A case of Brugada pattern “bigeminy”

The present case reports for the first time an unusual presentation of Brugada type 1 pattern occurring in a “bigeminy way” without no drug challenges or any apparent causes in a family member of a proband with type 1 pattern.     

Analysis of local pain after cranial deficiency repair: 1 case report

1GENERALDATACasecondition:Famle,aged35yearsold,craninalbonerepairwasperformedonMay1998.deficiencyofcranial5cm×5cm,region:temporaandparietalarea.Operativetime:typeofoperationisIItyperepair,repairmaterialwasfixedwithdoublesize7silk,andmouldedunderlocalintensifiedanesthesin.Woundwereduchedwithgentamycinsulfateliquid,drainwaslaid,removedonnextday.Secondaryoperation:Resultofexploration(leadingtopain):subcutaneoushydrops.2DiscussionAboutmaterialofrepair:Thematerialprovidedtorepaircranialbon…     

Effectiveness of yoga in eating disorders – A case report

Eating disorders are among the most common psychosomatic diseases and are often associated with negative health consequences. The use of yoga as a treatment method in eating disorders is controversial discussed. The interviewee was a 38 year old female patient suffering on anorexia nervosa and various psychosomatic-psychiatric diagnoses in her medical history. The patient reported that yoga recovered the soul contact which she lost and she had learned to perceive and feel herself again. She stated that yoga helped her to find access to her body and its needs and to cope with her traumatic experiences. She also reported that attitudes have changed in relation to her stomach in the treatment of her anorexia. The case report confirmed the positive effect of yoga on eating disorders. Research should pay particular attention to taking into account the influence of individual’s co-morbidities, as eating disorders usually occur in association with co-morbidities.     

Isolated vaginal metastasis from stage Ⅰ colon cancer: A case report

BACKGROUND Distant metastasis occasionally occurs in patients who have been diagnosed with colorectal cancer(CRC), but it occurs in a few patients with stage I CRC. The vagina as a metastasis site has also been reported, albeit rarely. Most reported cases of vaginal metastasis(VM) report their origin from advanced CRC. We encountered a patient who was diagnosed with isolated VM originating from stage I colon cancer(T2N0) and herein present the case of this patient.CASE SUMMARY A 63-year-old woman visited the outpatient clinic because of a positive result from a stool occult blood test. She underwent laparoscopic anterior resection and was pathologically diagnosed with stage I(T2N0) sigmoid colon cancer. Neither lymphovascular invasion nor perineural invasion was observed. Ten months following the surgery, isolated vaginal metastases were detected on gynecologic examination. The examination was performed due to vaginal spotting. A transvaginal wide excision was performed, and no other adjuvant treatment was provided after discussion with a multidisciplinary team and the patient.Subsequently, a new VM was discovered after 33 mo. An additional transvaginal excision was performed. To date, there has been no evidence of further disease progression. From the time of diagnosis of VM, the patient’s overall survival has been 54 mo.CONCLUSION VM can occur as a result of early-stage colorectal cancer. Surgeons should consider the possibility of VM following complaints of gynecologic symptoms following surgery.     

Spontaneous regression of stage Ⅲ neuroblastoma: A case report

BACKGROUND Neuroblastoma(NB) is the most common type of extracranial solid tumour in children. The overall prognosis of NB is poor, but at the same time, NB shows significant clinical diversity. NB can demonstrate spontaneous regression or can differentiate into benign ganglioneuroma.CASE SUMMARY This study retrospectively analyzed the clinical data of a patient with spontaneous regression of stage Ⅲ NB who was admitted in May 2015. Studies of the spontaneous regression of NB published from October 1946 to September 2019 were retrieved through Pub Med. The clinical manifestations, diagnosis,treatment, and follow-up results were analysed.CONCLUSION Spontaneous regression of stage Ⅲ NB is rare in the clinic. The report of this case is an important supplement to the study of the spontaneous regression of NB.     

Unusual complication in patient with Gardner’s syndrome: Coexistence of triple gastrointestinal perforation and lower gastrointestinal bleeding: A case report and review of literature

Gardner’s syndrome (GS) is a rare syndrome with autosomal dominant inheritance, which is characterized by multiple intestinal polyps, dental anomalies, desmoid tumors, and soft tissue tumors. All gastrointestinal symptoms seen in GS are associated with the underlying familial adenomatosis polyposis and abdominal desmoid tumors, with the most common symptoms being anemia, lower gastrointestinal bleeding, abdominal pain, diarrhea, obstruction, and mucous defecation. To our best knowledge, no case of GS that has presented with gastrointestinal perforation and bleeding has ever been reported in the English language medical literature. A 37-year-old male who had been diagnosed with GS five years earlier was referred to our clinic for lower gastrointestinal bleeding. Despite the absence of a bleeding focus on conventional angiography, the patient was operated on with laparotomy, due to the persistence of both signs and symptoms of mild peritonitis. On the laparotomy, the patient was noted to have areas of perforation in the duodenum, splenic flexura, and mid-rectum. The third and fourth part of the duodenum, the proximal 15 cm segment of the jejunum, a 10 cm segment of the terminal ileum, the whole colon, and the upper and middle rectum were resected, and duodeno-jejunal side-to-side anastomosis and terminal ileostomy were performed. The histopathological analysis of the large mass measuring 30 cm × 20 cm was reported as a desmoid tumor. The pathological examination of the tumor foci detected in the colonic specimen revealed poorly differentiated adenosquamous carcinoma.     

