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1.  Decorative crystal balls causing intestinal perforation 
Crystal jelly balls are used for decorative purpose in homes and offices. They swell on contact with water. We managed a patient with a clinical diagnosis of acute abdomen. At surgery, there was fecal peritonitis and three ileal perforations caused by previously ingested decorative crystal balls.
doi:10.4103/0971-9261.83493
PMCID: PMC3160050  PMID: 21897572
Acute abdomen; crystal balls; generalized peritonitis; intestinal perforation; missing foreign body
2.  Case report: A ball valve blood clot in the airways – life-saving whole tube suction 
Critical Care  2004;8(5):R289-R290.
Respiratory tract obstruction due to a blood clot may result in life threatening ventilatory impairment. Ball valve blood clot obstructions of the airways are rare. A ball valve blood clot acts as a one-way valve, allowing (near) normal air entry into the airways, but (completely) blocking expiration. In a near fatal case of obstruction of the airways by a ball valve blood clot, we performed 'whole tube suction' to resolve the airway problem.
doi:10.1186/cc2903
PMCID: PMC1065016  PMID: 15469570
blood clot; airway obstruction; suction; tracheostomy
3.  Bentall procedure 39 years after implantation of a Starr-Edwards Aortic Caged- Ball-Valve Prosthesis 
We report a case of a male patient who received an implantation of a Starr-Edwards-caged-ball-valve-prosthesis in 1967. The surgery and postoperative course were without complications and the patient recovered well after the operation. For the next four decades, the patient remained asymptomatic - no restrictions on his lifestyle and without any complications. In 2006, 39 years after the initial operation, we performed a Bentall-Procedure to treat an aortic ascendens aneurysm with diameters of 6.0 × 6.5 cm: we explanted the old Starr-Edwards-aortic-caged-ball-valve-prosthesis and replaced the ascending aorta with a 29 mm St.Jude Medical aortic-valve-composite-graft and re-implanted the coronary arteries.
This case represents the longest time period between Starr-Edwards-caged-ball-valve-prothesis-implantation and Bentall-reoperation, thereby confirming the excellent durability of this valve.
doi:10.1186/1749-8090-5-12
PMCID: PMC2848035  PMID: 20298579
4.  A necrotic lung ball caused by co-infection with Candida and Streptococcus pneumoniae 
Introduction
A necrotic lung ball is a rare radiological feature that is sometimes seen in cases of pulmonary aspergillosis. This paper reports a rare occurrence of a necrotic lung ball in a young male caused by Candida and Streptococcus pneumoniae.
Case report
A 28-year-old male with pulmonary candidiasis was found to have a lung ball on computed tomography (CT) of the chest. The patient was treated with β-lactams and itraconazole and then fluconazole, which improved his condition (as found on a following chest CT scan) and serum β-D-glucan level. The necrotic lung ball was suspected to have been caused by coinfection with Candida and S. pneumoniae.
Conclusion
A necrotic lung ball can result from infection by Candida and/or S. pneumoniae, indicating that physicians should be aware that patients may still have a fungal infection of the lungs that could result in a lung ball, even when they do not have either Aspergillus antibodies or antigens.
doi:10.2147/IDR.S24269
PMCID: PMC3259690  PMID: 22259251
lung ball; necrotic lung ball; Candida; Streptococcus pneumoniae
5.  An apricot story: view through a keyhole 
Background
Very few cases of small bowel obstruction due to ingested fruits have been described in literature, and most of these have managed by a laparotomy. Laparoscopic assisted surgery can effectively deal with such impacted foreign bodies, thereby avoiding a formal laparotomy.
Case presentation
A 75 years old lady was admitted via the Accident and Emergency to the surgical ward with a three-day history of abdominal pain and vomiting. Investigations were suggestive of acute small bowel obstruction. On laparoscopy, there was an area of sudden change in calibre of small bowel with dilated proximal and collapsed distal segment in distal jejunum. A foreign body, dried undigested apricot, was extracted by mini-laparotomy.
Discussion
Small bowel obstruction is a frequent cause of emergency surgery, and aetiology may include food bolus obstruction. Diagnosis is usually confirmed intra-operatively. Foreign body impacted in small bowel can be removed by open or laparoscopic methods.
