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  • Idiopathic retroperitoneal fibrosis and ankylosing spondylitis – A new case report with review of the literature

    Retroperitoneal fibrosis (RPF) is an uncommon disease (annual incidence estimated at 1/20,000–500,000) characterized by the development of dense fibrous tissue in the retroperitoneal compartment [1]. RPF can be idiopathic or secondary to drugs, infections, radiotherapy, malignant diseases, major abdominal surgery, trauma and retroperitoneal injuries [2,3]. RPF has also been reported in patients with systemic autoimmune diseases including rheumatic diseases [4-7]. Several cases of RPF in patients with ankylosing spondylitis have been described. Herein, we report a new case of retroperitoneal fibrosis in a patient with ankylosing spondylitis.


    Aim: Facial Fat Grafting(FFG) was first described in the early 20th century but for many years remained a relatively underused technique due to the unreliability of long-term volume expansion and retention. FFG was initially used as a technique to improve facial aesthetics. Over the years the technique  has evolved into more complex reconstructive and regenerative procedures and new clinical applications. Methods: In the last two decades the indications of FFG have been extended into cranio-maxillofacial reconstructive surgery. This includes post-traumatic soft tissue defects,  aesthetics,congenital and other postsurgical volume deficits. Results: While several approaches were suggested for fat harvesting and grafting, the results were rather unsatisfactory due to the degeneration of many adipocytes that occurred during these manipulations. The technique of autologous fat transfer has then been perfectioned becoming an augmentation-regenerative process that can be used to treat a wide range of difficult and challenging reconstructive problems. The procedure  described herein has been performed in different patients with various pathology sequelae with sactisfactory morpho-aesthetic results and a low complication rate. Conclusion: FFG can be used in any facial area where is lack,of soft tissue or where there is scarring,producing natural and long-lasting results. Mesenchymal stem cells represent a great tool in regenerative medicine because of their ability to differentiate into a variety of specialized cells. However more definitive studies are still needed in order to answer specific questions regarding the best technique to be used and the role of ADSC’s.Clinical cases with volume paucity or deficiencies are presented with a long-term outcome in augmentation and regeneration.

  • Intra-Abdominal Desmoplastic Small Round Cell Tumor: A Diagnostic Dilemma In Resource-Constrained Settings

    Introduction. Desmoplastic small round-cell tumours (DSRCT) are primarily intra-abdominal soft tissue sarcomas that are extremely rare and aggressive with a rapidly deteriorating clinical course and poor outcome despite therapy. It belongs to the family of small round blue-cell tumours, symptoms of the disease are non-specific and metastasis is often present at diagnosis. Objective. This report presents a typical case of an intra-abdominal DSRCT while highlighting how challenging the diagnosis can be in resource-poor settings and best-practice in the management of its attendant complications. Case presentation. This is a case 10-year-old boy who presented with a two-month history of weight loss and a two-week history of colicky abdominal pain, abdominal distension and vomiting and loss of appetite. He was pale, had left mandibular lymphadenopathy with a distended abdomen and ascites. A palpable mass was occluding ~80% of his rectal lumen. CT scan showed intra-abdominal masses in the rectovesical pouch and hepatic flexure with abdominopelvic lymphadenopathy Patient was worked up for exploratory laparotomy, colostomy placement and tumor biopsy, with the subsequent histology and immunohistochemistry a diagnosis of DSRCT was made. The patient developed moderate anaemia, acute kidney injury, hypertension and anarsarca while on admission; these were successfully managed with blood transfusions, intravenous fluids and drugs subsequently. He had a re-exploration for fecal disimpaction and adhesiolysis due to persistent intestinal obstruction. Patient was discharged 15 days after admissionin a stable clinical state. Conclusion. Desmoplastic round-cell tumour (DSRCT) primarily occurr within the abdomen, it is capable of mimicking the symptomatology of other intra-abdominal malignancies and a high index of suspicion is requisite to make a diagnosis especially in resource-poor settings with swift implementation of treatment modalities necessary to halt disease progress.

  • Exergaming improves functional fitness in MCI patients. Does the APOE genotype moderate the outcome?

