Objective: To present a case of osseous metaplasia in thyroid nodule. Introduction: Long standing thyroid nodules undergo changes. Sometimes they degenerate, may lead to hemorrhage or fibrosis and sometimes ectopic bone formation. Case report: 41 years old Yemeni married lady, presented to our surgical clinic with left thyroid nodule for 3 years duration. She had right thyroid lobectomy 6 years ago. She presented with left neck swelling and was taken to OR for thyroidectomy. histopathology came as extensive fibrosis and osseous metaplasia with small remnant of thyroid tissue. Discussion; Most thyroid stay longer with no complications but some undergo calcification or hemorrhage, fibrosis and sometimes osseous metaplasia. It may occur in benign or malignant thyroid swellings.
Tracheal rupture is a rare condition associated with high morbidity and mortality. Iatrogenic tracheal injury is also very rare and can occur as a serious complication after endotracheal intubation. We report a case study of tracheal rupture of patient with a history of rheumatoid arthritis and corticosteroid treatment during surgical procedure with orotracheal intubation in a supine position. Lesions were healed after conservative treatment without stenosis, signs of mediastinitis or local infection. Patient was able to undergo three other surgical procedures during the next 8 month without any other complications connected to endotracheal intubation.
Glandular odontogenic cyst (GOC) is an extremely rare cyst of jaw bone with only 182 cases documented so far in the English literature. GOC is considered to be a locally aggressive lesion with high rate of recurrence. Anterior mandible is the most common site of involvement for GOC, involvement of the maxillary bone which is a rare occurrence. The clinical and radiographic finding of GOC are varied & often pathognomic. As clinical & radiographic findings are overlapping with those of other odontogenic cyst, a careful histopathological examination is needed to arrive at a definite diagnosis of GOC. In the present paper we reported a rare case of GOC in a 23yrs old male involving maxillary bone along with a review of literature focussing on clinical & radiological presentation and treatment outcome.
Pneumoperitoneum is often a surgical emergency related to gastrointestinal tract perforation. On rare occasions, free intraperitoneal air can be present without any discernible cause and is considered Idiopathic Spontaneous Pneumoperitoneum (ISP). Deciding which patients with ISP can be managed conservatively would help prevent some patients from undergoing unnecessary surgery. We describe here two cases of successful management of ISP and the review of literature of ISP management for the past 29 years. In the first case, a patient with ISP with no significant abdominal symptoms was successfully managed nonoperatively. In the second case, a patient with ISP and symptoms of small bowel obstruction was successfully treated surgically with exploratory laparotomy and small bowel resection. We recommend conservative management for the subset of ISP patients with no sign of peritonitis or sepsis.
Introduction Crowned dens syndrome (CDS) is a rare clinical presentation of chondrocalcinosis or calcium pyrophosphate crystal deposition (CPPD) disease, characterized by fever, neck pain and stiffness, associated with increased biological markers of inflammation. Diagnosis is made mainly via imaging, and the best modality remains the magnetic resonance imaging (MRI) of the neck showing calcification and calcium pyrophosphate crystals deposition around the odontoid process (1). The aim of this report is to increase awareness of this rare and ill-known clinical tableau and to review its complications and the latest modalities of its diagnosis and treatment. Clinical case: An 83-year-old female patient presented to the emergency department (ED) of the Middle East Institute of Health (MEIH) with severe acute onset neck stiffness and pain of 10/10 intensity, radiating to the submandibular area and reaching the occipital part of the head, associated with nausea and 2 episodes of chills one day prior to presentation. Patient denied any recent history of trauma or surgery of the head and neck. Physical exam at that time was only remarkable for marked limitation of neck motion, and positive Kernig and Brudzinski signs. No skin changes, facial sinuses tenderness, cervical lymphadenopathies or neck swellings were noted. Vital signs at ED were within normal range except for a low grade fever. Laboratory work-up upon presentation showed hyperleukocytosis (WBC = 14000/mm3) with left shift and a C-reactive protein (CRP) of 189 mg/L (0-5 mg/L). Chest X-Ray only showed degenerative osteoarthritis of the thoracic spinal vertebrae. CT-scan of the brain without IV contrast done urgently showed no acute changes. As Clinical and biological features were suggestive of acute meningitis, cultures were taken including blood, urine and CSF fluid from lumbar puncture. The patient was admitted to the hospital for IV antibiotic treatment with a large spectrum carbapenem and close observation. On…
Ototoxicity and neurotoxicity from exposure to a mixture of organic solvents and noise, a case report
Background: Neuropsychological alterations and decreased hearing, are related to organic solvents (OS) exposure; and if noise is present it potentiates the hearing damage. Aim: to evaluate neuropsychological performance and hearing of a 50 years old worker, occupationally exposed to OS mixtures for 26 years (toluene, ethyl acetate and isopropyl alcohol) and noise > 85 dB (A). Design of study: Report of a case assessed by Neuropsychological tests, CT and SPECT studies of hearing and clinic-occupational history. Results: He presented, loss between 35 to > 55 dB HL of his hearing in both ears, both in low frequencies (125 Hz-2 kHz) as well as the treble ones (3-8 kHz), in relation to his age. There was an otoacoustic emissions absence at the same frequencies. He showed cerebellar atrophy, cognitive, motor and emotional disorders. Conclusions: We Integrated diagnosis of: moderate to severe hearing loss, mental and behaviour disorders due to the simultaneous exposure to noise and an OS mixture, mainly toluene. It should fully evaluate workers exposed to noise and OS.
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.