During routine educational dissection of the upper part of the abdominal cavity in a female cadaver (67 years old, Netherlands) a unique association of two rare biliary and vascular patterns was discovered. The gastroduodenal artery originated from the celiac trunk along with the right hepatic, gastric and splenic arteries, and gave origin to the accessory right and left hepatic vessels. The right hepatic artery took the course typical for the common hepatic artery; however, as a component of the portal triad, the artery was located behind the bile duct and portal vein. Next to the hilum of the liver, it branched off the cystic artery to the gallbladder and bifurcated into two segmental hepatic branches. The described hepatic vascular pattern was associated with the presence of an accessory aberrant cystic duct connecting the body of the gallbladder with the right anterior inferior segmental bile duct. The case is reported to emphasize the importance of a detailed preoperative investigation of the patients considered for open and laparoscopic procedures on the liver and gallbladder documenting the variability of both the biliary and vascular patterns.
Fracture of the penis is a misnomer, the cause being rupture of one or both of the tunica albuginea that covers the corpora cavernosa. It usually occurs following sexual intercourse or masturbation. Here we report 2 cases of penile fracture in our institution. Ultrasonography was done which confirmed the diagnosis. In both the cases, the urethra was intact. Exploration with evacuation of the hematoma and repair of the tunica albuginea was done.
During routine educational dissection of a cadaver (63-year-old, male, USA), an atypical course of the left inferior suprarenal vessels via the posterior pararenal space was discovered. Detailed analysis of the abdominal vascular pattern showed that the atypical inferior suprarenal artery represented a terminal branch of the left inferior phrenic artery. The last one branched off from the very beginning of the left renal artery, ascended between the fibers of the left crus of the diaphragm, then ran laterally giving off muscular branches and, finally, descended along the costal part of the diaphragm to the left posterior pararenal space. The terminal branch of the inferior phrenic artery pierced the retrorenal fascia and entered the perirenal space as an atypical left inferior suprarenal artery. It ran upward and medially crossing the anterior surface of the kidney to reach and supply the lower pole of the left suprarenal gland. The left inferior phrenic vein accompanied the artery taking a similar course. It received numerous tributaries passing via the posterior pararenal space, drained the inferior suprarenal vein, and opened into the left renal vein. Such anomalous pararenal vascular pattern is a challenge for surgeons performing open procedures on retroperitoneal organs, not to mention specialists employing minimally invasive laparoscopic techniques. The anatomical variation reported in this paper requires urgent attention of the related specialists.
Safety of percutaneous dilational tracheostomy in patients ventilated with high positive end-expiratory pressure (PEEP) and high FiO2
Case report of bronchoscopically guided percutaneous dilational tracheostomy in-patient with acute respiratory distress syndrome ventilated with high positive end-expiratory pressure (PEEP) and high FiO2.
Soil Transmitted Helmenthiasis (STH) is a major public health problem in the developing countries. Trichuriasis is one of the common prevalent parasitic infestations in the tropical and sub-tropical countries across the globe incuding India. However, there has been a steady decline of STH in the last five years where there has been success of albendazole with Mass Drug Administration (MDA) in National Filariasis Control Program and Kerala state has been one of them. We report a case of whipworm infection that was incidentally diagnosed by colonoscopy where repeated stool microscopy was uncontributory. The worm can be overlooked, particularly if colon preparation is not good.
Acute Coronary syndrome in a patient newly diagnosed with Charcot-Marie-Tooth Neuropathy: a review of cardiovascular disease in this inherited neuropathy
Whilst we suspect that there is no clear association between the two major diagnoses we made in this patient during this hospitalisation (i.e. coronary artery disease and CMT neuropathy), the literature from a series of published case reports does perhaps show an association between CMT and abnormalities of cardiac conduction. Brief Summary: This case reports follows the occurrence of an antero-lateral ST segment elevation myocardial infarction in a 34-year-old male newly diagnosed with an inherited neuropathy in the form of Charcot-Marie-Tooth type 1A.