    Objectives: Mild cognitive impairment could be defined as the condition between healthy aging and dementia. MCI patients seem to retain the neuroplasticity to benefit from Physical Exercise (PE) interventions delaying the progression to dementia. The present study investigates the impact of PE via “Exergaming” on the functional fitness of MCI adults, depending on the presence of the APOEɛ4 allele. Methods: 159 MCI participants were recruited. They were separated to two groups (performing PE or not). The Fullerton Functional Test was used as a primary outcome measure in two-time points (prior to and after PE). Results: The Active group showed more considerable improvement compared to the Passive group in all Fullerton components despite the presence of APOEε4. Discussion: ΡΕ via exergaming has a beneficial functional effect in MCI patients, whether carrying the APOEɛ4 allele or not.


    Dodd and Cockett defined varicose veins, saying “a varicose vein is one which has permanently lost its valvular efficiency.” [1] Varicose veins constitute a progressive disease, remission of the disease does not occur, except after pregnancy and delivery. [2] The first documented reference of varicose veins was found as illustrations on Ebers Papyrus dated 1550 B.C. in Athens. [3]Greek philosopher Hippocrates (460-377 B.C.) described the use of compressive bandages and was advisor of small punctures in varicose veins. First patient who underwent operation for his varicose vein appears to be Canus Marius, the Roman tyrant. Giovanni Rima (1777-1843) introduced mid thigh ligation of the saphenous vein. Ligation of the sapheno-femoral junction as it is practiced today was first described by John Homans in his paper in 1916. [2] The Mayo Brothers, postulating that there would be additional benefit in removing the saphenous vein, pursued excision of the GSV through an incision extending from the groin to below the knee. The final technologic leap was introduction of the intraluminal stripper by Babcock. [2] In the era of minimally invasive surgery, the first documented case of Endovenous Laser Ablasion was published in 1999 using 810 nm Diode Laser. Since then several wavelengths were introduced; 810, 940, 980, 1064, 1320, 1470 and newly introduced 1940 nm. [4, 5] It is generally agreed that varicose veins affect from 40 to 60% of women and 15 to 30% men. [6] During the 1930s to 1960s, several large studies reported the prevalence of varicose veins to roughly average 2% in the general population. [7] However, more recently, large population studies such as Edinburgh Vein Study demonstrated an age-adjusted prevalence of truncal varices of 40% in men and 32% in women. [8] Vein ablation is the most modern treatment option for superficial venous disease. Several endovenous modalities…


    Long lasting back pain due to degenerative disc disease is one of the major reasons for reduced quality of life and work incapacity. In some of these patients conservative treatment will not improve back pain significantly. Therefore fusion surgery as a surgical option is offered to these patients. The main aim of this kind of treatment is the reduction of segmental motion leading to an improvement in pain. Rigid fixation leads to high fusion rates but may also contribute to stress shielding and adjacent segment degeneration. Therefore a semi-rigid stabilization with PEEK rods may be an option because it is associated with less implant related rigidity and is a less invasive procedure. The aim of this retrospective study was to evaluate the improvement in back pain after minimally invasive semi-rigid lumbar stabilization with screws and PEEK rods in 45 patients and to identify potential implant failures during a follow up of two years. Six weeks after surgery the patients showed a significant improvement in their back pain, which persisted during the whole observation time of two years (p

  • Unilateral Vestibular schwannoma with Pituitary macroadenoma- Rare concurrent dual intracranial lesion

    The presenting clinic features of the cerebellopontine angle tumours and their management are well known, however there is limited knowledge regarding coexistence of other primary brain tumours which can be incidentally detected. A 70-year-old otherwise normal gentleman was referred from routine hearing screening programme centre with more of right sided hearing loss and occasional right sided tinnitus. Pure tone audiogram revealed an asymmetric high frequency sensorineural hearing loss .Gadolinium contrast enhanced MRI showed a right distal mass filling the entire internal acoustic meatus with an intracanalicular dural extension indenting the middle cerebellar peduncle with no significant enhancement. Additionally, an incidental enhancing asymmetric macroadenoma was detected in the pituitary sella indenting the left cavernous sinus without an extension and displacing the pituitary stalk to the right and displacing the carotids superiorly exerting insignificant pressure on the optic nerves. He had Hyperprolactinemia but normal visual fields. Here we present this rare concurrent presentation of dual intracranial primary tumours which by itself clinically is very uncommon.


