-559
E. Cazzo, Ow Maciel, O. OliveiraNeto, Tl Miolo
Introduction Intestinal obstruction is commonly seen at emergency services but is not usually caused by internal hernias. Herniation through defects of the broad ligament is even rarer. This case report discusses Intestinal obstruction secondary to incarcerated broad ligament hernia. Case report A 39-year-old female without surgical or gynaecological antecedents, presented with small bowel obstruction. Radiograph and a computed tomography scan confirmed obstruction but did not provide a cause. On laparotomy, an incarcerated internal hernia through a broad ligament defect was found and liberated. The patient had an uneventful postoperative evolution. Discussion The authors give a brief literature review and discuss the importance of considering this aetiology in cases of intestinal obstruction in females without surgical antecedents since diagnosis is often difficult. The necessity of early intervention that prevents severe complications is also emphasised. Conclusion Broad ligament hernia is a rare entity that may lead to severe complications. It must be considered as a possible cause of intestinal obstruction in females, and early surgical treatment is mandatory in these cases; it can be carried out through open or laparoscopic approaches. Introduction Intestinal obstruction is a common clinical cause for presentation at an emergency service. The occurrence of small bowel obstruction secondary to internal hernias is an infrequent condition1,2. Internal hernias are caused by the herniation of bowel segments through natural or unnatural openings within the peritoneal cavity. They may be acquired or congenital and persistent or intermittent3. Herniation through defects of the broad ligament of the uterus is even rarer3,4. It is a severe condition due to the risk of strangulation and perforation of the hernial content, even in small hernias4. This case report presents a 39-year-old female with intestinal obstruction secondary to an incarcerated internal hernia through a broad ligament defect.
{"title":"Intestinal obstruction secondary to incarcerated broad ligament hernia: a case report","authors":"E. Cazzo, Ow Maciel, O. OliveiraNeto, Tl Miolo","doi":"10.13172/2052-0077-2-4-559","DOIUrl":"https://doi.org/10.13172/2052-0077-2-4-559","url":null,"abstract":"Introduction Intestinal obstruction is commonly seen at emergency services but is not usually caused by internal hernias. Herniation through defects of the broad ligament is even rarer. This case report discusses Intestinal obstruction secondary to incarcerated broad ligament hernia. Case report A 39-year-old female without surgical or gynaecological antecedents, presented with small bowel obstruction. Radiograph and a computed tomography scan confirmed obstruction but did not provide a cause. On laparotomy, an incarcerated internal hernia through a broad ligament defect was found and liberated. The patient had an uneventful postoperative evolution. Discussion The authors give a brief literature review and discuss the importance of considering this aetiology in cases of intestinal obstruction in females without surgical antecedents since diagnosis is often difficult. The necessity of early intervention that prevents severe complications is also emphasised. Conclusion Broad ligament hernia is a rare entity that may lead to severe complications. It must be considered as a possible cause of intestinal obstruction in females, and early surgical treatment is mandatory in these cases; it can be carried out through open or laparoscopic approaches. Introduction Intestinal obstruction is a common clinical cause for presentation at an emergency service. The occurrence of small bowel obstruction secondary to internal hernias is an infrequent condition1,2. Internal hernias are caused by the herniation of bowel segments through natural or unnatural openings within the peritoneal cavity. They may be acquired or congenital and persistent or intermittent3. Herniation through defects of the broad ligament of the uterus is even rarer3,4. It is a severe condition due to the risk of strangulation and perforation of the hernial content, even in small hernias4. This case report presents a 39-year-old female with intestinal obstruction secondary to an incarcerated internal hernia through a broad ligament defect.","PeriodicalId":19393,"journal":{"name":"OA Case Reports","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84933780","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 : 2013-05-01DOI: 10.13172/2052-0077-2-4-562
