IntroductionA volvulus occurs when a segment of intestine, usually part of the colon, twists around its mesentery. Following this rotation, initially venous return is disturbed and causes ischemia caused by venous stasis. With the prolongation of obstruction in the mesenteric vessels, along with the distention of the twisted segment of the intestine due to the progressive production of gas by the bacteria inside it, the arterial input is also disturbed, and the mucosal ischemia gradually progresses towards the muscular and serous layers, leading to perforation of the entire thickness of the intestineSigmoid volvulus accounts for 2% to 5% of colonic obstructions in Western countries and 20% to 50% of colonic obstructions in Eastern countries (1). This occurs mostly in patients with lack of mobility and a history of chronic constipation, where the sigmoid colon becomes chronically distended and redundant.Undescended testis (UDT) is defined as one or both testicles absent in scrotal sac when descending processes become disturbed and testis remains inside the peritoneal cavity (2). There are some very known complications of a undescendent intra-abdominal testicle such as cancer, ischemia and infertility(3); But the rotation of the colon around the spermatic cord of one UDT, it is a very rare phenomenon that there is no similar report.In this article, we introduce a 67-year-old man who underwent laparotomy with the diagnosis of sigmoid volvulus, and the intraoperative findings were surprising.
INTRODUCTIONTakotsubo syndrome is an acute heart disease that mimics the typical features of acute coronary syndrome (ACS) . Although takotsubo syndrome has an uncertain prevalence in the general population, in women with suspected ACS, the prevalence is estimated to be around 5-6% . The annual incidence is very low and is approximately 0.02% .Unlike ACS, TS is reversible and the heart often heals within four to eight changes weeks. The syndrome is characterised by transient systolic and diastolic left ventricular dysfunction with wall motion abnormalities . This condition, which was first described by Dote et al. in Japan in 1990 , usually affects postmenopausal women who have experienced some physical or psychological stress. However, it can also occur in the absence of these triggers .The prevalence of saccular aneurysms in the general population is estimated at 3.2%. Approximately 20 to 30% of cases present in the form of multiple aneurysms . Intracranial aneurysms are generally diagnosed after episodes of subarachnoid haemorrhage (SAH), which causes a high rate of morbidity and mortality . Rupture of an aneurysm is believed to be responsible for 0.4 to 0.6% of all aneurysm deaths, and approximately 10% of patients die before arriving at the hospital. Takotsubo syndrome is generally reported to have an incidence of 0.8-17% in patients with SAH caused by ruptured aneurysm . However, this case report is relevant for the clinical and pathophysiological observation of the possible association between aneurysms of the internal carotid arteries (ICA) and TS, with the latter being able to serve as an alert for possible aneurysms and thus allow for intervention prior to disruption.
Background: Aberrant migration of parathyroid glands from their embryologic origin may result in undescended parathyroid glands. We present a case of an ectopic parathyroid adenoma at the level of the pyriform sinus. Methods: A 41-year-old female was evaluated for primary hyperparathyroidism. Following non-localizing ultrasound and planar sestamibi imaging, the patient underwent
AUTHORSDr. Saroj Poudel Clinical Pharmacist Critical Care Medicine, Nepal Mediciti Email: firstname.lastname@example.orgDr. Rupak Chalise Anesthesiologist Critical Care Medicine, Nepal Mediciti Email: email@example.comDr. Manoj Bist Medical Officer Critical Care Medicine, Nepal Mediciti Email: firstname.lastname@example.orgDr. Ashim Regmi Junior Consultant Critical Care Medicine, Nepal Mediciti Email: email@example.comDr. Anup Ghimire Junior Consultant Critical Care Medicine, Nepal Mediciti Email: firstname.lastname@example.orgDr. Kishor Khanal Intensivist and ICU Coordinator Critical Care Medicine, Nepal Mediciti Email: email@example.com
Introduction:Pericardial syndromes are not uncommon manifestations in clinical practice . About 5% of all patients admitted to the emergency department with the chief complaint of chest pain, are diagnosed with acute pericarditis . Cardiac involvement is a common presentation of different autoimmune rheumatic diseases. Systemic lupus erythematous (SLE) is a chronic autoimmune rheumatic disease with multiorgan involvement. Cardiac involvement has been reported in about 50% of SLE patients; in some cases, as their first presentation of SLE . The most common type of cardiac involvement in SLE patients is pericarditis . While it is classically known that SLE like most of other autoimmune diseases are more prevalent in women, cardiac involvement as pericarditis in SLE is more prevalent in male patients . Although being a common manifestation of SLE, it is uncommon for acute fibrinous pericarditis with constrictive features to be the first presentation of SLE in patients with severe manifestations and in need for hospital admission .
