Pacemakers are implanted through the subclavian vein to the right side of the heart. In rare cases, pacemakers may be inserted into the left ventricle via the subclavian artery, carrying a risk of thromboembolism. This is a case of a pacemaker inserted via the subclavian artery into the left ventricle.

Trans-radial approach (TRA) is nowdays a more common approach during percutaneous coronary angiography and intervention. Catheter knot is rare but still a matter of concern for a catheterizing cardiologist. Hence, we describe our case of catheter unknotting using balloon internal fixation of angiography catheter.

Woman admitted for COVID-19 respiratory failure requiring intubation, renal failure and rising bilirubin, requiring CVVHD. Due to dropping hemoglobin and platelets, TTP was suspected and empiric plasma exchange initiated. Platelets normalized; she improved; ADAMTS13 level resulted 50.7%, indicating possible benefit of plasma exchange for COVID19 thrombotic microangiopathy despite normal ADAMTS13.

Ebstein anomaly, a rare congenital heart disease, is defined as displacement of hinge points of septal or posterior tricuspid leaflets but not anterior leaflet. Here we report a 35 year old lady with an extremely rare pattern of EA with all three tricuspid leaflets displaced downward to the apex.

Transesophageal echocardiography is mandatory if you do suspect infective endocarditis. By approaching via a small right thoracotomy, vegetectomy and mitral valvuloplasty following severe mediastinitis were successfully accomplished without any complications. 

Herein, we present a new surgical approach for vibrant soundbridge implantation in advance of the plastic reconstruction of the auricle in patient with unilateral microtia-atresia and highlight the importance of cooperation between otologists and plastic surgeons in the performance of this technique.

Clinical ImagesTitle: Twenty-years’ use of expanded polytetrafluoroethylene sheet for an artificial cardiac pacemakerKenji Yorita1*, Junichi Takahashi2, Kazutoshi Tano3, Yoichi Ichikawa3, Nobumasa Hamaguchi4, Wataru Yasui51Department of Diagnostic Pathology, Japanese Red Cross Kochi Hospital, Kochi-city, Kochi, Japan2Department of Internal Medicine, Japanese Red Cross Kochi Hospital, Kochi-city, Kochi, Japan3Department of Cardiovascular Surgery, Japanese Red Cross Kochi Hospital, Kochi-city, Kochi, Japan4Department of Thoracic Surgery, Japanese Red Cross Kochi Hospital, Kochi-city, Kochi, Japan5Department of Internal Medicine, Yusuhara Hospital, Kochi-city, Kochi, JapanThe authors report no conflict of interest, financial or otherwise.＊Corresponding Author: Kenji Yorita, M.D., Ph.D.,Department of Diagnostic Pathology, Japanese Red Cross Kochi Hospital, 1-4-63-11, Hadaminamimachi, Kochi-city, Kochi 780-8562, JapanTel: +81-88-822-1201Fax: +81-88-822-1056E-mail: [email protected] : expanded polytetrafluoroethylene sheet, cardiac pacemaker, foreign body

A middle aged female presented with a large flank mass, was initially reported to be a renal cell carcinoma of the sarcomatoid variant. Discordant presentation lead to further pathological work-up and a primary renal synovial sarcoma was diagnosed. We present our journey in images.

The objective of this study was to determine whether a caries management by risk assessment (CAMBRA) tool improves oral self-care behaviors and decreases caries diagnoses as compared to traditional oral health education strategies. Findings show patients with a CAMBRA lowered their caries risk as evidenced by lower plaque index scores.

Oropharyngocutaneous fistula is an unfavorable complication that may occur after head and neck reconstruction. The authors used a “stick-shaped platysma flap” technique to close these narrow and deep intractable fistulas. It is a highly efficient and straightforward method to close intractable fistulas with minimal morbidity.

The similarity between intestinal tuberculosis and Crohn's disease could lead us to erroneously prescribe corticosteroid therapy. Therefore, it is essential to differentiate the two pathologies because of the therapeutic implications of Crohn's disease, which can lead to an explosion of tuberculosis symptoms.

We present the case of a 35-year-old male with no medical history who presented with pancytopenia and melena and was found to have PNH in the setting of acute COVID-19 infection. Other infectious, autoimmune, and malignant etiologies were ruled out. It is unclear if this was an acquired PIG-A mutation.

An 89-year-old woman who had type 2 diabetes mellitus suddenly presented with abdominal pain. Abdominal computed tomography showed thickening of the wall and intramural gas in the gastric hilum, suggesting emphysematous gastritis. The patient underwent treatment with a proton pump inhibitor, and broad-spectrum antibacterial agents.

Rosai-Dorfman disease (RDD) is a rare non-malignant histiocytosis disorder, commonly manifesting with massive painless cervical lymphadenopathy. Renal involvement develops in only four percent of patients with RDD. Generally, RDD is self-limiting and has a good prognosis; however, in patients with renal involvement, mortality rate can be as high as 40%.

Central vision loss, photopsia, floaters, and macular edema in a highly myopic patient can easily be misrelated to high myopia complications. However, in atypical cases, detailed examination along with a thorough diagnostic is required to establish the right diagnosis, which is often beyond the limits of the condition originally considered.

Corticosteroid administration can be a trigger of the onset of invasive pulmonary aspergillosis in patients with hepatocellular carcinoma. It is necessary to pay attention to the presence of cirrhosis, which may be the basis of hepatocellular carcinoma especially when administering systemic corticosteroid.

Zygomatic arch fractures are the most common facial fractures or second in frequency after the nasal fractures. The high incidence of zygomatic fractures probably relates to its prominent position in the facial skeleton hence it is frequently exposed to fractures.

The colonic involvement in acute pancreatitis is quite rare and most commonly occurs in the adjacent colonic part including transverse and splenic flexure colon. This case showed that extrinsic, secondary acute appendicitis could be as a complication of acute pancreatitis.