Sonographic appearance of proliferative fasciitis‐‐‐A case report

Proliferative fasciitis is a benign entity involving the subcutaneous tissues and fascias, characterized by the proliferation of fibroblast‐like spindle cells and ganglion‐like cells. However, proliferative fasciitis may be easily confused with sarcoma clinically and pathologically, because it appears as a rapidly growing painful mass and has histologic features such as high cellularity, bizarre morphologic patterns, mitotic figures, and diffuse infiltrative proliferation. Imaging findings of proliferative fasciitis have been very rarely reported. We report the sonographic findings in a case of proliferative fasciitis in a 43‐year‐old woman with histopathological correlation. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 45 :445–449, 2017     

Lyonia ovalifolia (Angeri) poisoning: A case report

Lyonia ovalifolia (angeri) is a deciduous tree whose shoot and leaves are toxic. Its chemical constituents include grayanane diterpenoids, lyoniol A, and other toxic compounds. Young children might consume it intentionally or unintentionally, with subsequent adverse health outcomes and even mortality depending on the amount ingested. We present a case of an adolescent girl who developed poisoning on ingestion of angeri leaves.     

Ultrastructural changes in rat thyroid tissue after acute organophosphate poisoning and effects of antidotal therapy with atropine and pralidoxime: A single-blind, ex vivo study

Background: Organophosphate (OP) insecticides are widely used in both agricultural and landscape pest control, and the potential for human exposure to these compounds is significant.Objectives: The aims of this study were to investigate the effects of acute poisoning with the OP methamidophos and the effects of antidotal therapy with atropine and pralidoxime on rat thyroid tissue ultrastructure.Methods: In this single-blind, ex vivo study, male Wistar albino rats weighing 220 to 230 g were divided into 4 treatment groups. Group 1 received a median lethal dose of methamidophos (30 mg/kg) via oral gavage. Group 2 received saline via oral gavage and served as the control group for group 1. Group 3 received methamidophos (30 mg/kg) via oral gavage, and after 8 minutes atropine 0.05 mg/kg and pralidoxime chloride (2-FAM) (40 mg/kg) were administered intraperitoneally (IP). Atropine was titrated to reverse signs of cholinergic excess. Group 4 received saline via oral gavage followed by IP injections and served as the control for group 3. Rat thyroid tissues were examined using electron microscopy, and the histologic changes were examined by a histopathologist who was blinded to treatment. All rats were euthanized by intracardiac blood collection. The rats in groups 1 and 2 were euthanized 8 minutes after treatment. The rats in groups 3 and 4 were euthanized 96 hours after treatment.Results: Thirty-four male rats (aged 16 weeks) were included in the study. The rats were grouped accordingly: group 1 (n = 10); group 2 (n = 7); group 3 (n = 10); and group 4 (n = 7). The mean (SD) pseudocholinesterase (FCE) activity was significantly lower in the methamidophos-treated rats (group 1) compared with the corresponding control group (group 2) (32.6 [17.0] vs 579.4 [59.0] U/L, respectively; P < 0.001). PCE activity was significantly higher in rats treated with atropine and 2-PAM (group 3) (392.5 [39.4] U/L; P < 0.001) compared with those not receiving antidotal therapy (group 1). Group 1 experienced changes in thyrocytes and organelles that were not detected in the antidote-treated rats in group 3. These changes included follicular cell nuclei exhibiting an increase in chromatin content, pyknotic nuclei, mitochondrial degeneration, dilated granular endoplasmic reticulum cisternae, reduced microvilli, and intraluminal cellular debris. Within follicular cells, formation of vacuoles filled with fine granular material was noted.Conclusion: Acute OP poisoning was associated with histopathologic effects in rat thyroid tissue that appeared to be mitigated by antidotal therapy in this small animal study. More extensive studies using immunohistochemical methods are needed.     

Management of Subcutaneous Emphysema with “Gills”: Case Report and Review of the Literature

Background

Subcutaneous emphysema is often a symptom of a serious pathologic condition but rarely requires direct treatment. Subcutaneous emphysema itself occasionally may interfere with effective cardiopulmonary resuscitation and require direct intervention.

