Jornal de relatos de casos clínicos

We present a case of an 81-year-old male who presented with a 1-week history of upper abdominal pain and fevers. CT imaging revealed what appeared to be a metal surgical clip in the distal common bile duct related to the patient’s laparoscopic cholecystectomy 17 years prior. This was confirmed on a dedicated CT intravenous cholangiogram. The patient went on to have an ERCP, which revealed that the metallic clip had passed spontaneously.

Kimura’s disease is a rare, benign, chronic inflammatory disease with an unknown etiology, which predominantly affects Asian males. It has predilection for the head and neck region, and primarily involves the major salivary glands and is accompanied with loco-regional lymphadenopathy. It is therefore often misdiagnosed for a salivary gland tumor or lymphadenopathy secondary to metastases, lymphoma or tuberculosis. We present a case of Kimura’s disease in a middle aged Chinese male patient manifesting as painless lumps over the left jaw and neck. Based on the CT scan, the differential diagnoses of lymphomatous/metastatic adenopathy affecting the left cervical and parotid nodes or a primary left parotid malignancy with ipsilateral metastatic adenopathy were considered. However, a fine needle aspiration biopsy of the left sided adenopathy yielded the diagnosis of Kimura’s disease. The triad of subcutaneous masses in head and neck region, regional lymphadenopathy and masses in one or more of the major salivary glands should raise the suspicion of Kimura’s disease.

Case report: We present a 68-year-old male, retired civil servant who was seen in the neurology clinic at Barau Dikko Teaching hospital, Kaduna-Nigeria with a complaint of abnormal movements of upper and lower limbs for one year, and difficulty in walking for two months. The abnormal movement started on the distal part of both upper limbs simultaneously. It was noticed more at rest and got aggravated during movements. He was diagnosed with PD and was treated with L-dopa and Artane. However, six weeks after the commencement of his therapy he started developing a visual hallucination that subsequently became so intense that he started isolating himself and became suspicious of the wife conniving with strange people to kill him. His psychosis was initially treated with clozapine which controlled the hallucination to some extent but made his dyskinesia worse. This prompted us to stop the clozapine and to decrease the l-dopa, while introducing an anticholinesterase pyridostigmine which helped in treating the psychotic episode.

Discussion: The use of psychotropic medication may control the psychotic features but will aggravate the PD. A trial with anticholinesterases has been found to be effective in the control of psychosis in PD.

Seborrheic keratosis is a benign skin disease occurring mostly over the sun exposed areas of the body. This dermatological problem is rare in the region of nipple areola complex. Most of the breast surgeons are unaware of this disease. The authors are describing a rare surgical encounter where a provisional diagnosis of breast polyp was made. He was further investigated to rule out any underlying breast malignancy. Finally, excision biopsy revealed the diagnosis. A prior suspicion of this disease could have avoided the need for all these complex investigations.

Herein the author presents a case of esthesioneuroblastoma, a rare malignancy affecting the sinonasal cavity. This uncommon lesion is thought to originate from the olfactory neuroepithelium. The mass may invade the orbit and intracranial space, and may metastasize to the neck or to distant sites. This case was successfully treated with an endoscopic craniofacial resection, multilayer skull base reconstruction, and postoperative radiation. The differential diagnosis, radiographic findings, and surgical and adjuvant treatment of this rare tumor are discussed.

In response to our recent OR fire, our institution initiated a safety review and quality improvement project regarding our emergency preparedness. Several major modifications have been implemented including an all hands-on deck approach to training, increased frequency of simulation exercises with OR safety and fire-fighting equipment, as well as inclusion into our surgical timeout process. Operating room fires are rare but potentially catastrophic with costly loss of resource and possibly life

Background: Homocystinuria is an autosomal recessively inherited defect of methionine catabolism. This rare condition causes abnormal accumulation of homocysteine in the blood and urine that is not typically found in significant quantities. While elevated homocysteine levels can cause damage to multiple organ systems, they most often affect the cardiovascular, musculoskeletal, ocular, and central nervous systems. Nearly 20% of affected individuals who are untreated die from thrombotic complications before the age of 30.