IntroductionCoronavirus belongs to RNA viruses that cause respiratory, neurologic, enteric, and hepatic diseases distributed among mammals, including humans and birds (1). A novel coronavirus discovered in late 2019 in China caused Coronavirus Disease 2019 (COVID-19). It is associated with complications like severe viral pneumonia, ARDS, AKI, cardiac injury, liver dysfunction, spontaneous pneumothorax, lung cavitation, pleural effusion, pericardial effusion, along with other minor ailments like fever, loss of smell, myalgia, dry cough, lymphadenopathy (2) (3).Pneumothorax due to COVID-19 pneumonia is very rare, and few cases are reported with bronchopleural fistula-associated persistent pneumothorax while recovering from COVID-19 pneumonia (4) (5) (6).
IntroductionEctopic pancreas tissue (EPT) or pancreatic heterotopia is a rarely observed congenital abnormality defined as the presence of pancreatic tissue in another organ without any anatomical or vascular connection to the pancreas. The term consists of the two Greek words ”hetero-” which means ”other” and ”-topia” which means ”site”, pointing out the unique location of pancreatic cells. EPT’s favored sites are the stomach, duodenum, colon, jejunum, and Meckel’s diverticula (1). The gallbladder is a highly infrequent location for EPT (2). Almost all cases are detected incidentally during the histopathological examination after cholecystectomy for other pathologies. The prevalence of EPT in the gastrointestinal tract varies from 0.6% to 13.7% in autopsy series and 0.2% in laparotomies (3, 4). Although the malignant transformation of this tissue is not frequently expected, pathologists must be aware of it to ensure no malignant pathology is present and prevent further misdiagnosis. In this study, we present a case of EPT that we found incidentally during the histopathological examination of the specimen from the gallbladder in a patient who underwent cholecystectomy due to acute cholecystitis.Case HistoryA 40-year-old male was referred to the emergency department for acute pain in the right upper quadrant of the abdomen. The pain was constant and initiated hours before and intensified when he had dinner. He also reported fever, anorexia, nausea, and one involuntary vomiting episode containing only stomach contents. Besides intellectual disability and epilepsy, patient’s medical history was unremarkable otherwise. He was on Valproate(200mg/D), Risperidone(1mg/BD) and Clonazepam(1mg/HS). He denied smoking and any recreational drug use. No allergies were reported. During the clinical examination, his vitals were slightly above normal ranges (Blood pressure: 115/70mmHg; Heart rate: 108bpm; Respiratory rate: 19 breaths/min; Temperature: 37.9°C; Oxygen saturation: 99% without supplemental oxygen). The palpation of the abdomen revealed tenderness in the right upper quadrant and a positive Murphy sign with no rebound tenderness or guarding. The laboratory evaluation was within normal range except for a WBC count of 10300, ESR of 32, and a 2+ CRP. Additionally, he underwent an ultrasonographic evaluation of the upper abdomen, reporting a thickened wall gallbladder containing multiple stones (measuring up to 8x10mm). The patient was scheduled for emergency laparoscopic cholecystectomy under the diagnosis of acute calculous cholecystitis. During surgery, the gallbladder was found to be gangrenous. The patient had a complicated postoperative period due to surgical wound infections and was hospitalized for a week to receive intravenous antibiotics; however, he did not report any delayed complications or symptoms after discharge.