    Osteoporosis is a common metabolic disease of the bones that increases bone fragility due to decreased bone mass and bad quality of bone, leading to an increased risk of bone fracture. This disease affects all the bones, including femurs/pelvis, spine, forearms, ribs, mandible, and maxillary bone. Periodontitis is an inflammation of the tissue around the teeth that results from infections and leads to tooth loss due to attachment loss and destruction of the alveolar bones around the teeth. Apart from Periodontitis, does Osteoporosis also lead to tooth loss? The purpose of this article is to answer this question. An electronic search of English language literature was conducted through PubMed, Medline, and Google scholar. The articles were selected through their topics and contents regarding osteoporosis, periodontitis, and tooth loss. The selected articles included cross-sectional, cohort, and review studies. Osteoporosis and periodontitis are multifactorial diseases and recent studies revealed a positive relation between periodontal disease and osteoporosis. In summary, as well as osteoporosis has an indirect correlation with tooth loss by periodontitis, it also has a direct relationship with tooth loss by decreasing mandibular and maxillary alveolar bone density. Not only Tooth loss could occur due to periodontitis, but also it has many other reasons, which with nowadays researches osteoporosis counts as one of them. Due to the effect of osteoporosis in the reduction of BMD and its relationship with periodontitis, it can both directly and indirectly result in tooth loss. Further well-controlled researches are required to clarify the inter-relationship between osteoporosis and tooth loss.

  • Evaluating the Potential for Improved and Sustainable Adoption of Conservation Agriculture in Northern Namibia

    The study evaluated the potential for improved and sustainable adoption of conservation agriculture in five regions in Namibia namely, Omusati, Kunene, Oshikoto, Ohangwena, and Oshana. Conventional system of farming involves, monoculture and deep soil tillage with ox-drawn ploughs with limited mechanisation. These practices are unproductive and unsustainable given increased uncertainty due to climate change.Therefore, conservation agriculture was introduced in the regions through the Food and Agricultural Organisation’s (FAO) assisted programme. The aim of the programme was to lower vulnerability by increasing the resilience of the smallholder farmers in the selected regions to adapt to climate change risks through the implementation of Conservation Agriculture (CA) and other complementary Good Agricultural Practices (GAPs). The hypothesis is that increased CA knowledge would enhance improved outcomes. An empirical estimation of the relationship between the farmers learned CA skills, and the level of CA outcome was carried out using econometrics method. One hundred and forty-four farmers were sampled from the selected regions. The result indicates that additional CA knowledge may result in farmers’ improving their General Agricultural Practices. In order words, farmers are more likely to improve weeding than not, the area planted is more likely to increase than decrease and fertilizer application is more likely to increase significantly than not. There is an increase in the ordered log-odds of moving from a lower to a higher outcome level. For instance, a one-unit increase in the farmers’ CA knowledge will result in 0.05 unit increase in ordered log-odds of being in the higher category for the ‘area planted’ outcome variable while the other variables in the model are held constant. The same relationship applies to other outcome variables for farmers’ improved knowledge. In addition, the sustainability of the CA project was investigated. Using a probit probability choice model, it was found that CA adoption will…

  • Diffuse-type tenosynovial giant cell tumour of the temporo-mandibular joint: an indication for alloplastic joint replacement

    A 25-year old female patient was referred to our department with a mass at the level of the right temporomandibular joint (TMJ). The patient experienced symptoms of paroxysmal pain of the TMJ and weight loss. Magnetic resonance imaging (MRI) revealed a tumour in the right masticatory space extending into the right TMJ, with invasion of the temporal bone. Surgical resection of the mass and total TMJ replacement surgery with a custom-made pros-thesis were performed. Final histological diagnosis of the resected specimen showed a dif-fuse-type tenosynovial giant cell tumour (D-TGCT). The multidisciplinary team’s decision was to give adjuvant radiotherapy; however, the patient declined further treatment. At 6 months follow-up, the patient had an excellent recovery with no signs of tumour recurrence on MRI. This is the first described case of D-TGCT treated with total TMJ replacement sur-gery using a custom-made alloplastic device.