Case report: The authors present the case of a 54-year-old man with massive pulmonary emboli and severe pulmonary hypertension secondary to undiagnosed homocystinuria.

Conclusion: When dealing with unexplained thrombophilia, it is important to include homocystinuria in the differential diagnosis in order to avoid delayed diagnosis which can be life threatening.

In Japan, the incidence of Shigellosis is low at approximately 150 cases per year, with the majority of these being imported, mainly from Asia. Sporadic domestic occurrences are also reported, the majority of which absent epidemiological association. We report a case of gastroenteritis caused by Shigella flexneri in a 60-year-old Japanese female who recovered fully following treatment with levofloxacin. While we were unable to identify the route of infection, we suspected imported frozen marine products that may have been handled or processed in an unsafe manner. Shigellosis should be included in the differential diagnosis when presented with a patient exhibiting symptoms of gastrointestinal infection, even in the absence of a history of travel to an endemic area.

Angioleiomyoma is a benign, rare tumor. Our case speaks about a 41-year-old otherwise healthy man presented with a painful mass in his left medial retromalleolar region. It was described as an acute retromalleolar pain irradiated to the plantar aspect of the foot towards the big toe and the second and third toe. A positive Tinel’s sign was found with regional numbness and paresthesia. During the surgery the lesion was easily cleavable and it was lying in the supra-fascial region just over the neurovascular bundle. Posterior tibial artery, vein and nerve were located below an intact fascial layer; no signs of compression were detectable. Our case is the second case in the litterature describing an angioleiomyoma mimicking a tarsal tunnel syndrome.

We are reporting a case of interhemispheric-pericallosal lipoma, associated with bilateral small lateral ventricle choroid plexuses and third ventricle lipoma as well as partial agenesis of splenium of corpus callosum. Presentation in our case does not correspond to existing classification of pericallosal lipoma and as it is very rare, we are presenting it as a case report. Intracranial lipoma itself is a very rare anomaly and account for 0.06% to 0.46%. It represents a group of developmental abnormality of brain parenchyma that occur during embryogenesis, and it is located more frequently (about 50%) in the pericallosal cistern and may extend into one or both lateral ventricles. Pericallosal lipoma can also be associated with varying degree of callosal anomalies.

The aim of this study was to investigate the feasibility of using 980 nm diode laser for interstitial laser photocoagulation (ILP) before clinical application in benign thyroid nodule treatment. The bovine livers were cut into blocks to irradiate with 980 nm laser through the lumen of a 20-gauge spinal needle using a fiber optic guide. Laser irradiation was performed with the output power of 2 W and 3 W for 60, 120 and 180 seconds respectively. The liver blocks containing lesions were dissected along the axis of the fiber optic tracts and then cut transversely into slices. The thermal effect was evaluated by measuring the dimensions of the zone of coagulation necrosis. We present a case treated with 980 nm diode laser for the benign large thyroid nodule. All the irradiated areas zone measured in the gross specimens were 5.5 mm ± 1.4 mm (2 W, 60 s), 6.9 mm ± 1.4 mm (2 W, 120 s), 7.3 mm ± 0.5 mm (2 W, 180 s), 8.8 mm ± 2.2 mm (3 W, 60 s), 9.2 mm ± 0.8 mm (3 W, 120 s), 12.5 mm ± 4.1 mm (3 W, 180 s) respectively. The transverse diameter was as 5.1 mm ± 0.5 mm (2 W, 60 s), 6.1 mm ± 0.2 mm (2 W, 120 s), 9.9 mm ± 2.5 mm (2 W, 180 s), 6.2 mm ± 1.8 mm (3 W, 60 s), 7.7 mm ± 1.2 mm (3 W, 120 s), 8.8 mm ± 0.7 mm (3 W, 180 s) respectively. ILP was well tolerated and there was no complication. Interstitial laser photocoagulation with 980 nm diode laser induces well-defined tissue ablation correlated with energy parameters in bovine liver tissue and therefore, could be an efficient therapeutic tool in benign thyroid nodular disease.