A case of dark urine,hyperpigmentation and hepatomegaly

We report a case of malignant melanoma in which the presenting feature was melanuria. Melanuria should be considered in the differential diagnosis of any patient presenting with dark urine.     

Gastric variceal bleed in a patient without liver cirrhosis: an unusual cause of haematemesis

Tumours of the pancreas presenting as haematemesis are rare entities, with scarce documentation in literature. We report a 50-year-old woman who presented with haematemesis secondary to gastric fundal variceal bleeding due to splenic vein occlusion by a large mucinous cystadenoma of the pancreas. We also review the literature pertaining to unusual pathologies presenting as haematemesis.     

Unusual presentation of culture positive brucellosis

We have reviewed the clinical presentation of 100 consecutive culture positive cases of brucellosis which came under our care during the last two years. Of these, six had atypical presentations and but for the routine practice of sending blood for brucella culture, the diagnosis would have been missed. The unusual presentations included a 19 year old boy presenting as an acute abdomen ending in laparotomy, a 52 year old man presenting with a psoas abscess, a 29 year old woman presenting with a transient perinephric mass, a 75 year old man with an acute flare up of his osteoarthritis, a 65 year old diabetic man presenting in an insulin-resistant diabetic state and a 35 year old man presenting with a cauda equina syndrome.     

Jugular vein thrombosis associated with distant malignancy

We describe two patients who developed internal jugular vein thrombosis associated with primary malignant disease arising outside the neck, and in one patient it was the presenting feature. Computed tomography was performed and the findings characteristic of internal jugular vein thrombosis are illustrated. We conclude that malignant disease should be considered in patients presenting with spontaneous internal jugular vein thrombosis with no other predisposing factors and that computed tomography is of value in confirming the diagnosis.     

Management of patients with chronic kidney disease presenting with acute coronary syndrome

We evaluated the treatment pattern of patients with chronic kidney disease presenting with acute coronary syndromes. In a retrospective chart review of 400 patients with and without kidney disease presenting with angina pectoris we found that patients with chronic kidney disease have longer hospital stays, receive fewer diagnostic angiographies, and have a delay in therapy.     

Symmetrical Brodie's abscess.

Chronic recurrent multifocal osteomyelitis is often confused with symmetrical Brodie''s abscess as it has a similar pathogenesis. We report an otherwise healthy 17-year-old boy presenting with a true symmetrical Brodie''s abscess. We conclude that a symmetrical Brodie''s abscess presenting in an otherwise healthy patient is a separate clinical condition with a different management protocol.     

Chest pain, enzymes and hypothyroidism

Hypothyroidism is a common disorder and when presenting with classical symptoms and signs is easy to recognise. However, hypothyroidism may present in a manner suggestive of an acute myocardial infarction with an elevated creatine kinase and electrocardiographic abnormalities. We report a case of severe hypothyroidism presenting as a cardiac event whose symptoms and signs dispersed following treatment with thyroxine.     

《医学细胞生物学》双语教学模式的探讨

通过对医学本科《医学细胞生物学》双语教学模式探索实践,应用方差分析比较了三种不同模式下的教学效果。以"课件幻灯片中常用专业名词、相关概念以简单的英文句子或短语形式表达,并且具中文对照,其它以中文形式表现,中英文结合讲授"的双语教学模式对一年级的医学本科生进行双语教学最为合适。     

Rigors in tuberculosis.

Rigors are not a recognized characteristic of miliary tuberculosis. We report two patients presenting with persistent rigors, thought to be suggestive of acute pyogenic infection, who were subsequently found to have miliary tuberculosis. In both cases, there was significant diagnostic delay. Miliary tuberculosis should therefore be included in the differential diagnosis of any patient presenting with unexplained rigors.     

Constipation--another manifestation of eosinophilic gastroenteritis

Eosinophilic gastroenteris (EG) is a unique disease in which eosinophils penetrate into the layers of the GI tract. It is classified by the depth of the eosinophilic penetration, that can either be mucosal, muscularis or serosal. Symptoms vary with the bowel site involved as well as the depth of the eosinophilic penetration. Symptoms of the mucosal form of EG usually include nausea, vomiting, diarrhea and abdominal pain while constipation is extremely rare. We present a case of mucosal EG presenting as constipation and abdominal pain in a 43 year old female. Constipation is not a typical symptom associated with EG and while muscularis EG can cause decreased colonic motility and obstruction, constipation with mucosal EG has not been previously reported. We are presenting the first case report of constipation associated with mucosal EG. Thus EG should be considered in the differential diagnosis of patients presenting with constipation and abdominal pain and can easily be diagnosed with mucosal biopsies and treated with steroid therapy.     