Objective

The aim of this article is to present a case of subcutaneous emphysema during cardiac arrest and to describe a therapeutic technique that we call the “gills” procedure, as well as the background and rationale for this and other similar techniques.

Case Report

A 56-year-old man sustained cardiac arrest in the setting of a perforated duodenal ulcer with massive subcutaneous emphysema and pneumomediastinum that interfered with effective cardiopulmonary resuscitation. A “gills” procedure consisting of bilateral skin incisions over the clavicles was performed, with the return of spontaneous circulation.

Conclusion

Subcutaneous emphysema and pneumomediastinum can cause tension physiology, impairing normal cardiovascular and pulmonary function. Only with release of this tension can normal cardiopulmonary function return. The gills procedure is one of several possible therapeutic options.     

Subcutaneous Target Stimulation–Peripheral Subcutaneous Field Stimulation in the Treatment of Refractory Angina: Preliminary Case Reports

Abstract: Spinal cord stimulation is now established as an effective treatment for refractory angina. We present the use of an alternative approach to neuromodulation of anginal pain using subcutaneous leads placed at the site of pain. In this case series, five patients with refractory angina received successful treatment with subcutaneous target stimulation–peripheral subcutaneous field stimulation. This technique was able to provide good analgesia in two patients that had had poor pain relief from existing spinal cord stimulators. All five patients achieved significant pain relief with a reduction in symptoms and a decrease in the use of pain medication.     

Subcutaneous angiolipoma in the scrotum: A case report

BACKGROUNDAngiolipoma has been reported in many cases, and it often occurs in the skin of the trunk and limbs. However, angiolipoma in the scrotum is a rare disease with unknown etiology. This condition is difficult to diagnosis with other lumps in the scrotum.CASE SUMMARYA 32-year-old man presented to the urinary department with a history of an enlarged left scrotum with increasing discomfort for about 5 years. Physical examination revealed that there were a palpable mass measuring about 7.0 cm × 6.5 cm in the left scrotum, with smooth surfaces but without tenderness or adhesion to the skin. Ultrasound showed that there was a hyperechoic mass under the skin of the top scrotum, about 72 mm × 64 mm × 21 mm in size, with clear borders, uneven internal echo, and abundant blood flow signals. Serum human chorionic gonadotropin and alpha-fetoprotein were in normal level. Subcutaneous mass resection at the bottom of the left scrotum was performed under local anesthesia with 1% lidocaine. Postoperative pathological examination resulted in a diagnosis of subcutaneous angiolipoma of the scrotum. No evidence of recurrence was found at 6 mo after surgery and there were no complaints of discomfort.CONCLUSIONAngiolipoma is an extremely rare type of benign tumor extremely rarely found in the scrotum, but needs to be considered when evaluating scrotal masses especially when the mass is solid. According to the characteristics of angiolipoma, surgical resection is the best treatment strategy and it is not prone to recurrence after resection.     

Intestinal tuberculosis—the challenging mimicker—in a young Sudanese patient: A case report

This article reported a case of intestinal tuberculosis (ITB)in a young patient. ITB could mimic many other diseases such as inflammatory bowel diseases (Crohn’s disease), abdominal lymphoma, and others which make it difficult to differentiate; hence, many ITB patients could get mis‐diagnosed and suffer wrong treatment consequences.     

Dominant omodysplasia—A sporadic case—A new case report and review of the literature

Omodysplasia is an extremely rare skeletal dysplasia. Since introducing this phenotype as a new syndrome, ten cases of the autosomal dominant type of this disease have been reported. Here, we present a new patient and review published articles in this field to provide a clinical diagnostic criterion.     

Sinonasal immunoglobin G4—related disease: case report and review

Immunoglobin G4—related disease (IgG4‐RD) is a chronic fibro‐inflammatory condition that presents as a single or multiple tumefactive lesions affecting virtually any organ system. Here we report a case of recurrent sinonasal IgG4‐RD and review the literature of this evolving entity.     