F. Singh, Kumar A Singh, Gupta A, Rao Asn Warfarin, M. Singh, U. Prashanth, Ashutosh Kumar, R. Singh, A. Gupta, Asn Rao
Introduction Warfarin-induced skin necrosis is a rare but catastrophic complication of warfarin therapy, ranging in prevalence from 0.01% to 0.1%. This case report discusses a case of warfarininduced skin necrosis. Case report We report the case of an obese, 55-year-old woman who presented with extensive skin necrosis of the left lower limb on the fifth day of warfarin therapy and responded well with early diagnosis and treatment. Discussion Warfarin-induced skin necrosis is the result of a relatively hypercoagulable state produced by warfarin. Warfarin-induced skin necrosis typically occurs in obese, perimenopausal women of around 50 years of age with high loading doses of warfarin. Warfarin-induced skin necrosis typically involves skin and subcutaneous tissue overlying areas with significant adipose tissue, such as the breast, abdomen, thigh or buttocks. It presents within three to six days after beginning therapy. Conclusion Prevention and management of warfarin-induced skin necrosis in a timely manner should be emphasised to prevent permanent tissue damage. A more gradual approach using low initial dose and gradual increase in daily doses is believed to reduce the risk of warfarin-induced skin necrosis. Introduction Warfarin is a very commonly used anticoagulant in medical practice. Warfarin-induced skin necrosis (WISN) is a rare but catastrophic complication of warfarin therapy, ranging in prevalence from 0.01% to 0.1%1,2. Here, we report the case of a 55-year-old woman with WISN. Case report A 55-year-old woman was admitted to the hospital due to pain and swelling of her right leg. Her right lower limb was cold and right leg circumference was 8 cm more that the left one. Her vital parameters were in the normal range. Cardiovascular, respiratory and abdominal examination was normal. The patient had had a right hip fracture 35 days prior to presentation and was under conservative therapy at the time of presentation at our hospital. Colour Doppler ultrasound of the lower limb vessels revealed thrombosis in the right popliteal, superficial, deep and common femoral veins. Parenteral heparin and oral warfarin were started and coagulation tests were performed daily. Warfarin was initiated at a dose of 15 mg on the first day, 10 mg on the second day and 5 mg on the third day. On the third day, the international normalised ratio (INR) was in the normal range and parenteral heparin was discontinued. On the fifth day of warfarin therapy, the patient developed diffused, extremely painful, erythematous skin eruptions in the left lower limb. On the sixth day, the skin began to peel off and the condition progressed to an extensive lesion with severe skin necrosis of the left lower limb (Figure 1). Warfarin was discontinued and intravenous heparin was started. Vitamin K and fresh frozen plasma were also administered. Tests for factor V Leiden, lupus anticoagulant, anticardiolipin and antiphospholipid antibodies were negative. Surgical debridement of the ne
