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1.  Prompt recognition of stump appendicitis is important to avoid serious complications: a case report 
Cases Journal  2009;2:7415.
Stump appendicitis is a rare complication of appendectomy due to recurrent inflammation of the residual appendix. The diagnosis is often delayed due to low index of suspicious, which may result in serious complications.
Case presentation
We describe a case of stump appendicitis occurred 12 months after appendectomy in 25 years old man. Despite past medical history of appendectomy the diagnosis was made by means of ultrasound scan and an high degree of clinical suspicion.
Stump appendicitis is a rare but important complication of appendectomy, often misdiagnosed. Prompt recognition is important to avoid serious complications. This pathologic entity should always be kept in mind on case of right lower quadrant pain.
PMCID: PMC2740171  PMID: 19829956
2.  Successful radiofrequency catheter ablation of atrioventricular nodal reentrant tachycardia in a patient with dextrocardia due to unilateral pulmonary agenesis: a case report 
Radiofrequency catheter ablation of the slow pathway is considered to be the treatment of choice for patients with atrioventricular nodal reentrant tachycardia. We report a 34-year-old female with mirror image dextrocardia due to unilateral pulmonary agenesis who underwent successful slow pathway ablation for typical atrioventricular nodal reentrant tachycardia. Using contrast injection, cardiac anatomy was identified in a short time and successfully ablated.
PMCID: PMC4321640
dextrocardia; AVNRT; ablation; pulmonary agenesis
3.  Bottle Gourd (Lagenaria Siceraria) Toxicity: A “Bitter” Diagnostic Dilemma 
Consumption of a glass of bottle gourd juice is thought to work as a health “tonic” and part of traditional healthy living practices in India. The juice may in certain circumstances turn bitter with increased levels of the cytotoxic compound called Cucurbitacins. If the bitter juice is consumed it causes a toxic reaction in the gut, leading to abdominal discomfort/pain, vomiting, hematemesis, and hypotension which may be rarely fatal, especially in persons with pre-existing illness. In the absence of clear cut history regarding the consumption of the bitter bottle gourd juice and the initiation of symptoms, the differential diagnosis for the above symptoms will include diseases causing gastrointestinal bleed with hypotension and/or shock.
We report a case of bitter bottle gourd poisoning presenting with abdominal symptoms, hematemesis and shock and with an initial differential diagnosis of septicemia with septic shock and multi-organ involvement. We conduct a literature review and ponder the various differential diagnoses of this clinical scenario.
PMCID: PMC4316287  PMID: 25653981
Bottle gourd; Cucurbitacins; Food-borne illness
4.  Brown Tumor of the Cervical Spines: A Case Report with Literature Review 
Asian Spine Journal  2015;9(1):110-120.
To report a rare case of axis brown tumor and to review literature of cervical spine brown tumor. Brown tumor is a rare bone lesion, incidence less than 5% in primary hyperparathyroidism. It is more common in secondary hyperparathyroidism with up to 13% of cases. Brown tumor reactive lesion forms as a result of disturbed bone remodeling due to long standing increase in parathyroid hormones. Cervical spine involvement is extremely rare, can be confused with serous spine lesions. To date, only four cases of cervical spine involvement have been reported. Three were due to secondary hyperparathyroidism. Only one was reported to involve the axis and was due to secondary hyperparathyroidism. This is the first reported case of axis brown tumor due to primary hyperparathyroidism. A case report of brown tumor is presented. A literature review was conducted by a Medline search of reported cases of brown tumor, key words: brown tumor, osteoclastoma and cervical lesions. The resulting papers were reviewed and cervical spine cases were listed then classified according to the level, cause, and management. Only four previous cases involved the cervical spine. Three were caused by secondary hyperparathyroidism and one was by primary hyperparathyroidism which involved the C6. Our case was the first case of C2 involvement of primary hyperparathyroidism and it was managed conservatively. Brown tumor, a rare spinal tumor that presents with high PTH and giant cells, requires a high level of suspicion.
PMCID: PMC4330206
Osteitis fibrosa cystica; Axis neoplasm; Osteoclastoma; Brown tumor; Hyperparathyroidism
5.  Osteosarcoma arising on a background of Paget's disease report of an unusual case 
BMJ Case Reports  2013;2013:bcr2012007770.
