Iron deficiency anemia (IDA) is a common but underdiagnosed cause of morbidity in adolescent females. Associated thrombocytopenia is rare, but resolves when the anemia is treated with iron supplementation. Menorrhagia is an important cause in the multifactorial etiology and may be familial. This article presents a case of severe anemia and thrombocytopenia in the presence of iron deficiency due to menorrhagia. A holistic approach to IDA is discussed with an approach to the management thereof in adolescent females.
Merkel cell polyomavirus on primary Merkel cell carcinoma of the skin with partial regression after biopsy
Introduction: Merkel cell carcinoma (MCC) is an uncommon primary cutaneous tumour. The majority of these tumour (about 80%) have integration of the polyomavirus DNA into the genome of Merkel cell carcinoma. Reports about at least nine cases of partial regression in primary and or metastatic lesions have been published. It is likely that regression is an immunological response mediated by T cells. Case Report: We report an 81year old woman who presented with a rapidly growing tumor in the left thigh. An incisional biopsy of the lesion was performed. Histopathologic and immunohistochemically diagnosis were consistent with Merkel cell carcinoma. Scant peritumoral lymphocytic infiltrate was CD3+, CD4+, and scant CD8+ was observed. The reporter test polymerase chain reaction (PCR) for Merkel virus yielded a positive result. Twenty days after the initial biopsy the lesion began to regress. Conclusion: Merkel cell carcinoma is a rare and aggressive tumour. At least nine cases of partial regression on primary and or metastatic lesions have been published. It is likely that regression is a T cell-mediated immunological response. A reporter test (PCR) for Merkel virus and both types of lymphocytic infiltrate and distribution (intratumoral and peritumoral) in our case very important as there are several known mechanisms that can contribute to cellular immune escape in MCP y V positive Merkel cell carcinoma. Study of integration and regulation of the immunological system implies future development of individually of different immunological therapies.
Individualized approach for Coarctation of the Aorta in a Patient with PHACE syndrome and Extensive Hemangiomas
PHACE syndrome is a neurocutaneous disorder with large facial segmental hemangiomas associated with anomalies of the brain, eye and heart. We report a case of a 3 years old girl who presented at the age of 6 weeks with severe coarctation of the aorta and aortic arch aneurysm. In addition, she had extensive strawberry hemangiomas over the scalp, neck and chest which, after extensive investigation, led to the diagnosis of PHACE syndrome. After complete evaluation we successfully initiated treatment with propranolol that was pursued without complications over three years with striking success and remarkable regression of her hemangiomas. Meanwhile the coarctation was managed conservatively. This case highlights that propranolol treatment, while effective against hemangiomas, may contribute to slow the progression of aortic arch aneurysm and delay the need for high risk surgical intervention.
Intra-areolar polythelia (IAP) is an extremely rare congenital malformation with the presence of two or more nipples within a normal sized areola. This is a case report of a 25-year-old gentleman who presented with two nipples on the areola of his left breast since birth. Surgical excision was done under local anesthesia for aesthetic purpose.
A pre-auricular sinus will rarely present in coexistence with a post-auricular dermoid cyst. The coexistence of a discharging pre-auricular sinus with a post-auricular dermoid cyst presents a diagnostic challenge. Without meticulous history taking and physical exam, one would subject the patient to aggressive and unwarranted investigation and management modalities as though the infected post-auricular dermoid cyst were a mastoid abscess. We present a 15-year-old male who presented to the ENT clinic of Mulago National Referral Hospital and was diagnosed with an infected pre-auricular sinus with an infected post-auricular dermoid cyst.
An accessory aberrant testicular artery branching from the inferior suprarenal artery: embryologic and genetic consideration
During routine educational dissection of a cadaver (61-year-old, male, white descent), multiple aberrant right testicular artery and veins were discovered. Detailed analysis of the abdominal vascular pattern showed that the accessory aberrant testicular artery branched off the right inferior suprarenal artery. It crossed the anterior pararenal space, gave several branches to the soft tissues of the posterior pararenal space, and descended towards the deep inguinal ring. The accessory aberrant testicular vein accompanied the aberrant artery and was drained by the right inferior suprarenal vein into the renal one. Two other testicular veins followed a typical course and opened into the inferior vena cava. The anatomical variability reported in this paper requires attention of the related specialists, as it may significantly complicate surgical and minimally invasive procedures on the organs of the retroperitoneal space and inguinal region. Thorough preoperative investigation regarding the variability of the vascular pattern should be conducted in patients considered for intervention on the adrenal gland, kidney, or testis.
Autologous Tenocyte Implantation for the Treatment of Chronic Degenerative Rotator Cuff Tendinopathy
The use of injectable cell therapies to treat tendon pathology has become significantly more popular in recent years. They are appealing treatment modalities as they are minimally invasive, autologous, non-surgical management options which theoretically allow tendon regeneration and return to function. This case report will focus on the use of autologous tenocyte implantation (ATI) injection therapy to treat chronic degenerative rotator cuff tendinopathy.
Successful use of a novel biological plug in the percutaneous treatment of a refractory gastro-cutaneous fistula following omental patch repair of perforated peptic ulcer
Background: Gastro-cutaneous fistula following re-leak of omental patch repair of perforated peptic ulcer is a very rare but challenging surgical complication. We describe the use of a novel biological plug as a viable repair for gastro-cutaneous fistula that failed medical, endoscopic, and operative management. Additionally, we present a thorough literature review of reported cases of gastro-cutaneous fistulae following omental patching of peptic perforations to further highlight their treatment challenges. Summary: A 69-year-old man underwent repair of a perforated pyloric ulcer with a pedicled omental patch. After one week, patient developed a re-leak from the omental patch, and underwent a second laparotomy with repeat omental patching of the gastric perforation. Ten weeks after the second operation, the patient developed a gastro-cutaneous fistula that failed conservative management with nil per os and enteral nutrition delivered distal to the fistula site; multiple image-guided percutaneous attempts at fistula closure by interventional radiology via fibrin sealant injection and collagen-based vascular closure device; and endoscopic clipping by gastroenterology. Ultimately, this refractory gastro-cutaneous fistula was closed with a novel biological plug (Biodesign® Enterocutaneous Fistula Plug, Cook Biotech). Conclusion: Gastro-cutaneous fistulae following omental patching of perforated peptic ulcer represent a significant complication requiring a multidisciplinary management approach. The Biodesign® Enterocutaneous Fistula Plug offers a promising new tool for the non-operative treatment of refractory gastro-cutaneous fistulae.
The 5-year survival rate of advanced non-small cell lung cancer is less than 5%. In recent years, immunotherapy represented by PD-1 antibody has become the standard treatment recommended by many lung cancer guidelines. With the treatment, the total survival time and quality of life have been significantly prolonged in patients with advanced Primary non-small cell lung cancer (NSCLC). In this study, the domestic anti-PD-1 monoclonal antibody, Camrelizumab, combined with chemotherapy was used to treat advanced non-small cell lung cancer. The efficacy of Camrelizumab and occurrence of cutaneous capillary hyperplasia (CCEP) were analyzed.
A 53 year old gentlemen, with a history of intravenous drug use, presented to the Emergency Department in septic shock with an acute abdomen. He had been recently treated with dalteparin for a deep venous thrombosis of his left leg. He was resuscitated with fluids and antibiotics, and cross-sectional imaging suggested a diagnosis of necrotising fasciitis of the abdominal wall. He was admitted to ITU, and a laparotomy, abdominal washout, muscle debridement and laparostomy was performed overnight. No bowel perforation or contamination was identified. Over the next few weeks he underwent multiple debridements, and a negative pressure abdominal dressing was utilised. After a prolonged rehabilitation phase he was discharged home to live independently. He is currently in discussion with the plastics team regarding reconstruction of his abdominal wall. We would like to stress the importance of consideration of necrotising fasciitis as a diagnosis in the context of a critically unwell and septic patient with a history of subcutaneous/intravenous medication usage.