{"title":"Warfarin-induced skin necrosis: a rare but catastrophic complication of warfarin","authors":"F. Singh, Kumar A Singh, Gupta A, Rao Asn Warfarin, M. Singh, U. Prashanth, Ashutosh Kumar, R. Singh, A. Gupta, Asn Rao","doi":"10.13172/2052-0077-2-4-562","DOIUrl":"https://doi.org/10.13172/2052-0077-2-4-562","url":null,"abstract":"Introduction Warfarin-induced skin necrosis is a rare but catastrophic complication of warfarin therapy, ranging in prevalence from 0.01% to 0.1%. This case report discusses a case of warfarininduced skin necrosis. Case report We report the case of an obese, 55-year-old woman who presented with extensive skin necrosis of the left lower limb on the fifth day of warfarin therapy and responded well with early diagnosis and treatment. Discussion Warfarin-induced skin necrosis is the result of a relatively hypercoagulable state produced by warfarin. Warfarin-induced skin necrosis typically occurs in obese, perimenopausal women of around 50 years of age with high loading doses of warfarin. Warfarin-induced skin necrosis typically involves skin and subcutaneous tissue overlying areas with significant adipose tissue, such as the breast, abdomen, thigh or buttocks. It presents within three to six days after beginning therapy. Conclusion Prevention and management of warfarin-induced skin necrosis in a timely manner should be emphasised to prevent permanent tissue damage. A more gradual approach using low initial dose and gradual increase in daily doses is believed to reduce the risk of warfarin-induced skin necrosis. Introduction Warfarin is a very commonly used anticoagulant in medical practice. Warfarin-induced skin necrosis (WISN) is a rare but catastrophic complication of warfarin therapy, ranging in prevalence from 0.01% to 0.1%1,2. Here, we report the case of a 55-year-old woman with WISN. Case report A 55-year-old woman was admitted to the hospital due to pain and swelling of her right leg. Her right lower limb was cold and right leg circumference was 8 cm more that the left one. Her vital parameters were in the normal range. Cardiovascular, respiratory and abdominal examination was normal. The patient had had a right hip fracture 35 days prior to presentation and was under conservative therapy at the time of presentation at our hospital. Colour Doppler ultrasound of the lower limb vessels revealed thrombosis in the right popliteal, superficial, deep and common femoral veins. Parenteral heparin and oral warfarin were started and coagulation tests were performed daily. Warfarin was initiated at a dose of 15 mg on the first day, 10 mg on the second day and 5 mg on the third day. On the third day, the international normalised ratio (INR) was in the normal range and parenteral heparin was discontinued. On the fifth day of warfarin therapy, the patient developed diffused, extremely painful, erythematous skin eruptions in the left lower limb. On the sixth day, the skin began to peel off and the condition progressed to an extensive lesion with severe skin necrosis of the left lower limb (Figure 1). Warfarin was discontinued and intravenous heparin was started. Vitamin K and fresh frozen plasma were also administered. Tests for factor V Leiden, lupus anticoagulant, anticardiolipin and antiphospholipid antibodies were negative. Surgical debridement of the ne","PeriodicalId":19393,"journal":{"name":"OA Case Reports","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90271151","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 : 2013-05-01DOI: 10.13172/2052-0077-2-4-561
S. Nayak, A. Aithal, R. Melanie, A. Guru, Naveen Kumar
Introduction: Knowledge of variations regarding the formation, termination and tributaries of the portal vein, superior mesenteric vein and splenic vein are very useful and of utmost importance for surgeons performing surgeries of the pancreas and duodenum. Normally, the jejunal veins are the tributaries of the superior mesenteric vein. We report here, a very unusual case where two proximal jejunal veins drained into the splenic vein instead of the superior mesenteric vein. Case Report: During the dissection classes for undergraduate medical students, we noted variations in the termination of the upper jejunal veins in an adult male cadaver who was approximately 65 years old. We found that the union of three veins formed the portal vein: the splenic vein, jejunal veins and the superior mesenteric vein. Conclusion: Familiarity with such anatomical variation provides useful information for surgeons performing abdominal surgical procedures.