One of the serious complications of Paget's disease (PD) is a significant increase in the risk of developing osteosarcoma. Approximately 1% of the patients with PD develop osteosarcoma. This contributes significantly to the mortality and morbidity of the patients with PD. We present the case of an elderly person, who developed osteosarcoma 1 year after being diagnosed to have PD. The patient had been diagnosed to have lymphoma 8 years prior to the diagnosis of PD. The association between PD and follicular lymphoma is discussed.
PMCID: PMC3603794  PMID: 23365160
6.  Radiofrequency Ablation of Typical Atrial Flutter via Right Jugular Vein due to Bilateral Obstructed Iliac Veins in a Patient with Dilated Cardiomyopathy 
Case Reports in Cardiology  2015;2015:401580.
Ablation of cavotricuspid isthmus (CTI) is the gold standard method in the treatment of isthmus dependent atrial flutter (AFl). Venous access was obtained usually via right or left femoral veins. In rare cases of obstruction of iliofemoral veins, ablation of CTI can be performed only through the superior approach. We present a 74-year-old woman of typical AFl and dilated cardiomyopathy that was ablated through the right jugular vein because of obstruction of the left and the right iliac veins. This is the first report of successful ablation of CTI in a patient with dilated cardiomyopathy via superior approach.
PMCID: PMC4322302
7.  Conjunctival Necrosis Following a Subconjunctival Injection of Triamcinolone Acetonide in a Child 
Conjunctival necrosis is a rare complication following periocular/intraocular triamcinolone acetonide injection and has been reported extensively in adults. We describe a child who developed conjunctival necrosis following subconjunctival injection of triamcinolone acetonide for severe chronic anterior uveitis. Prompt diagnosis and management of this uncommon condition is vital.
PMCID: PMC4302469  PMID: 25624689
Children; Conjunctival Necrosis; Subconjunctival Injection; Triamcenolone Acetonide; Uveitis
8.  Coronary spasm during cardiac electrophysiological study following isoproterenol infusion 
Sudden cardiac death (SCD) remains the leading cause of death in industrialized world. The majority of SCD is caused by ventricular fibrillation associated with structural and/or ischemic heart disease. Ventricular fibrillation represents the final common pathway for SCD and, thus, is an attractive target for ablation. According to class I recommendation level of evidence A, an implantable cardioverter defibrillator (ICD) should be implanted for such patients [1]. Other than programmed electrical extrastimulus technique, isoproterenol infusion is commonly used in invasive cardiac electrophysiology labs for arrhythmia induction. We hereby report a rare case of transient coronary spasm during isoproterenol infusion for ventricular tachycardia induction testing.
PMCID: PMC4274359  PMID: 25598993
complication; coronary spasm; electrophysiology study; isoproterenol; sudden cardiac death
9.  Administration of general anaesthesia to a paediatric patient with osteopetrosis 
BMJ Case Reports  2012;2012:bcr2012006901.
Osteopetrosis is a rare clinical syndrome characterised by the failure of bone resorption and remodelling, which causes multiple anatomical and physiological impairments. Pathological fractures can occur, in addition to, haemathological and metabolic impairments. Our patient was a 9-year-old girl diagnosed with osteopetrosis in the neonatal period. She had severe anaemia, thrombocytopaenia, hypocalcaemia, as well as growth and development delays. In this case report, the administration of general anaesthesia to the patient for a biopsy of the scalp and skull and a partial maxillectomy is presented.
PMCID: PMC4312795  PMID: 23188843
10.  Laparoscopic Cholecystectomy in a Patient with Previous Pneumonectomy: A Case Report and Discussion of Anaesthetic Considerations 
Case Reports in Anesthesiology  2014;2014:582078.
Increasing numbers of patients require cholecystectomy after previous pneumonectomy, but there are little data to guide anaesthetic management. A laparoscopic approach is associated with less postoperative respiratory compromise than open cholecystectomy but may be relatively contraindicated due to the undesirable effects of pneumoperitoneum on respiratory function. We describe the case of a 72-year-old patient who successfully underwent elective laparoscopic cholecystectomy 23 years after left pneumonectomy. An understanding of the combined physiological consequences of pneumonectomy and pneumoperitoneum facilitated the provision of safe and uneventful anaesthesia. We propose that laparoscopic cholecystectomy is feasible and safe to perform in patients with a single lung.
PMCID: PMC4241691  PMID: 25431680
11.  Management of anesthesia in unspecified extra-adrenal pheochromocytoma patient who used beta-blocker 
Saudi Journal of Anaesthesia  2014;8(Suppl 1):S105-S108.