TITLE PAGEArticle TypeClinical pictureTitlePOUNDing score of Intracranial LipomasAuthorsYuta Aikawa, Takanobu Sato, Ryo IchibayashiAffiliationsDivision of Emergency Medicine Department of Internal Medicine, Toho University Medical Center, Sakura Hospital, Chiba, JapanCorresponding AuthorRyo Ichibayashi, MD, PhDORCID iD https://orcid.org/0000-0002-1273-4875Division of Emergency Medicine Department of Internal MedicineToho University Medical Center, Sakura Hospital564-1 ShimosizuSakura-shi, Chiba 285-8741, JapanPhone: +81-43-462-8811Fax: +81-43-462-8835e-mail: firstname.lastname@example.orgRunning titleIntracranial LipomasKeywordsLipomas, Headache, Intracerebroventricular, Diagnostic imagingConflict of interestThe authors have no conflict of interest to disclose.Financial supportThe author(s) received no financial support for this article’s research, authorship, and/or publication.Patient consentWritten informed consent was obtained from the patient to publish this report by the journal’s patient consent policy.Author contributionTS wrote and drafted the manuscript. YA, KI, and RI helped draft the manuscript. All authors read and approved the final manuscript.Data availability statementThe data presented in this study are available on request from the corresponding author. The data are not publicly available due to privacy and ethical considerations.AcknowledgmentsNone.Key clinical messageMost intracranial lipomas are asymptomatic, but headache is the most common symptom. The POUNDing score is sometimes high. Therefore, it is necessary to monitor imaging findings in parallel with the treatment of migraine.Clinical pictureA 29-year-old woman presented to the emergency department with a 2-month-old headache. Her headache was a unilateral throbbing headache like she had never experienced before. Her headache lasted more than 4 hours and was accompanied by vomiting. Otherwise, she had no abnormal neurological findings. She has a history of obsessive-compulsive disorder. She is on regular oral paroxetine hydrochloride and cloxazolam. She gained 30 kg weight in 4 years. So far, she has not seen a doctor because of her headache, although she has acknowledged it many times. She was conscious, had blood pressure 120/80 mmHg, pulse 60/beat, body temperature 35.0°C, pupil 5 mm/5 mm, and bilateral light reflex. No neck stiffness or unconsciousness was noted in her. Her blood tests showed no abnormalities. She underwent a head CT to rule out subarachnoid hemorrhage. Her head CT showed no intracranial hemorrhagic lesions. However, she had bilateral lateral ventricles and low-density structures in the right ventricle. CT values ranged from -20 to -80. When the head CT was set to the condition of the lung field, it was visually confirmed that it was not air (Fig. 1A). As a result, she was diagnosed with an intraventricular lipoma. The POUNDing score was 5 points, suggesting the possibility of migraine.1 After her symptoms improved with analgesics, she was sent home for outpatient follow-up. Intracranial lipoma is a rare benign tumor. Most are located in the midline within the cranium. Lipomas around the corpus callosum are associated with the hypomorphic and amorphic of the corpus callosum. Many cases are asymptomatic, with headache being the most common symptom. It is often found incidentally on head CT. Intracranial lipomas with headaches are found not only in the ventricle but also in other sites.2 At first glance, it can be mistaken for air mixed in the skull. When the CT value is measured, it shows a numerical value from 0 to -100 and is diagnosed as adipose tissue. It is rarely removed by surgery and is observed. The pounding score is a scale for diagnosing migraine. There are no reports of its use for intracranial lipoma. In our case, lipomas were found in the proper and third ventricles, and the right ventricle was more significant than the left (Fig. 1B). Headache due to intracranial lipoma was also considered. Still, from the result of the POUNDing score, it was diagnosed as a headache due to a migraine. Intracranial lipomas that have complained of headaches may include cases of migraine. Therefore, even if the intracranial lipoma is diagnosed, measuring the POUNDing score and differentiating migraine is necessary. On the other hand, the causal relationship between intracranial lipoma and headache has not been elucidated. For this reason, even if symptoms improve with analgesics, follow-up imaging is necessary when ventricular laterality, giant lipoma, and unexplained headache persist.References1. M. Tejero Mas, R. Burgos Blanco, J.J. Aguirre Sánchez, F. Buitrago Ramírez. The mnemonic POUNDing rule in the diagnosis of patients with migraine. Rev Clin Esp . 2018; 218(7): 388-389. doi: 10.1016/j.rce.2018.05.0042. Bilir O, Yavasi O, Ersunan G, Kayayurt K, Durakoglugil T. Incidental Finding in a Headache Patient: Intracranial Lipoma. Western Journal of Emergency Medicine . 2014;15(4):361-2. doi: 10.5811/westjem.2014.4.21298Figure １A・B Head CTUpper row： A is a lipoma in the right ventricle and B in the third ventricle. （white arrow）Lower row： It can be confirmed that both A and B are not air under lung field conditions. （black circle）