The torsed intraabdominal testis presenting with a mechanical large intestinal obstruction – A maiden case report
Torsion of an intraabdominal testis is a well-known complication and is usually associated with a testicular malignancy. Torsed intraabdominal testis compressing the large bowel leading to a mechanical gut obstruction is still an unreported entity. A 27 years old young patient presenting with nonspecific abdominal pain after 48 hours of delay. Due to features of gut obstruction, an emergency laparotomy was done. A large torsed intraabdominal testis was found with an empty right scrotum which was compressing the sigmoid colon leading to a complete gut obstruction. Interestingly, two of his siblings also were also suffering from undescended testicles.
Identical Twins with Endogenous Tinea Versicolor This case report was inspired by recent medical data consistent with the obser-vation that Tinea Versicolor caused by Malassezia Furfur species may be en-dogenous produced by human body. This case report involves a pair of identical twins –ages 71- who have had recur-rent Tinea Versicolor infections for over six decades. The author of this article twin A, a physician and his brother twin B have in summer months had skin lesions – on chest and upper extremities of round ap-proximately 1 inch wide – diagnosed as tinea versicolor by many doctors in di-verse medical settings in different countries since their adolescence. The infec-tions have been successfully treated by antifungal medications. Both twins were born in Istanbul Turkey. Twin A who lives in Houston Texas had lived in Los Angeles California and Dahran Saudi Arabia. Twin B who lives in Athens and spent the majority of his adult life in Washington DC. Neither twin reported any association between location and tinea versicolor infections yet they both observed that almost always infections emerged in warmer climates. Both twin A and twin B have been diagnosed with hypertension and hypercho-lesterolemia well controlled by amlodipine 10 mg and atorvastatin 20 mg respec-tively.
Acute soft head syndrome and a mini review of bone and neurologic complications in patients with sickle cell disease
Introduction: Acute soft head syndrome is a rare complication in patients with sickle cell disease (SCD) that is characterized by progressive skull pain and swelling, it is usually related to skull bone infarction and full recovery is achieved with conservative management. This case represents a very rare association of sickle cell disease and acute soft head syndrome that necessitates to be differentiated from other bone and neurologic presentations occurring in this entity of patients. Case: We report a rare case of an 11 years old Saudi male patient with sickle cell disease who developed acute soft head syndrome that presented with severe headache. An underlying osteomyelitis of skull and lower limb bones couldn’t be excluded and the patient had full recovery after conservative treatment. Conclusion: Acute soft bone syndrome seldomly occurs in SCD, however, its presentations mimics those of bone and neurologic complications so differentiation is essential in order to set up a clear plan of management.
Reports of emergency surgical repair of a retrosternal hernia causing respiratory failure in an adult are rare. We treated an 82-year-old man who had been suffering breathlessness upon exertion, some speech difficulty, and, most recently, visual hallucinations. He had consulted a physician who ordered an arterial blood gas test, which revealed hypoxemia, and thoracoabdominal computed tomography (CT), which revealed a hernia that was compressing the pulmonary parenchyma. Over the next 30 days, the hernia worsened, acute respiratory failure developed, and the patient was transferred to our hospital by ambulance. The patient presented to us not only with respiratory failure but also a decreased level of consciousness. CT performed upon admission revealed prolapse of the transverse colon from the posterior surface of the sternum to the right thoracic cavity, left deviation of the mediastinum, and compression of the pulmonary parenchyma, which we believed to be the cause of the hypoxemia. With the hernial orifice appearing to be on the right, a Morgagni hernia was diagnosed. Emergency surgery was deemed necessary. An epigastric midline laparotomy incision was placed, and we observed a retrosternal hernia, with an enlarged foramen of Morgagni measuring 70mm × 50 mm as the hernial orifice. The hernia contained portions of the greater omentum and transverse colon. We returned the contents to the peritoneal cavity manually closed the hernia orifice by simple suturing and reinforced the repair with a mesh patch. With signs of cardiac failure developing, temporary noninvasive positive-pressure ventilation was instituted from postoperative day 5 to postoperative day 11, but the patient’s general condition improved thereafter, and he was discharged on postoperative day 29.