{"title":"Unusual jejunal tributaries of the splenic vein and their surgical importance: a case report","authors":"S. Nayak, A. Aithal, R. Melanie, A. Guru, Naveen Kumar","doi":"10.13172/2052-0077-2-4-561","DOIUrl":"https://doi.org/10.13172/2052-0077-2-4-561","url":null,"abstract":"Introduction: \u0000Knowledge of variations regarding the formation, termination and tributaries of the portal vein, superior mesenteric vein and splenic vein are very useful and of utmost importance for surgeons performing surgeries of the pancreas and duodenum. Normally, the jejunal veins are the tributaries of the superior mesenteric vein. We report here, a very unusual case where two proximal jejunal veins drained into the splenic vein instead of the superior mesenteric vein. \u0000Case Report: \u0000During the dissection classes for undergraduate medical students, we noted variations in the termination of the upper jejunal veins in an adult male cadaver who was approximately 65 years old. We found that the union of three veins formed the portal vein: the splenic vein, jejunal veins and the superior mesenteric vein. \u0000Conclusion: \u0000Familiarity with such anatomical variation provides useful information for surgeons performing abdominal surgical procedures.","PeriodicalId":19393,"journal":{"name":"OA Case Reports","volume":"41 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80309491","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 : 2013-04-01DOI: 10.13172/2052-0077-2-3-555
S. Nayak, S. Shetty, Naveen Kumar, S. Sirasanagandla
Introduction: Abnormalities of the dural folds are very rare. Knowledge about the abnormalities of dural folds is important for neurosurgeons and neuroradiologists as these folds might result in bleeding during the suboccipital approach to the brain and also in misinterpretations during the imaging of the posterior cranial fossa. We report the duplication of falx cerebelli and presence of a large meningeal artery in the posterior cranial fossa. Case Report: During the routine brain removal dissection for the undergraduate medical students, the following variations were noted in the posterior cranial fossa of an adult male cadaver aged approximately 70 years. The right and left falces were of equal length (35 mm). The gap between the two falces was broadest anteriorly and measured 15 mm, whereas the narrowest part of the gap was in the middle and measured 10 mm. The occipital sinus was plexiform and was situated in the midline between the two falces. It terminated by opening into the left sigmoid sinus. Meningeal branch of the right occipital artery was unusually large and it entered the posterior cranial fossa through the right jugular foramen. After a course of about 4 cm in the posterior cranial fossa it divided into the right and left branches. It was accompanied by two venae comitantes. Conclusion: The knowledge of the variations observed in the current case may be of use in radiological and neurosurgical procedures.
{"title":"Double falx cerebelli, single occipital sinus and an unusually large meningeal artery in the posterior cranial fossa: a case report","authors":"S. Nayak, S. Shetty, Naveen Kumar, S. Sirasanagandla","doi":"10.13172/2052-0077-2-3-555","DOIUrl":"https://doi.org/10.13172/2052-0077-2-3-555","url":null,"abstract":"Introduction: \u0000Abnormalities of the dural folds are very rare. Knowledge about the abnormalities of dural folds is important for neurosurgeons and neuroradiologists as these folds might result in bleeding during the suboccipital approach to the brain and also in misinterpretations during the imaging of the posterior cranial fossa. We report the duplication of falx cerebelli and presence of a large meningeal artery in the posterior cranial fossa. \u0000Case Report: \u0000During the routine brain removal dissection for the undergraduate medical students, the following variations were noted in the posterior cranial fossa of an adult male cadaver aged approximately 70 years. The right and left falces were of equal length (35 mm). The gap between the two falces was broadest anteriorly and measured 15 mm, whereas the narrowest part of the gap was in the middle and measured 10 mm. The occipital sinus was plexiform and was situated in the midline between the two falces. It terminated by opening into the left sigmoid sinus. Meningeal branch of the right occipital artery was unusually large and it entered the posterior cranial fossa through the right jugular foramen. After a course of about 4 cm in the posterior cranial fossa it divided into the right and left branches. It was accompanied by two venae comitantes. \u0000Conclusion: \u0000The knowledge of the variations observed in the current case may be of use in radiological and neurosurgical procedures.","PeriodicalId":19393,"journal":{"name":"OA Case Reports","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88678255","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 : 2013-04-01DOI: 10.13172/2052-0077-2-3-554
N. Sood, Js Nigam
Abstract Introduction Keratoacanthomas are rapidly growing cutaneous tumours, which usually resolve leaving an atrophic scar. The term ‘giant keratoacan-thoma’ is applied to a lesion greater than 2–3 cm in diameter. This case report discusses squamous cell carci-noma-like giant keratoacanthoma with delayed presentation in a known case of xeroderma pigmentosum. Case report A 50-year-old female patient, a known case of xeroderma pigmen-tosum, presented with a large, dome-shaped, crateriform lesion over her right cheek that had persisted for the last four months. Histological exami-nation showed an exophytic lesion with a large central keratin-filled crater surrounded by deep bulbous nodules of proliferating squamous cells that had abundant keratin with a lip of normal epidermis. The demar-cation was discrete except for tiny foci of deep infiltration at the periphery. However, immunohistochemistry for p53 revealed strong positivity only in the basal layer of the infiltrating islands, weak Ki-67 and desmoglein positivity, along with down regula-tion of Bcl-2 and E-cadherin. Follow-up for 18 months did not reveal any site recurrence or metastasis.
