The gradual increase in shoulder implants has resulted in a parallel increase in periprosthetic fractures of the humerus. Currently, there are no definite certainties about the best methods of treatment and there are no adequate devices to ensure optimal healing. Undoubtedly, the multitude of experience in treating femoral periprosthetic fractures can be a guide used to improve the approach to periprosthetic fractures of the humerus. The use of metallic fixation devices, in combination with bone grafts, could represent a favourable mixed mechanical and biological solution in the treatment of periprosthetic fractures of the humerus. This article presents a case of periprosthetic humeral fracture in a 77-year-old woman with reverse shoulder prosthesis.
Clinical use of Amplatzer Vascular Plug in central and peripheral vascular system has been extensively described in the literature. We present a case of occlusion of left vertebral artery (LVA) performed by deploying an Amplatzer Vascular Plug, in addition to microspheres plus coils for embolization of the deep cervical branches that feed a cervical metastasis involving the left VA. After the endovascular intervention, the patient underwent surgical resection of the lesion. The application of the device, the use of multiple embolic materials, as well as the angiographic and clinical results of the procedure, were evaluated because not previously reported in the literature. Hence, we provide an updated literature review about clinical use of Amplatzer Vascular Plug in supra-aortic vessels.
Munchausen syndrome is a complex type of abuse, which is often underdiagnosed or misdiagnosed in clinical practice, and has harmful consequences for children. Its relationship with child abuse, of which it is a variety, must be recognized in clinical and forensic practice. The authors report herein two observed cases of different types of Münchausen syndrome by proxy (MSbP). The first, is the most severe form ofMSbP, with induced, true illness and related pathological symptoms into victim. The second case is a moderate form, much more complex to detect, in which a perpetrator parent simulates and aggravates the child‘s illness. Adequate training of health professionals and investigators is essential in revealing cases of MSbP. Diagnosis must be based on the study of the different forms of "abuse" and the knowledge of clinical protocols used to validate any suspected behaviour which could be potentially harmful to the child. Moreover, a lack of training may lead to misleading interpretations of medical history interpretation and fallacious conclusions. Our study aims to review the features that are to be considered in a suspected case of MSbP, in accordance with a recently updated consensus statement by the Committee on Child Abuse and Neglect from the American Academy of Pediatrics.
The pseudo-aneurysm is an encapsulated hematoma of post-traumatic origin which is in communication with the lumen of the artery of relevance. We present a rare case of pseudo-aneurysm occurring after superior thyroid trans-esophageal echocardiography (TEE) and external cardioversion. Singular occurrence in otolaryngology, if not recognized early a pseudo-aneurysm can result in dramatic events such cataclysmic bleeding or acute occlusion of the upper airway.
Prune Belly Syndrome (PBS) is a rare congenital syndrome characterized by three main features: abdominal wall flaccidity, bilateral intra-abdominal cryptorchidism, and urologic abnormalities.
In this study we describe the case of a 2,600 gr baby, born at the Central Hospital of Beira, Mozambique.
Our study confirms that in a low-income country only conservative management can be delivered, and therefore prognosis is worse and less effective than high-income countries.
A 16-year-old girl had been undergoing intensive chemotherapy (ALL 2009) for Early T -cell precursor acute lymphoblastic leukemia (ETP). At 22:00 of the 26th day of induc-tion phase IA, she was found to have developed febrile neutropenia. After blood cul-tures were obtained, empirical therapy with ceftriaxone and amikacin was initiated, according to internal protocol. Clinical condition improved and she remained afebrile for 24 hours. The following day, at 04:00, she suddenly developed a cough with hemoptysis. At this time, fibrinogen was 167 mg/dL, and platelets 35000/uL. A chest X-ray showed thickening in the middle of the right lower zone, and a chest CT scan showed a nodule with central hypodense area (necrotic-colliquative evolution of the infiltrate). In spite of supplementation with platelets, red blood cells, plasma, fibrino-gen, antithrombin, and activated factor VII, the patient's clinical condition worsened rapidly and the pulmonary hemorrhage became uncontrollable. She died at 12:00. Blood cultures yielded a strain of Pseudomonas aeruginosa, with reduced sensitivity to antibiotics.
Aspergillosis is the most frequent infectious cause of massive pulmonary hemorrhage in pediatric leukemias, while bacterial pneumonia or TBC are by far less frequent. As-pergillus requires the presence of neutrophils to cause hemoptysis or cavitation, while bacteria (Gram-positive or -negative) can cause pulmonary necrosis also in patients with neutropenia.