Conclusion
Generally, laparotomy is performed for diagnosis and management in acute bowel obstruction, but with increasing expertise, laparoscopy can be equally effective with all the other advantages of minimal access approach.
doi:10.1186/1749-7922-2-20
PMCID: PMC1976312  PMID: 17697369
6.  Twice recurrent gallstone ileus: a case report 
Introduction
Gallstone ileus is a rare cause of bowel obstruction and results from the passage of gallstones into the bowel.
Case presentation
We present the case of an 83-year-old Caucasian woman who had three episodes of gallstone ileus, each of which was managed with simple enterotomy. This sequence is one of the first reported in the medical literature and may be seen to challenge the traditional surgical approach of enterotomy alone.
Conclusions
The available evidence comparing enterotomy alone with combined enterotomy, cholecystectomy, and fistula closure in the management of gallstone ileus is reviewed. Neither approach is clearly identified as superior, but available series suggest that simple enterotomy may be safer than a combined approach and does not result in a higher rate of recurrent biliary disease.
doi:10.1186/1752-1947-6-362
PMCID: PMC3492071  PMID: 23095215
Recurrent gallstone ileus; enterotomy; fistulectomy
7.  “Cannon Balls or Pus Balls” in Pap Smears: A Case Report 
A 50–year old female presented with the chief complaint of a discharge per vaginum, which was there for the past 15 days. A routine PAP smear was received in the Department of Pathology, Government Medical College, Patiala, India. After its fixation and staining, it was examined under the microscope. It showed the Trichomonas vaginalis infection, with the neutrophils forming cannon balls at places. Neutrophils in the PAP smear are a nonspecific finding, particularly if they are low in numbers or if they are seen in the premenstrual and the menstrual phases. The neutrophils which are adherent to the squamous cells are called “cannon balls” or “pus balls”, which are common in the Chlamydia infection. This case is being presented because of the presence of these rare morphological structures i.e. “cannon balls” or “pus balls”.
doi:10.7860/JCDR/2013/5799.3265
PMCID: PMC3782945  PMID: 24086888
PAP; Cannon ball; Trichomonas vaginalis
8.  Common bile duct obstruction secondary to infection with Candida. 
Journal of Clinical Microbiology  1978;7(5):490-492.
A patient is reported who had biliary tract obstruction secondary to infection of the common bile duct with Candida albicans, with the formation of a fungus ball. Treatment consisted of surgical removal of the fungus ball and drainage. Chemotherapy was not necessary. Ureteral obstruction through fungus ball formation, and even pulmonary fungus ball formation, has been attributed to candida, but this is the first case reported, to our knowledge, of bile duct obstruction.
Images
PMCID: PMC275030  PMID: 350898
9.  Determinants of Long-term Survival after Isolated Aortic Valve Replacement: A 10- to 17-Year Follow-up 
Texas Heart Institute Journal  1987;14(2):144-153.
During a 9-year period from January 1965 through December 1973, we performed isolated aortic valve replacement (AVR) for aortic stenosis (AS) or aortic regurgitation (AR) in 165 patients. All operations were done during total cardiac arrest using chemical cardioplegia according to the method of Bretschneider. The prostheses used were predominantly Starr-Edwards caged ball valves. One hundred thirty-nine patients were alive 30 days after operation. The 5-, 10-, and 15-year cumulative survival rates (± SE) were 78 ± 4%, 62 ± 4%, and 29 ± 9%, respectively. In comparison to a sex- and age-matched control population, our patients had an excess mortality in the first postoperative year and again after the twelfth year. Patients who underwent AVR in 1972 and 1973 had better results than those who had operations in 1965 through 1971 (p < 0.05); the 1972-1973 patients had 5- and 10-year survival rates of 81 ± 5% and 72 ± 5%, respectively. The 1-year survival rate was 91% for patients with AS and 71% for those with AR (p < 0.05). In AS patients, long-term survival was adversely affected by a history of left ventricular failure, inclusion in NYHA functional class IV, cardiothoracic index of ≥ 0.56, cardiac index of < 3.0 L/min/m2, age > 55 years, previous myocardial infarction, systemic pulse pressure of ≤ 40 mm Hg, mean left atrial pressure of ≥ 15 mm Hg, and mean pulmonary artery pressure of ≥ 24 mm Hg. In AR patients, an adverse prognosis was associated with left ventricular failure, syncope, age ≥ 60 years, and NYHA class IV status. These results indicate that, in both AS and AR patients, operation should be performed early, before severely limiting symptoms and signs arise. (Texas Heart Institute Journal 1987; 14:144-153)
PMCID: PMC324714  PMID: 15229734
Aortic valve insufficiency; aortic valve stenosis; heart valve prosthesis
10.  Cholangitis Due to Candidiasis of the Extra-Hepatic Biliary Tract 
HPB Surgery  1998;11(1):51-54.