{"title":"Squamous cell carcinoma-like giant keratoacanthoma with delayed presentation in a known case of xeroderma pigmentosum","authors":"N. Sood, Js Nigam","doi":"10.13172/2052-0077-2-3-554","DOIUrl":"https://doi.org/10.13172/2052-0077-2-3-554","url":null,"abstract":"Abstract Introduction Keratoacanthomas are rapidly growing cutaneous tumours, which usually resolve leaving an atrophic scar. The term ‘giant keratoacan-thoma’ is applied to a lesion greater than 2–3 cm in diameter. This case report discusses squamous cell carci-noma-like giant keratoacanthoma with delayed presentation in a known case of xeroderma pigmentosum. Case report A 50-year-old female patient, a known case of xeroderma pigmen-tosum, presented with a large, dome-shaped, crateriform lesion over her right cheek that had persisted for the last four months. Histological exami-nation showed an exophytic lesion with a large central keratin-filled crater surrounded by deep bulbous nodules of proliferating squamous cells that had abundant keratin with a lip of normal epidermis. The demar-cation was discrete except for tiny foci of deep infiltration at the periphery. However, immunohistochemistry for p53 revealed strong positivity only in the basal layer of the infiltrating islands, weak Ki-67 and desmoglein positivity, along with down regula-tion of Bcl-2 and E-cadherin. Follow-up for 18 months did not reveal any site recurrence or metastasis.","PeriodicalId":19393,"journal":{"name":"OA Case Reports","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81850816","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 : 2013-04-01DOI: 10.13172/2052-0077-2-3-553
M. Bolognesi, P. Barbier, D. Bolognesi
A 43-year-old man, who was an elite triathlete, was referred to our sports medical centre for pre-participation screening and abilitation in the triathlon competition. This athlete has been active in racing triathlon and long distance cycling competitions for the last 10 years. His family history revealed no known congenital or other cardiovascular disease and no known causes of premature sudden cardiac death among close relatives. He had no relevant past medical history and physical examination was unremarkable. Peripheral blood pressure was 110/70 mmHg. Resting 12-lead electrocardiogram showed a sinus bradycardia and incomplete right bundle block. The cycloergometre and treadmill maximal exercise test showed a good performance and absence of any electrocardiographic abnormality, with a peak cycling workload of 330 watt, 15 METS on the treadmill Astrand protocol and a maximal heart rate of 165–170 bpm. Twodimensional trans-thoracic echocardiogram demonstrated a left atrium divided into two compartments by an incomplete membrane appearing in an incomplete thin diaphragm in all echocardiographic windows (Figures 1, 2 and 3). The mitral valve appeared slightly dysplastic with mild regurgitation. Pulmonary artery pressure was estimated to be 25 mmHg. Hence, the filling pressure was not elevated and the athlete was asymptomatic. Suspected diagnosis of nonobstructive cor triatriatum sinister was performed. Subsequently, a two-dimensional echocardiogram
{"title":"Incidental echocardiographic fi nding of non-obstructive cor triatriatum in a healthy triathlete","authors":"M. Bolognesi, P. Barbier, D. Bolognesi","doi":"10.13172/2052-0077-2-3-553","DOIUrl":"https://doi.org/10.13172/2052-0077-2-3-553","url":null,"abstract":"A 43-year-old man, who was an elite triathlete, was referred to our sports medical centre for pre-participation screening and abilitation in the triathlon competition. This athlete has been active in racing triathlon and long distance cycling competitions for the last 10 years. His family history revealed no known congenital or other cardiovascular disease and no known causes of premature sudden cardiac death among close relatives. He had no relevant past medical history and physical examination was unremarkable. Peripheral blood pressure was 110/70 mmHg. Resting 12-lead electrocardiogram showed a sinus bradycardia and incomplete