Subcutaneous Target Stimulation (STS) in Chronic Noncancer Pain: A Nationwide Retrospective Study

Stimulation of primary afferent neurons offers a new approach for the control of localized chronic pain. We describe the results with a new neurostimulation technique, subcutaneous target stimulation (STS), for the treatment of chronic focal noncancer pain. STS applies permanent electrical stimulation directly at the painful area via a percutaneous‐placed subcutaneous lead. We reported the clinical outcomes of 111 patients with focal chronic, noncancer pain treated with STS in this first nationwide, multicenter retrospective analysis. The indications for STS were low back pain (n = 29) and failed back surgery syndrome (back pain with leg pain) (n = 37), cervical neck pain (n = 15), and postherpetic neuralgia (n = 12). Pain intensity was measured on a numerical rating scale (NRS) before and after implantation. Data on analgesic medication, stimulation systems, position, and type of leads and complications were obtained from the patients' records. After implantation, the mean pain intensity improved by more than 50% (mean NRS reduction from 8.2 to 4.0) in the entire patient group (P = 0.0009). This was accompanied by a sustained reduction in demand for analgesics. In all the patients, the STS leads were positioned directly at the site of maximum pain. Lead dislocation occurred in 14 patients (13%), infections in 7 (6%), and in 6 cases (5%), lead fractures were observed. The retrospective data analysis revealed that STS effectively provided pain relief in patients suffering from refractory focal chronic noncancer pain and that STS is an alternative treatment option. Prospective controlled studies are required to confirm these retrospective findings. This article presents a new minimally invasive technique for therapy‐resistant focal pain.     

Once was not enough: A case report of the concomitant intoxication of amlodipine (calcium channel blocker) and clonazepam (benzodiazepine)

We report a case of concurrent ingestion of Clonazepam and Amlodipine in a 25‐year‐old man, in a second attempt to take his life, which resulted in unconsciousness, hypotension, and hypokalemia. The clinical and/or biochemical presentation varied from the individual pattern when ingested. In the scarcity of consensus recommendations, supportive treatment helped.     

Sonographic findings in Nicolau syndrome following intramuscular diclofenac injection: A case report

Nicolau syndrome (also known as embolia cutis medicamentosa and livedoid dermatitis) is a rare but severe localized adverse drug reaction of intramuscular injection of various drugs. The typical presentation is pain around the injection site soon after injection, followed by erythema, livedoid patch, hemorrhagic patch, and finally necrosis of skin, subcutaneous fat, and muscle tissue. We report a case that occurred in a 34‐year‐old woman after intramuscular injection of diclofenac sodium. Sonography showed diffuse thickening with increased echogenicity of the skin and subcutaneous fat layer, while MRI revealed extensive edema involving gluteal and piriformis muscles and deep fascia, and fluid collection. © 2010 Wiley Periodicals, Inc. J Clin Ultrasound, 2010     

4-Aminopyridine (fampridine) effectively treats amlodipine poisoning: a case report

A case of a serious poisoning with the calcium entry blocker amlodipine is described, which was treated effectively with 4-aminopyridine. Calcium is suggested as general treatment of poisoning with calcium entry blockers in many guidelines. The use of intravenous 4-aminopyridine is theoretically useful to treat poisoning from calcium entry blockers and was demonstrated in this case report.     

醒脑静注射液配合高压氧治疗急性一氧化碳中毒疗效观察

目的 :观察醒脑静注射液配合高压氧治疗急性一氧化碳 (CO)中毒的疗效。方法 :急性 CO中毒患者分 2组治疗。 2组常规治疗相同 ,对照组 (4 6例 )加用高压氧治疗 ,治疗组 (31例 )加用醒脑静注射液静滴和高压氧治疗 ,观察 2组疗效。结果 :醒脑静治疗组与对照组总有效率分别为 87.1%和 6 7.4% ,发生迟发脑病例数分别为 2例和 6例 ,2组比较均有显著差异 (P均 <0 .0 5 )。结论 :醒脑静注射液配合高压氧治疗急性 CO中毒能明显提高总有效率 ,缩短意识恢复时间 ,减少迟发脑病的发生 ,且无不良反应