A case of isolated candidal fungal balls in the common bile duct causing obstructive jaundice and cholangitis is described. There were no predisposing factors. The fungal balls were removed from the common bile duct and a transduodenal sphincteroplasty was performed. Microscopic analysis yielded colonies of candida. Postoperative period was uneventful. At follow-up no evidence of candida infection was evident. He is now 3 years post-surgery and is well.
doi:10.1155/1998/75730
PMCID: PMC2423915  PMID: 9830582
11.  Successful management of a renal fungal ball in a pretermature neonate: A case report and review of literature 
Invasive fungal infection is common in the present day NICUs - generally manifesting as candiduria or candida sepsis. Fungal balls in the kidneys are very uncommon and most are amenable to higher antifungal agents. However, we had a child who did not respond to such measures and ultimately needed a surgical removal of the fungal ball in his kidney.
We report this case along with a review of literature to highlight about this uncommon, but an important cause of persistent sepsis in pre-term infants and to review the treatment options including a surgical removal.
doi:10.4103/0971-9261.116047
PMCID: PMC3760312  PMID: 24019645
Invasive candidiasis; pre-term infants; renal fungal balls
12.  The gym ball as a chair for the back pain patient: A two case report 
The popularity of the gym ball has led to its increased use in programs designed for fitness, rehabilitation and prevention. Some people are using the gym ball to replace the office chair and others are sitting on it at home, which has created some controversy among therapists, researchers, ergonomics experts and the general public. The controversy is due in part to a lack of knowledge and experience with this application for the gym ball. Both patients in this report were suffering with low back pain, and both improved when they began consistently using the gym ball. There are two reasons for case presentations, to document a treatment of a condition and to promote discussion that may lead to research. This presentation will hopefully accomplish this.
PMCID: PMC1924654  PMID: 17657291
gym ball; back pain; Gymball; mal de dos
13.  Percutaneous Holmium Laser Fulguration of Calyceal Diverticula 
Case Reports in Urology  2012;2012:716786.
Introduction. Calyceal diverticular stones are uncommon findings that represent a challenge in their treatment, due to the technical difficulty in accessing the diverticulum, and the high risk of their recurrence. Current percutaneous technique for calyceal diverticular stones involves establishing a renal access, clearing the stone, and fulguration of the diverticular lining with a roller-ball cautery electrode using hypotonic irrigation solution such as sterile water or glycine solution which may be associated with the absorption of hypotonic fluids with its inherent electrolyte disturbances. Case Report. In this paper, we present for the first time percutaneous holmium laser fulguration of calyceal diverticula in 2 patients using normal saline. Their immediate postoperative sodium was unchanged and their follow-up imaging showed absence of stones. Both patients remain asymptomatic at 30 months post-operatively. Conclusion. This demonstrates that holmium laser is a safe alternative method to fulgurate the calyceal diverticulum after clearing the stone percutaneously.
doi:10.1155/2012/716786
PMCID: PMC3352233  PMID: 22606636
14.  Anticipatory effects of intonation: Eye movements during instructed visual search 
Journal of memory and language  2008;58(2):541-573.
Three eye-tracking experiments investigated the role of pitch accents during online discourse comprehension. Participants faced a grid with ornaments, and followed pre-recorded instructions such as “Next, hang the blue ball” to decorate holiday trees. Experiment 1 demonstrated a processing advantage for felicitous as compared to infelicitous uses of L+H* on the adjective noun pair (e.g. blue ball followed by GREEN ball vs. green BALL). Experiment 2 confirmed that L+H* on a contrastive adjective led to ‘anticipatory’ fixations, and demonstrated a “garden path” effect for infelicitous L+H* in sequences with no discourse contrast (e.g. blue angel followed by GREEN ball resulted in erroneous fixations to the cell of angels). Experiment 3 examined listeners’ sensitivity to coherence between pitch accents assigned to discourse markers such as ‘And then,’ and those assigned to the target object noun phrase.
doi:10.1016/j.jml.2007.06.013
PMCID: PMC2361389  PMID: 19190719
15.  A case of fungus ball type pansinusitis caused by Schizophillum commune 
Medical Mycology Case Reports  2012;1(1):115-118.