Burkholderia pseudomallei meningitis following inadequate treatment of melioidotic mycotic aneurysm

We report a 64-year-old man presenting with meningitis caused by Burkholderia pseudomallei predisposed by persistent aortic graft infection following inadequate treatment of a melioidotic mycotic aneurysm. The relapse of melioidosis presenting as acute meningitis is a unique event. Successful treatment of deep-seated melioidosis can only be achieved when robust antimicrobial therapy is combined with appropriate surgical debridement.     

Nesidioblastosis-associated hypoglycaemia presenting with prominent cardiac manifestations.

We present a case of nesidioblastosis presenting with hyperinsulinaemic hypoglycaemia and electrocardiographic abnormalities.     

应用H_2O_2肝脏声学造影观察门脉高压血流动力学改变的初步研究

本文报告了应用H_2O_2肝脏声学造影方法观察17例门脉高压血流动力学改变的结果.观察结果发现:门脉高压患者门静脉循环时间延长.门脉各支血流速度变慢,肝实质显示差,呈颗粒状,团块状强回声区.气泡向脾静脉流动6例,下腔静脉显影2例.     

Invasive pulmonary aspergillosis: a rare presentation of non-Hodgkin's lymphoma.

We describe a patient with rapidly progressive pneumonia and a high level of serum lactate dehydrogenase, in whom postmortem study revealed the presence of a diffuse, small and large-cell multicentric non-Hodgkin''s lymphoma, together with an invasive pulmonary aspergillosis. Aspergillosis is rare as a presenting feature of a lymphoproliferative disease; only one previous case has been reported to the best of our knowledge. Invasive aspergillosis and lymphoma should be considered in patients presenting with pneumonia and high level of lactate dehydrogenase.     

Late-onset progressive visual loss in a man with unusual MRI findings: MS, Harding's, Leber's or Leber's Plus?

Leber’s hereditary optic neuropathy (LHON) is a maternally inherited disorder, typically presenting in the second and third decade. We report the case of an elderly gentleman with significant vascular risk factors, presenting with slowly progressive, bilateral, visual loss with high signal lesions in the pericallosal and periventricular deep white matter on MRI brain studies. Possible diagnoses included late-onset MS, ischaemic optic neuropathies, a mitochondrial disorder or an overlap syndrome such as Harding’s disease.     

The sign of Leser-Trélat: a paraneoplastic cutaneous syndrome that facilitates early diagnosis of occult cancer

The sign of Leser-Trélat has been described as a rare cutaneous marker of internal malignancy. We report a patient presenting with the sign of Leser-Trélat, in whom a limited diagnostic workup for an associated malignancy lead to the early diagnosis of asymptomatic renal cell carcinoma and curative tumor nephrectomy. A review on this and other cutaneous paraneoplastic syndromes is given. Since they may be the only presenting sign of an occult cancer, patients with these syndromes should undergo a diagnostic screening program for malignant disease.     

A case report on bronchoalveolar carcinoma presenting as non-resolving consolidation

Bronchoalveolar carcinoma presenting as non-resolving consolidation is an uncommon presentation. The typical presentation of bronchoalveolar carcinoma is asymptomatic (solitary nodule) and remains without symptoms even as disease disseminates. We report a case of bronchoalveolar carcinoma presenting as non-resolving consolidation in a young male with productive cough, exertional breathlessness and physical examination revealing the features of right lower consolidation on x-ray chest, with subsequent CT of the chest and bronchoscopic examination revealed bronchoalveolar carcinoma. Patient had a good score and was managed conservatively.     

Multiple small bowel cavernous hemangioma with hemorrhage： A case report

Hemangiomas of the gastrointestinal tract are uncommon, accounting for only 0. 05% of all intestinal neoplasm. Bleeding, chronic anemia, and abdominal pain are the most common presenting features. We report a case of small bowel multiple cavernous hemangioma presenting as gastrointestinal tract bleeding.     

Ankylosing spondylitis presenting with discitis

Ankylosing spondylitis is not an uncommon disease worldwide, yet is relatively rare in Bahrain. There is a typical pattern of joint involvement in cases of ankylosing spondylitis, but the presentation of discitis is rare. We present a case of a patient presenting with backache and was diagnosed to have discitis. The diagnosis of ankylosing spondylitis was made only after he was found to be Human Leukocyte Antigen-B27 positive. This is the first case report of ankylosing spondylitis presenting as discitis in Bahrain.     

Multilobated B-cell lymphoma of the spleen.

We report a case of multilobated B-cell lymphoma presenting with primary splenic involvement. This is a very unusual tumour occurring in an uncommon site.