An operation was planned for a female patient aged 59 for intra-abdominal mass. The patient was using nebivolol for hypertension. Blood pressure (BP) of the patient was raised to 200/130 mmHg during anesthesia induction. BP was gradually reduced by remifentanil infusion. Following the manipulation of the mass, BP began to increase (225/160 mmHg), thus nitroglycerin and followed nitroprusside infusion was started. Propofol (200 + 200 mg) and furosemide (20 mg) were administered intravenously. BP suddenly dropped (90/60 mmHg) following the removal of the mass, nitroglycerine, and nitroprusside infusions were stopped; remifentanil dose was decreased and fluid was quickly infused. The patient was uneventually recovered. Vanilmandelic acid level was higher in the patient and pheochromocytoma was considered.
PMCID: PMC4268506  PMID: 25538499
Adrenergic beta-antagonists; anesthesia; general; pheochromocytoma
12.  Locked-in syndrome caused by the pressure exerted by the sound gun 
Saudi Journal of Anaesthesia  2014;8(Suppl 1):S109-S112.
A 19-year-old male patient who wounded himself with a gun in the cranial region had a Glasgow coma scale of 3E. At posttraumatic day 7, locked-in syndrome was considered upon detection of vertical eye movements, meaningful winks, and quadriplegia. Apart from the classical view, computed tomography (CT) and postmortem examination of the brain showed an infarct area in the cerebellum. However, vertebrobasilar artery system was normal. In this case report, we would like to present that unlike cases with ischemia, specific CT findings may not be evident in posttraumatic cases and ischemia may occur in the cerebellum as a result of the pressure exerted by a sound gun.
PMCID: PMC4268507  PMID: 25538500
Locked-in syndrome; sound gun; trauma
13.  Congenital hypertrophy of retinal pigment epithelium (CHRPE) in patients with familial adenomatous polyposis (FAP); a polyposis registry experience 
BMC Research Notes  2014;7(1):734.
Familial Adenomatous Polyposis (FAP) is an autosomal dominant condition giving rise to multiple adenomatous polyps in the colon which invariably become malignant by the fourth decade. Congenital hypertrophy of retinal pigment epithelium (CHRPE) is one of its extra intestinal manifestations early in childhood seen, present in 90% of FAP population and is easy to detect.
Patients diagnosed with FAP and at risk first degree family members were screened for CHRPE using a slit lamp and indirect ophthalmoscopy. The retina of 17 diagnosed FAP patients and 13 individuals at risk were examined. The site and size of CHRPE lesions were documented. Thirteen (76%) of 17 FAP patients (male-10, female – 7, median age - 30 years; range 15-55 years) had CHRPE lesions; seven (54%) had bilateral CHRPE lesions and six (46%) had unilateral lesions. A single lesion was detected in 6 (46%) while 7 (54%) patients had multiple lesions. Of 13 at risk individuals (7- male, female-6 ; median age 34; range 16-52 years), one was positive for CHRPE and 12 were free of retinal lesions. The sensitivity of the presence of a CHRPE lesion in association with colonic polyps in FAP was 76%, specificity 92%, positive predictive value 93%, and negative predictive value 75%.
This study found a high sensitivity and specificity for a CHRPE lesion to be associated with colonic polyps of FAP and hence a useful screening method in a burdened health-care system. The method is minimally invasive and simple and would be of particular value in screening children at risk for FAP.
PMCID: PMC4210554  PMID: 25326340
Familial adenomatous polyposis coli; Retinal pigmentation; Ophthalmic screening
14.  Rectal Dieulafoy Lesions: A Rare Etiology of Chronic Lower Gastrointestinal Bleeding 
Case Reports in Medicine  2014;2014:180230.
Dieulafoy lesion is rarely seen, yet it can be life-threatening. This lesion makes up to 1-2% of gastrointestinal bleedings and must definitely be considered in gastrointestinal bleedings whose source cannot be identified. In this case study, the 75-year-old woman was suffering from active, fresh, and massive rectal bleeding. Colonoscopy was applied in order to find out the source of bleeding. In the typical endoscopic appearance of the lesion a single round mucosal defect in the rectum and arterial bleeding were observed. To procure hemostasis, epinephrine was injected into the lesion and the bleeding vein was sutured.