Robot-assisted total remnant gastrectomy for interposed jejunal pouch dysfunction 25 years after proximal gastrectomy for gastric cancer: A case report

Proximal gastrectomy (PG) in combination with jejunal pouch interposition is a technique aimed at improving the postoperative dietary outcomes; however, some cases are reported to require surgical intervention owing to difficulty of food intake caused by pouch dysfunction. Herein, we present a case of robot-assisted surgery for interposed jejunal pouch (IJP) dysfunction in a 79-year-old male, occurring 25 years after the initial PG for gastric cancer. The patient had chronic anorexia for 2 years and was treated with medications and dietary guidance; however, 3 months prior to admission his quality of life had reduced, owing to worsening symptoms. The patient was diagnosed with pouch dysfunction due to extremely dilated IJP identified using computed tomography and underwent robot-assisted total remnant gastrectomy (RATRG) with IJP resection. After an uneventful course of intraoperative and postoperative treatment, he was discharged with sufficient food intake on postoperative day 9. RATRG can, thus, be considered in patients with IJP dysfunction after PG.     

Interstitial laser therapy in hemangiomatosis of the liver – A case report

ObjectiveDiffuse neonatal hemangiomatosis (DNH) is a severe disease with multiple organ involvement. If left untreated, it results in high mortality rates. Death occurs due to intractable heart failure following arteriovenous shunting or due to massive cerebral or gastrointestinal bleeding. If there are large liver hemangiomas and medical treatment is not sufficient, it is necessary to use interventional or surgical procedures such as embolization or ligation of the hepatic artery. We present another local tumor destruction procedure to treat liver hemangiomas in DNH, the interstitial laser therapy (ILT).MethodILT was performed in a 3-month-old male infant suffering from DNH with intractable heart failure and multiple liver hemangiomas. Due to the severity of the infant's condition and the minimally invasive character of the treatment, the ILT was performed directly in the neonatal intensive care unit. The ILT was carried out percutaneously by guiding a bare fiber (0.6 mm core diameter) via a puncture needle into the pathologically altered liver region. A Nd:YAG laser (1064 nm) was used as a light source for ILT because its light penetrates deeply into biological tissue. Tissue destruction was achieved with moderate laser power of 4–6 W and a long application time of 90–300 s. Using these applied physical laser parameters, almost spherical volumes of coagulation necrosis could be obtained with diameters of up to 1–2 cm. Puncture and the laser application were monitored by color-coded duplex sonography (CCDS). A decrease in color signal intensity at the tip of the bare fiber indicated the increasing tissue coagulation during application time.ResultsAfter 2 sessions of ILT of liver manifestation in 10 days the cardiac output was reduced by 50%. Postoperative Doppler imaging showed fibrosis in the treated areas of the liver. The child was transferred back to his country of origin but he died 3 months later of intracranial bleeding.ConclusionIn our opinion interstitial laser therapy can be an effective minimally invasive method to treat life-threatening liver hemangiomas in diffuse neonatal hemangiomatosis.     

A little “dab” will do ya’ in: a case report of neuro-and cardiotoxicity following use of cannabis concentrates

Context: The use of marijuana and cannabis concentrates is increasing, especially following decriminalization in several states. Psychosis and cardiotoxicity have been reported following cannabis use; however, myocardial injury from “dabbing” has not yet been reported. We report a case of hyperthermia, tachycardia, hypertension, severe agitation, neuro-, and cardiotoxicity following the use of “dabs” where there is concomitant confirmatory biological and sample testing.

Case details: A 17-year-old athletic man developed agitation requiring sedation and intubation for safety, with peak systolic blood pressures in the 190s and hyperthermia (to 102?°F). He developed elevated serum troponins with persistent tachycardia despite sedation and no clear non-intoxicant etiology. It was discovered that the patient had recently been “dabbing”; an exhaustive search of his home found a sample of the “dabs” which was analyzed along with a comprehensive urine drug screen by tandem liquid mass spectroscopy (t-LCMS) for confirmation.

Discussion: Tetrahydrocannabinol (THC) has been increasingly associated with agitation and cardiotoxicity, while cannabidiol (CBD) has been associated with neuroprotective, inhibitory states. We propose that increasing concentrations of THC as well as THC:CBD ratios seen in cannabis concentrates such as “dabs” may cause agitation and end-organ damage through sympathomimetic and serotonergic pathways.     

Oral rehabilitation of a Parkinson’s patient: A case report

Parkinson’s disease is an idiopathic disorder of the central nervous system, characterized by resting tremors, muscular rigidity, slow and decreased movements. Oral rehabilitation of these patients requires special care, especially in those cases where the patient’s socioeconomic status is not good and patient cannot come several times for fabrication of a complete denture. This clinical report presents a case of a Parkinson’s patient who was completely rehabilitated in 3 appointments using special techniques. Border molding, final impression and jaw relation procedures were done in one appointment by using a custom tray with detachable handles and occlusal rims.