right bundle block. The cycloergometre and treadmill maximal exercise test showed a good performance and absence of any electrocardiographic abnormality, with a peak cycling workload of 330 watt, 15 METS on the treadmill Astrand protocol and a maximal heart rate of 165–170 bpm. Twodimensional trans-thoracic echocardiogram demonstrated a left atrium divided into two compartments by an incomplete membrane appearing in an incomplete thin diaphragm in all echocardiographic windows (Figures 1, 2 and 3). The mitral valve appeared slightly dysplastic with mild regurgitation. Pulmonary artery pressure was estimated to be 25 mmHg. Hence, the filling pressure was not elevated and the athlete was asymptomatic. Suspected diagnosis of nonobstructive cor triatriatum sinister was performed. Subsequently, a two-dimensional echocardiogram","PeriodicalId":19393,"journal":{"name":"OA Case Reports","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82267507","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 : 2013-04-01DOI: 10.13172/2052-0077-2-3-523
C. Augustatou, G. Tziris, C. Glynos
Abstract Introduction Haemoptysis is always an alarming symptom but a rather rare event in the recovery ward following an uneventful regional anaesthesia. The aim of this case report is to highlight all possible causes of haemoptysis in an anaesthetist’s daily practice, and to emphasize that tuberculosis is one of the possible causes of haemoptysis and a re-emerging disease. Case Report A young male patient, heavy smoker, submitted for emergency surgery, presented massive haemoptysis after uneventful regional anaesthesia. He was admitted to the ICU and discharged 48 h later. Initial diagnosis was lidocaineinduced cardiomyopathy. He received anti-tuberculosis treatment based on a positive Mantoux test. He completely recovered a year later. Conclusion Since tuberculosis is a re-emerging disease, preoperative evaluation should be more careful.
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Pub Date : 2013-03-01DOI: 10.13172/2052-0077-2-3-508
O. Ng, S. Thong
Case report: We report a case of 36 years-old primigravida at 34 weeks of gestation with known temporal lobe epilepsy, who was brought in by ambulance with tonic clonic seizure of more than 30 minutes duration. In view of her high blood pressure and seizure we decided to treat her as eclampsia and performed emergency caesarean section, as she was seizure free for the past 11 years. The women received treatment according to our hospital guideline for eclampsia to lower her blood pressure and underwent emergency operation under general anaesthetic. She was transferred to ITU, extubated the same day with no adverse outcome and the baby admit ted to special care unit. Discussion: Well controlled epilepsy may improve or even deteriorate during pregnancy(1). Usually women with poorly controlled epilepsy can get worse during pregnancy. Dif ferentiation between seizures caused by epilepsy or due to eclampsia is important as the management dif fers for both. In such situations patients should be treated as eclampsia unless otherwise proved(2). But uncontrolled seizures caused by either are detrimental to baby and will need delivering. In our patient as she had status like seizure on presentation with high blood pressure we had to treat her as eclampsia and treat accordingly. When her blood results were available, she had normal LFT’s and platelets which is one of the diagnostic feature against eclampsia. References: 1. Calderwood C, Nelson-Piercy C, Medical disorders complicating pregnancy. Anaesthes Intensive Care Med 2004;5(8):256-263 2. Wee L, Sinha P, Lewis M. The management of eclampsia by obstetric anaesthetists in UK: a postal survey.Int J Obstet Anesth. 2001;10(2):108-112 Learning points: Dif ferentiation between seizures caused by epilepsy or due to eclampsia in an acute situation is dif ficult. It is important to dif ferntiate between these conditions, as the management dif fers for both. In such situations patients should be treated as eclampsia unless otherwise proved.