Schizophillum commune has been increasingly reported from allergic bronchopulmonary mycosis (ABPM) as well as fungus ball, brain abscess and several cases of maxillary or allergic fungal sinusitis. In the present study, we reported a case of fungus ball type pansinusitis from a 32-year-old woman in Iran. According to computed tomography (CT) scan, fungus ball type pan-sinusitis was likely to be the first diagnosis. Mycological examination revealed hyaline hyphae with small projection and also clamp connection structures on PDA medium. To identify the obtained isolate properly, molecular analysis of the internal transcribed spacer region was performed and indicated that the causing agent of the infection is surely Schizophillum commune. The patient completely recovered after surgical endoscopic operation and consequent post-operation MRI revealed clearance of sinuses.
doi:10.1016/j.mmcr.2012.10.001
PMCID: PMC3854630  PMID: 24371755
Schizophillum commune; DNA sequencing; Fungus ball; Pansinusitis
16.  Gallstone ileus: Case report and literature review 
Gallstone ileus (GI) is characterized by occlusion of the intestinal lumen as a result of one or more gallstones. GI is a rare complication of gallstones that occurs in 1%-4% of all cases of bowel obstruction. The mortality associated with GI ranges between 12% and 27%. Classical findings on plain abdominal radiography include: (1) pneumobilia; (2) intestinal obstruction; (3) an aberrantly located gallstone; and (4) change of location of a previously observed stone. The optimal management of acute GI is controversial and can be: (1) enterotomy with stone extraction alone; (2) enterotomy, stone extraction, cholecystectomy and fistula closure; (3) bowel resection alone; and (4) bowel resection with fistula closure. We describe a case to highlight some of the pertinent issues involved in GI management, and propose a scheme to minimize recurrent disease and postoperative complications. We conclude that GI is a rare condition affecting mainly the older population with a female predominance. The advent of computed tomography and magnetic resonance imaging has made it easier to diagnose GI. Enterotomy with stone extraction alone remains the most common surgical method because of its low incidence of complications.
doi:10.3748/wjg.v19.i33.5586
PMCID: PMC3761115  PMID: 24023505
Gallstone ileus; Fistula closure; Intestinal obstruction; Bowel obstruction; Enterolithotomy
17.  Fungus ball in the urinary tract: A rare entity 
A fungal mass in the urinary tract (fungus ball), mainly occurring in compromised patients, is a rare and dangerous complication of candiduria. We report 2 cases of fungus ball associated with hydronephrosis and sepsis. As reported in the literature, we treated the first patient by prompt relief of obstruction by nephrostomy and local and systemic antifungal agent. The second patient failed to respond to this treatment due to a distal ureteral stenosis and required open surgery with fungus ball removal and ureteral reimplantation. Despite a large success in urinary tract drainage with antifungal treatments, some cases need a modified approach due to anatomical modification.
doi:10.5489/cuaj.1254
PMCID: PMC3926928  PMID: 24554976
18.  Asymptomatic large left-atrial ball thrombus. Secondary to mitral stenosis. 
Texas Heart Institute Journal  1997;24(4):376-378.
We describe the very unusual case of a patient with a large, free-floating left-atrial thrombus secondary to severe mitral stenosis, in whom the peculiar symptoms and complications of a ball thrombus were absent. The patient's only symptom before the episode reported here was mild dyspnea, which was attributed to mitral stenosis. She experienced neither embolism nor syncope. While even her clinical signs did not indicate a left-atrial ball thrombus, both echocardiography and angiography showed a free-floating thrombus. Because of the risk of stroke and acute obstruction of the mitral valve, emergency surgery was performed upon diagnosis of the ball thrombus. The surgery, which consisted of removing the thrombus and replacing the mitral valve with a mechanical prosthesis, was uneventful. A computed tomographic brain scan prior to discharge did not detect any cerebral infarction.