PMCID: PMC4198821  PMID: 25349614
15.  A New Approach to the Treatment of Metastatic Paraganglioma: Sorafenib 
Paragangliomas are relatively rare chromaffin cell tumors which may be cured through resection. Patients with paragangliomas may develop metastatic diseases. There is no consensus regarding refractory chemotherapy for treatment of metastatic disease. In this report, we presented a case of a 43-year-old woman who was admitted to the hospital with a history of episodic headaches, diaphoresis, and weakness. Elevated plasma catecholamine levels and a right paraaortic mass were observed on computed tomography. The mass was excised, and a diagnosis of paraganglioma was confirmed. After 20 months of follow-up, local recurrence and metastases were detected in the thorax, abdomen, and skeletal system. Plasma and urinary catecholamine levels were high. Chemotherapy was administered, and no improvement was observed. Therefore, following this palliative conventional chemotherapy, sorafenib was administered for three months, and, finally, positron emission tomography showed that the patient’s lesions had completely regressed.
PMCID: PMC4206070  PMID: 25036577
Extra-adrenal paraganglioma; Neoplasm metastasis; Sorafenib; Pheochromocytomas; Tyrosine kinase inhibitor
16.  Vasculitis and long standing ankylosing spondylitis in a patient with familial Mediterranean fever 
Coexistence of familial Mediterranean fever (FMF) and other inflammatory disorders has been frequently reported, but no specific underlying factor has been identified. We report a patient with FMF who is presented with long-standing ankylosing spondylitis (AS) and cutaneous leukocytoklastic vasculitis (LV) of the lower limbs. It is the first report on combination of FMF with AS and LV. The Mediterranean Fever (MEFV) gene mutation of heterozygote (R202Q/R726A) and HLA-B27 are detected in this case, and are believed to form genetic susceptibility to LV.
PMCID: PMC4274560  PMID: 25538787
Ankylosing spondylitis; familial Mediterranean fever; leukocytoklastic vasculitis; vasculitis
17.  Retroanastomotic hernia after Moynihan’s gastroenterostomy 
Retroanastomotic hernias after gastroenterostomies-either antecolic or retrocolic-are extremely rare but are associated with high mortality rates due to delayed identification which precludes immediate surgical reduction. In this report, we present a 77-year-old man with retroanastomotic herniation of the efferent loop segments that occurred 14 years after a Moynihan’s gastroenterostomy.
PMCID: PMC4176780  PMID: 25276289
Retroanastomotic hernia; Moynihan’s gastroenterostomy; Intestinal obstruction
18.  Abcès tuberculeux de la face postérieure de la cuisse: à propos d'un cas 
Les auteurs rapportent le cas d'un volumineux abcès tuberculeux de la face postérieure de la cuisse droite chez une femme de 55 ans. L’étude de cette observation nous a permis d'analyser cette affection, sa fréquence, sa localisation, les moyens de son diagnostic positif et différentiel, ainsi que les mesures thérapeutiques adéquates afin de prévenir les complications qu'elle peut engendrer.
PMCID: PMC4315479  PMID: 25667712
Abcès; tuberculeuse; parties molles; anti bacillaire; abscess; tuberculosis; soft tissue; anti bacillary
19.  Pemphigoïde bulleuse révélant un carcinome bronchique 
La pemphigoïde bulleuse (PB) est la plus fréquente des dermatoses bulleuses auto-immunes, touchants préférentiellement le sujet âgé de plus de 70 ans. L'origine paranéoplasique de La PB est rarement rapportée. Cette lésion peut apparaitre de manière synchrone ou parfois être une manifestation révélatrice de la tumeur. Nous rapportons l'observation d'un jeune patient présentant un cancer bronchique métastatique révélé par une PB. Chez le sujet jeune fumeur, toute pemphigoïde bulleuse justifie la recherche d'une néoplasie.
PMCID: PMC4317072  PMID: 25667707
Pemphigoïde bulleuse; carcinome bronchique; paranéoplasique; Bullous pemphigoid; lung carcinoma; paraneoplastic
20.  Coronary artery bypass graft surgery in a patient with ureterosigmoidostomy 
A 75-year-old male patient had stable angina pectoris. After coronary angiography we decided to perform a coronary artery bypass graft surgery. Twenty years ago the patient underwent radical cystectomy and bilateral ureterosigmoidostomy because of bladder cancer. After that, his micturition was via the rectum. We did not experience that before. As is known, monitoring of urine output is very important after cardiac surgery. The patient was consulted with an urologist for how to monitor urine output in him. Transrectal catheterization was recommended for our follow-up, but before the catheterization bowel cleansing is necessary. Four-vessel on-pump coronary artery bypass graft surgery was performed without any problem. Peroperative urine volume and arterial blood gas results were normal. Urine output is a sensitive variable reflecting the patient’s effective blood volume and tissue perfusion. Urinary catheterization is a standard for all cardiac surgeries, and it allows the patients’ urine to drain freely from the bladder for collection. Monitoring of urine output in patients with ureterosigmoidostomy is impossible by standard urinary catheterization method. In this case we performed transrectal catheterization for Urine flow follow-up. Urine flow follow-up is essential after the open-heart surgery and it can be measured in different ways, as in our case.