病例报告:我们报告一例36岁的孕34周初产妇，已知颞叶癫痫，谁是由救护车带来的强直性阵挛发作超过30分钟的持续时间。鉴于她的高血压和癫痫发作，我们决定将她作为子痫治疗并进行紧急剖腹产手术，因为她在过去的11年里没有癫痫发作。患者按照我院子痫指南进行降压治疗，并在全身麻醉下进行了紧急手术。她被转移到国际电联，当天拔管，没有不良后果，婴儿被送入特殊护理病房。讨论:孕期癫痫控制良好可能会改善甚至恶化(1)。通常，癫痫控制不佳的女性在怀孕期间病情会恶化。鉴别癫痫或子痫引起的癫痫发作是很重要的，因为两者的治疗方法不同。在这种情况下，除非另有证明，否则患者应作为子痫治疗(2)。但这两种情况引起的不受控制的癫痫发作对婴儿都是有害的，需要分娩。在我们的病人中，由于她有癫痫发作和高血压的症状，我们不得不把她当作子痫来治疗。当她的血液结果可用时，她的LFT和血小板正常，这是对子痫的诊断特征之一。引用:1。Calderwood C, Nelson-Piercy C，妊娠并发症。麻醉重症监护医学2004;5(8):256-263Wee L, Sinha P, Lewis M.英国产科麻醉师对子痫的管理:一项邮政调查。中华妇产科杂志，2001;10(2):108-112学习要点:癫痫引起的癫痫发作或由于子痫在急性情况下是困难的鉴别。区分这两种情况很重要，因为两者的管理方式不同。在这种情况下，除非另有证明，否则患者应作为子痫治疗。
{"title":"Spinal anaesthesia for emergency caesarean section in a parturient with acute subarachnoid haemorrhage","authors":"O. Ng, S. Thong","doi":"10.13172/2052-0077-2-3-508","DOIUrl":"https://doi.org/10.13172/2052-0077-2-3-508","url":null,"abstract":"Case report: We report a case of 36 years-old primigravida at 34 weeks of gestation with known temporal lobe epilepsy, who was brought in by ambulance with tonic clonic seizure of more than 30 minutes duration. In view of her high blood pressure and seizure we decided to treat her as eclampsia and performed emergency caesarean section, as she was seizure free for the past 11 years. The women received treatment according to our hospital guideline for eclampsia to lower her blood pressure and underwent emergency operation under general anaesthetic. She was transferred to ITU, extubated the same day with no adverse outcome and the baby admit ted to special care unit. Discussion: Well controlled epilepsy may improve or even deteriorate during pregnancy(1). Usually women with poorly controlled epilepsy can get worse during pregnancy. Dif ferentiation between seizures caused by epilepsy or due to eclampsia is important as the management dif fers for both. In such situations patients should be treated as eclampsia unless otherwise proved(2). But uncontrolled seizures caused by either are detrimental to baby and will need delivering. In our patient as she had status like seizure on presentation with high blood pressure we had to treat her as eclampsia and treat accordingly. When her blood results were available, she had normal LFT’s and platelets which is one of the diagnostic feature against eclampsia. References: 1. Calderwood C, Nelson-Piercy C, Medical disorders complicating pregnancy. Anaesthes Intensive Care Med 2004;5(8):256-263 2. Wee L, Sinha P, Lewis M. The management of eclampsia by obstetric anaesthetists in UK: a postal survey.Int J Obstet Anesth. 2001;10(2):108-112 Learning points: Dif ferentiation between seizures caused by epilepsy or due to eclampsia in an acute situation is dif ficult. It is important to dif ferntiate between these conditions, as the management dif fers for both. In such situations patients should be treated as eclampsia unless otherwise proved.","PeriodicalId":19393,"journal":{"name":"OA Case Reports","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87315618","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}
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