Images
PMCID: PMC325486  PMID: 9456496
19.  A comparative study of the surgical procedures to treat advanced Kienböck's disease. 
Journal of Korean Medical Science  1996;11(2):171-178.
We have treated a total of 16 cases of advanced Kienböck's disease, stage III and IV by Lichtman's classification, with triscaphe fusion, tendon ball replacement arthroplasty after excision of lunate, proximal row carpectomy as a salvage procedure and limited wrist fusion, since 1985. All cases were followed for minimal 16 months after each operation. Tendon ball replacement arthroplasty after excision of lunate could not prevent further carpal collapse with persistent chronic wrist pain. The triscaphe fusion or radio-lunate fusion induced a marked limited wrist motion later, and the triscaphe fusion alone was not fit for the treatment of advanced one because of progressive proximal migration of capitate and continuous wrist pain due to ligamentous carpal instability in follow-up. So we tried to simultaneously combine tendon ball replacement arthroplasty after excision of lunate with triscaphe fusion in far advanced Kienböck's disease, and their end results was favorable. Proximal row carpectomy could be done in far advanced Kienböck's disease with reasonably painless wrist motions. The overall end results of proximal row carpectomy are much better than any form of carpal arthrodesis. Conclusively the proper way to treat advanced Kienböck's disease seems to depend on the patient's age, their job and sex, and the stage of disease. And the cause of wrist pain in advanced Kienböck's disease seems due to ligamentous carpal instability rather than osteoarthritis on radio-lunate joint.
PMCID: PMC3053935  PMID: 8835766
20.  ‘Lint ball’ omphalitis, a rare cause of umbilical discharge in an adult woman: a case report 
Cases Journal  2009;2:7785.
Introduction
Umbilical discharge in adult is rare and is usually induced by foreign material, most commonly hair. Rarely, it may be due to embryonal anomalies. We are reporting an unusual case of umbilical discharge in adult secondary to an impacted lint ball.
Case presentation
A 55-year-old obese woman presented with a 4-month history of hemorrhagic discharge from the umbilicus. Deep from the base of the umbilicus, a 0.8 cm gray-tan mass was removed that on microscopic examination revealed a lint ball.
Conclusion
An impacted lint ball may be a rare cause of umbilical discharge in adult.
doi:10.4076/1757-1626-2-7785
PMCID: PMC2740229  PMID: 19830013
21.  Frontal Sinusitis with Mixed Bacterial Colonies Treated with the Combination of Endoscopic Modified Lothrop Procedure and External Approach 
Case Reports in Otolaryngology  2013;2013:541843.
Isolated frontal sinusitis with mixed bacterial colonies is extremely rare and has not been described. We report a case of isolated frontal sinus forming mixed bacterial colonies that occurred in the previously exposed frontal sinus. The material in the frontal sinus was macroscopically similar to sinus fungus ball. Surgical strategy followed that for sinus fungus ball. The material could not be completely removed even with an endoscopic modified Lothrop procedure (Draf type III procedure). Additional external incision enabled complete removal of the remnant infectious substance. Histological examination detected two different types of organisms as intermingled bacterial colonies. External approaches to the frontal fungus ball have recently been replaced by the endonasal approach. Our case suggests that material trapped in a pit or small crevice in a frontal sinus may not be removed intranasally.
doi:10.1155/2013/541843
PMCID: PMC3872163  PMID: 24386578
22.  Template Free Synthesis of Hollow Ball-Like Nano-Fe2O3 and Its Application to the Detection of Dimethyl Methylphosphonate at Room Temperature 
Sensors (Basel, Switzerland)  2012;12(4):4594-4604.
