Year 2018, Volume 2 - Issue 2

No abstract available

Background: Tourette syndrome (TS) is a childhood-onset neuropsychiatric disorder manifesting by motor and vocal tics. In severe, treatment resistant cases of TS cannabis-based medicine could be used alternatively as a rescue therapy Case presentation: We present the case of an 8-year-old boy with severe Tourette syndrome (TS) and comorbid attention deficit/hyperactivity disorder (ADHD) who significantly benefitted from treatment with cannabis-based medicine. During an episode with increased tics he became depressed, developed suicidal ideation and exhibited separation anxiety resulting in social isolation. As treatment with various antipsychotics and Habit Reversal Training turned out to be unsuccessful, we implemented therapy with oral delta-9-tetrahydrocannabinol (THC) as oil-based drops. Starting dose was as low as 0.7 mg THC/day once a day and was gradually increased up to maximum dose of 29.4 mg THC/day resulting in a significant improvement of both tics and behavioral symptoms. Follow-up visits over a period of 4 months demonstrated a sustained treatment effect without any adverse events. Conclusion: From this single case report it is suggested that THC is effective and safe in the treatment of tics, depression and ADHD in children with severe and otherwise treatment resistant TS.

Background: Hypercalcemia can cause a multitude of nonspecific symptoms, although it can manifest as a life-threatening metabolic emergency. Several underlying causes should be considered in the emergency department (ED). Life-threatening hypercalcemia as the initial manifestation of primary plasma cell leukemia (pPCL) is quite unusual. Case presentation: We present a case of a 63-year-old man who presented to the emergency department with symptomatic hypercalcemia and acute renal failure that was linked to a diagnosis of pPCL. Despite adequate treatment, his course was associated with significant morbidity and was severe enough to threaten his life. Conclusion: Severe hypercalcemia with particular attention to the peripheral blood smear should alert physicians to this highly deadly entity.

Background: PHACE syndrome (Posterior fossa malformations-hemangiomas-arterial anomalies-cardiac defects-eye abnormalities-sternal cleft and supraumbilical raphe syndrome) is a rare and serious neurocutaneous disorder. Cerebrovascular and cardiac abnormalities are the most important anesthetic concerns for patients with PHACE syndrome in order to provide safe and sufficient perioperative anesthesia care. Case Presentation: The present case discussed anesthetic implications of an infant boy who had PHACE syndrome and presented for elective laparoscopic-assisted pull through procedure under general anesthesia. Conclusion: Certain perioperative anesthetic implications should be considered mainly for difficult airway management that related to airway hemangiomas, abnormal cerebrovascular structure mainly carotid arteries involvement that affect CBF and results in cerebral ischemia and the association of congenital cardiac disease.

The acute fibrinoid and organizing pneumonia (AFOP) is an histophatological pattern featured for the presence of intra-alveolar fibrin and organizing pneumonia (1). AFOP is an entity that can be either idiopathic or associated with several clinical conditions, including infectious diseases, drug interactions and cancer. No specific treatment exists for AFOP but an excellent response to steroids therapy is observed. AFOP is still a not well understood entity and is defined with a distinct histological pattern that can appear adjacent to other entities, including hematologic malignancies. A 55-year-old man was admitted in hospital with pneumonia diagnosis, that had no response to antibiotics, but an excellent response to steroids. The lung biopsy supported the diagnosis of AFOP.

Background: Cefixime is widely used in treating infections in children, and it can commonly cause minor gastrointestinal adverse effects. However, hepatotoxicity and acute renal failure are among the rarely reported serious adverse drug reactions of cefixime and other cephalosporins. Case Presentation: We report the case of a 7-month-old infant who was previously well but was admitted to the pediatric intensive care unit as she developed acute onset hepatic and renal failure two days after cefixime treatment. