IJCR (2021), Volume 5

  • Myocardial infarction as initial presentation of polycythemia vera and its treatment challenges, a case report

    Polycythemia vera (PV) is one of Myeloproliferative neoplasm which has common and uncommon mode of presentations. Myocardial infarction (MI) is rare at initial presentation. Here we report 55-year-old women presented with MI and found to have PV in whom, coronary intervention was delayed as there is no evidence based literature guidance in cases of acute MI and PV.

  • The fall of conventional mechanical ventilation into the emergence of Veno -Venous Extracorporeal Membrane Oxygenation influenced Extreme Super Super obese patient survival with a COVID-19 ARDS

    The COVID-19 pandemic has unfolded and merged across 220 countries, territories worldwide. Recent studies conclude that obesity is an independent significant risk factor for COVID-19 infection. Thus, obesity is an epidemic disease. Any obesity allied with COVID-19 ARDS is life-threatening, heading to respiratory life support associated with several complications and mortality. In this clinical setting, the World health organization (WHO) and Extracorporeal Life Support Organization (ELSO) provide interim guidelines that Veno-Venous extracorporeal membrane oxygenation (VV- ECMO) can be beneficial in selective COVID-19 patients. However, the benefit of extracorporeal membrane oxygenation (ECMO) in Obesity and Severe Obesity remains controversial. Although a few studies favored ECMO in Obesity associated with COVID-19. In contrast, its benefit in extreme super-super obese (class v) is unknown to the present day. Herein we report our successful early VV- ECMO and its retrieval challenges in an extreme super-super obese of Body mass index (BMI >65 kg/m2). Our report describes our institutional practice, clinical characteristics, and early VV- ECMO induction to enhance patients’ speedy recovery and survival. ECMO is a limited resource and must be used selectively, particularly during a pandemic when all resources are scarce.

  • Appendiceal diverticulosis: Asymptomatic positive FDG-PET uptake in the appendix should prompt operative management

    Appendiceal diverticulosis is rarely diagnosed and presentation mimics acute appendicitis. It has a documented high malignant risk and increased complication rate and excision is recommended if suspected preoperatively. We report a case of an incidental FDG avid appendiceal lesion on PET scan which was suspected to be an appendiceal neoplasm, however histologically was appendiceal diverticulosis. This is the first case of appendiceal diverticulosis detected via PET scan and we discuss the implications of this.

  • The Interesting Link Between Neurocysticercosis and Glioblastoma in a 41-year-old Hispanic Female

    Neurocysticercosis (NC) is a common condition worldwide while glioblastoma is the most common brain cancer among adults but overall, a rare disease. NC is the most common cause of seizures in developing countries. Although no causal relationship is established, there have been an association previously reported between NC and glioblastoma. Here we present a case of a 41-year-old female who was diagnosed with NC, treated with antiparasitic medications who developed worsening neurologic deficits despite treatment, and was subsequently diagnosed with a large left frontotemporal mass consistent with glioblastoma. Patient then underwent treatment with concurrent radiation and temozolomide.

  • Complex Incisional Hernia – Easy To Diagnose But What To Do After?

    Introduction. Loss of domain represents a defect in abdominal wall or loss of continuity of fascial closure, with more than 20% of the peritoneal cavity content under the skin in a serous sac, where the reconstruction involves additional reconstructive techniques. Clinical Case. A 63-year-old active smoker with multiple comorbidities such as COPD severe form with the need for oxygen at home (may be an absolute contraindication) and surgical history of open umbilical hernia repair with a rapid development of loss of domain hernia (2 weeks after surgery) was prepared preoperatively with Botulinum Toxin type A and Preoperative Progressive Pneumoperitoneum. Discussion. Despite comorbidities, by optimizing the abdominal wall with Botulinum Toxin type A and Preoperative Progressive Pneumoperitoneum with the intraoperative use of the Rives-Stoppa technique or posterior separation of components, Abdominal Wall Strength Score improves significantly in a short time, with quick socio-economic reintegration and low-rate of complications. Conclusions. By preoperative preparation, with augmentation techniques of the abdominal wall, thus, even the barriers given by comorbidities (absolute contraindications) are overcame, with low postoperative risks, offering the patient a normal quality of life.

  • The emergence of bladder dysfunction secondary to lupus cystitis in a patient with established lupus nephritis: the first case from Pakistan

    Lupus cystitis is an uncommon manifestation of systemic lupus erythematosus (SLE). We describe the case of a 23-year-old woman with lupus that complained of abdominal pain, vomiting, and diarrhea for one week. Two years back, she was brought with an affirmative history that satisfied the clinical criteria of SLE which was renal biopsy-proven (class V membranous lupus nephritis). On radiologic workup, she was found to have bilateral hydronephrosis and a thick-walled bladder with diverticula. Immunosuppressive therapy was commenced however augmentation cystoplasty had to be opted for as the symptoms did not subside with medical therapy alone.

  • Cardiac Metastatic Involvement in Lung Cancer – Cardiac Metastatic Involvement

    Lung cancer is the second most common solid tumour and the first in mortality worldwide. Important progress has been reached in recent years in this pathology, focusing its treatment on histology, molecular biology and clinical presentation. Cardiac metastatic involvement consists in a severe clinical entity with increasing incidence due to better radiological techniques and longer survival of lung cancer. It requires special care and attention from many specialists. Clinical review about cardiac involvement secondary to lung cancer is provided, focused on its epidemiology, clinical presentation, diagnoses and treatment. Better understanding about cancer natural history is needed to offer the best treatment and care. Condensed abstract Cardiac metastatic involvement consists in a severe clinical entity with increasing incidence due to better radiological techniques and longer survival of lung cancer. It requires special care and attention from many specialists. Clinical review about cardiac involvement secondary to lung cancer is provided, focused on its epidemiology, clinical presentation, diagnoses and treatment.

  • Unexpected Combined Double Posterior and Anterior Approach to Treat Thoracic Disc Herniation: a Case Report

    Introduction: Although frequently observed in magnetic resonance images, symptomatic thoracic disc herniations are rare. Surgical treatment is indicated when patients suffer from functional symptoms with no response to medical treatment, when neurologic symptoms appear or worsen or in the event of myelopathy. Posterolateral approaches are commonly accepted as the treatment for lateral and mediolateral disc herniations and non-calcified medial herniations. On the other hand, anterior approaches have been accepted to treat gigantic calcified medial disc herniations. Case presentation: This case report presents on a 57-year-old female patient suffering from thoracolumbar pain and impairment. The magnetic resonance study showed images compatible with a posteromedial T12-L1 disc herniation that, after medical treatment failure, required surgical treatment. Initially, a posterior approach was performed, resulting in the immediate postoperative period in motor and sensitive deficit of the lower left limb, so a surgical reintervention was performed using an anterior approach, obtaining good clinical and functional results. Conclusion: Thoracic disc herniations are uncommon. Surgical indication is decided in the presence of neurologic symptoms. Neurologic injury is a common complication due to the lesion’s characteristics and it can also be secondary to the surgical procedure. An adequate election of the surgical approach may minimize neurologic injuries.

  • Celiac disease presenting as abnormal atrial rhythm resolving after gluten-free diet

    We describe a case of a teenager who presented with palpitations and abnormal low atrial rhythm. Celiac Disease (CD) serology, sent due to low ferritin, was positive and gastroscopy confirmed CD diagnosis. Both palpitations and abnormal rhythm resolved after gluten-free diet with normalization of CD serology.

  • Case Report: COVID 19 infection induced Autoimmune Hemolytic Anemia

    SARS-CoV 2 was designated a pandemic by WHO on March of 2019. There have been over 120 million confirmed cases of COVID-19 globally with greater than 4 million hospitalizations in the US alone. These cases can range from asymptomatic disease to multi-organ dysfunction resulting in death. The spectrums of complications stemming from COVID-19 are much broader and can include other autoimmune disorders. Here we present a case of a woman who developed autoimmune hemolytic anemia from COVID-19 infection and was successfully treated with high dose corticosteroids.