This paper is focused on the template-free synthesis of nanosized ferric oxide (nano-Fe2O3) and its application in quartz crystal microbalance (QCM) resonators to detect dimethyl methylphosphonate (DMMP), a simulant of Sarin. The X-ray diffraction (XRD) patterns confirm that the synthesized samples are made of Fe2O3 and the scanning electron microscopy (SEM) pictures show that the samples have ball-like shapes. The DMMP sensors with a sensing film of hollow ball-like and solid ball-like Fe2O3 are fabricated and their sensing characteristics are compared. The sensitivity of the hollow ball-like Fe2O3 sensor is more than 500% higher than the one of the solid ball-like Fe2O3 sensor. The hollow ball-like nano-Fe2O3 can be synthesized by a novel low temperature hydrothermal method. The sensors with the hollow ball-like Fe2O3 film perform well in a range of 1 to 6 ppm, with a sensitivity of 29 Hz/ppm at room temperature, while the appropriate recoverability and selectivity are maintained. In addition, the performance of different thicknesses of the sensing film of the hollow ball-like nano-Fe2O3 is investigated and the optimized relative film thickness of the hollow ball-like nano-Fe2O3 is found to be 20 μg/mm2.
doi:10.3390/s120404594
PMCID: PMC3355429  PMID: 22666047
nano-Fe2O3; quartz crystal microbalance (QCM); dimethyl methylphosphonate (DMMP); gas sensor
23.  Infants’ reasoning about opaque and transparent occluders in an individuation task 
Cognition  2002;85(1):B1-10.
There has been some debate about whether infants 10 months and younger can use featural information to individuate objects. The present research tested the hypothesis that negative results obtained with younger infants reflect limitations in information processing capacities rather than the inability to individuate objects based on featural differences. Infants aged 9.5 months saw one object (i.e. a ball) or two objects (i.e. a box and a ball) emerge successively to opposite sides of an opaque occluder. Infants then saw a single ball either behind a transparent occluder or without an occluder. Only the infants who saw the ball behind the transparent occluder correctly judged that the one-ball display was inconsistent with the box–ball sequence. These results suggest that: (a) infants categorize events involving opaque and transparent occluders as the same kind of physical situation (i.e. occlusion) and (b) support the notion that infants are more likely to give evidence of object individuation when they need to reason about one kind of event (i.e. occlusion) than when they must retrieve and compare categorically distinct events (i.e. occlusion and no-occlusion).
PMCID: PMC3708599  PMID: 12086715
Object individuation; Infant cognition; Cognitive development
24.  Laboratory reared Amblyomma hebraeum and Amblyomma variegatum ticks differ in their susceptibility to infection with Cowdria ruminantium. 
Epidemiology and Infection  1995;115(2):345-353.
The susceptibility of laboratory reared Zimbabwean Amblyomma hebraeum and A. variegatum ticks to infection with geographically distinct Cowdria ruminantium strains was investigated by feeding both species simultaneously on individual sheep infected with one of the four strains (Crystal Springs [Zimbabwe], Ball 3 [South Africa], Gardel [Guadeloupe] and Nigeria [Nigeria]). A. hebraeum ticks demonstrated a high susceptibility to infection with all four C. ruminantium strains. In comparison, A. variegatum were less susceptible to infection with the Crystal Springs and Ball 3 strains (P < 0.001), but showed a similar susceptibility to the Gardel and Nigeria strains. The differences in susceptibility of A. variegatum to infection with the four strains of C. ruminantium correlated with the origin of these strains. The consistently higher susceptibility of A. hebraeum ticks to infection with geographically different C. ruminantium strains may be one explanation for the observation that heartwater is a more serious problem where A. hebraeum is the vector of the disease.
Images
PMCID: PMC2271405  PMID: 7589273
25.  Pica — a case of acuphagia or hyalophagia? 
The Indian Journal of Surgery  2008;70(3):144-146.
Pica is an eating disorder typically defined as the persistent eating of nonnutritive substances for a period of at least 1 month at an age in which this behavior is developmentally inappropriate. Acuphagia being consumption of sharp objects and Hyalophagia consumption of glass materials. Majority of the foreign bodies ingested into the gastrointestinal tract pass through the rectum asymptomatically, where as objects which are sharp, long, jagged may not be able to pass through. These types of objects may cause complications like impaction, leading to intestinal obstruction, ulceration, perforation and bleeding, thus need surgical exploration. In this case of young female with impacted bunch of bangles in the stomach and few in the small and large bowel, who was completely asymptomatic, needed gastrotomy with enterotomy for complete and successful retrieval of glass bangles.
doi:10.1007/s12262-008-0040-x
PMCID: PMC3452446  PMID: 23133044
Pica; Acuphagia; Hyalophagia

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