Introduction: Thoracic splenosis is an acquired rare condition, resulting from het-erotopic autotransplantation of splenic parenchyma into chest, usually after traumatic spleen and diaphragm rupture. Methods and Results: This paper describes the thoracic splenosis, as an incidental di-agnosis and asymptomatic condition, 34 years after a thoracoabdominal trauma in a patient who underwent radiological investigations due to a 15 kg weight loss in the previous four months: the only abnormalities found were thoraco-parapericardial and abdominal nodules of splenosis. Discussion: Thoracic splenosis is a rare condition, usually following a thoracoabdomi-nal trauma with concomitant lesions of the spleen and diaphragm, which allow tho-racic implantation of splenic tissue. Patients are generally asymptomatic, and the con-dition is discovered incidentally during radiological investigations, which allow certain diagnosis without using invasive methods. Excision of splenosis should be considered for symptomatic patients or unconfirmed diagnosis. Conclusions: Thoracic splenosis is a rare condition. Imaging investigations allow to diagnose the condition, and excision of splenosis is not suggested for asymptomatic patients
Intra-abdominal desmoplastic small round cell tumors are rare aggressive neoplasms, with a very poor prognosis, observed in young adults with a male predominance. Their etiology is unknown and the diagnosis is based on histopathology, immunohistochem-istry and cytogenetics. Histological analysis shows typically clusters of round cells separated by abundant desmoplastic stroma. These tumors exhibit a multi-marker im-munohistochemistry profile expressing the three embryonic lineages: epithelial, neural and mesenchymal. They are positive for desmin and cytokeratin and are characterized by a specific recurring translocation t (11: 22) (q12 - p13), which involves EWSR1 WT1 gene. They are usually fatal despite an aggressive multidisciplinary therapeutic approach. Hereby we report the case of a 39 year old man who presented with an in-tra-abdominal desmoplastic small round cell tumor. The diagnosis was made by radio-logical, histological and immunohistochemistry profile analyses of a CT scanguided bi-opsy. This article also includes a mini review of the literature.
Retropharyngeal abscesses (RPA) are rare in adults. We report a case of a healthy adult with RPA presenting with clinical symptoms of acute thyroiditis. A 37-yr-old female presented with a painful mass in the anterior region of the neck, sore throat, mild fever and dysphagy for liquids and solids. Neck emergency US dis-closed normal thyroid ventrally displaced by a huge retropharyngeal hypoechoic mass. Direct laryngoscopy revealed erythema of the posterior pharyngeal wall with bulges (8 cm) preventing the correct visualization of the glottic plane. CT confirmed the pres-ence of retropharyngeal abscess and laryngoscopic drainage was performed. The pa-tient was discharged on 11th post-operative day, in good condition. The high mortality rate of retropharyngeal abscess is related to its association with invasion of contiguous structures and mediastinum: once mediastinitis occurs, mortality reaches 50%, even with antibiotic therapy. CT is fundamental for the diagnosis, but in many cases, as our, ultrasonography of the neck may play a pivotal role as quickly as possible. Surgi-cal treatment (intraoral incision and drainage) is the better definitive and resolutive treatment. The clinical diagnosis of retropharyngeal abscess in adult can be difficult because of the lacking and non specificity of clinical presentation. It is recommended to collect accurate clinical history, careful examination of the head and neck and use of early ultrasound examination of the neck, which in real time can give precise indications to guide the diagnosis and therapy. The management of a retropharyngeal abscess depends on the patient’s clinical condi-tion, moving from conservative treatment with steroids and antibiotics to reanimation and aggressive surgical drainage.
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. Rectal localization is rare. The gold standard for treat-ment is: surgery and tyrosine kinase inhibitors (TKIs) for metastatic or unresectable disease.
We report a case of a 62 year-old woman who underwent a gastroenterology visit for abdominal pain, tenesmus and constipation. After GIST diagnosis and staging, the pa-tient started induction therapy with imatinib followed by concomitant radio and tar-geted therapy before a sphincter-saving anterior resection, with a regular postopera-tive course.
The rationale of neoadjuvant treatment is lesion downsizing for an easier surgery. In epithelial cancers treated through concomitant therapies, the goal is also to preserve the functional integrity of organs, lowering the risk for salvage therapies. Also in GISTs, there is a direct correlation between downsizing, downstaging and outcomes.