PMCID: PMC4163771  PMID: 25232552
Open heart surgery; Urine output follow-up; Catheterization; Ureterosigmoidostomy; Coronary artery bypass graft
21.  Intestinal necrosis in young patient due to arterial tumour embolism 
BMJ Case Reports  2012;2012:bcr0120125558.
A patient in the thirties, currently undergoing chemotherapy for metastatic osteosarcoma diagnosed 3 years earlier, was admitted with in the emergency department with abdominal pain. Laparoscopic surgery revealed severe inflammation and an abscess. 18 cm of small intestine was removed because of intestinal necrosis. Histological examination showed several arterial tumour emboli, morphologically similar to the primary sarcoma. The patient died 1 year after successful surgery. Because of the improved survival of patients with osteosarcoma, acute mesenteric ischaemia should be considered in acute abdomen in these patients.
PMCID: PMC3448735  PMID: 22983997
22.  Intracranial Meningioma Diagnosed during Pregnancy Caused Maternal Death 
Case Reports in Medicine  2014;2014:158326.
Brain tumors are rarely diagnosed during pregnancy. Accelerated growth of intracranial meningiomas during pregnancy sometimes requires urgent surgical intervention. We describe a 41-year-old pregnant woman with severe neurological decompensation requiring immediate neurosurgery. Cesarean section resulted in maternal death. Meningioma diagnosed during a viable pregnancy should be managed according to the severity of maternal neurological symptoms and gestational age of pregnancy. Early intervention for intracranial tumors during pregnancy may save maternal and fetal lives.
PMCID: PMC4176917  PMID: 25295061
23.  Spinal Cord Ischemia Secondary to Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma 
Case Reports in Gastroenterology  2014;8(3):264-269.
Transcatheter arterial chemoembolization (TACE) is accepted worldwide as an effective treatment for patients with unresectable hepatocellular carcinoma. Although considered relatively safe, TACE has been associated with several complications. Spinal cord ischemia secondary to TACE is an extremely rare but disastrous complication. We report a very rare case of spinal cord injuries after TACE, together with a literature review. During the procedure, the patient suddenly experienced sensory impairment below the T10 dermatome and bilateral lower extremity motor weakness. She was given high-dose steroids and supportive therapy. The sensory deficits nearly improved completely, but motor strength remained unchanged. Thereafter, a chest computed tomography scan showed tumor metastasis to the lungs. The patient is now receiving sorafenib and follow-up.
PMCID: PMC4209262  PMID: 25408628
Hepatocellular carcinoma; Transcatheter arterial chemoembolization; Spinal cord ischemia; Paraplegia
24.  Mycosis Fungoides: Case Report and Literature Review 
Mycosis fungoides (MF), also known as Alibert-Bazin syndrome or granuloma fungoides, is the most common form of cutaneous T-cell lymphoma. Cutaneous lymphomas are an uncommon, heterogeneous group of non-Hodgkin lymphomas (NHLs) of T- and B-cell origin where the skin is the primary organ of involvement. This is a case of a 60-year-old Nigerian woman, who was diagnosed and managed as a case of chronic dermatitis but further investigations confirmed a diagnosis of MF; she was thereafter managed with topical glucocorticoids/chemotherapy and improved on these treatments. We make a plea for better awareness of the disease among physicians and pathologists in Africa.
PMCID: PMC4159375  PMID: 25232282
mycosis fungoides; granuloma fungoides; cutaneous T-Cell lymphoma
25.  Intraosseous Epidermoid Cyst Associated with Impacted Mandibular Wisdom Teeth: An Uncommon Entity 
Epidermoid and dermoid cysts of the jaws are seen rarely. The formation theories of the intraosseous epidermoid cyst (IEC) are not clear. The radiographic appearance is similar with unilocular cysts. Surgical enucleation is the suggested treatment method for epidermoid cysts. This case report presents bilateral mandibular intraosseous epidermoid cysts with impacted wisdom teeth which is the first documented case in the literature.
PMCID: PMC4149163  PMID: 25177657
Enucleation; Epidermoid cyst; Impacted wisdom teeth; Mandible

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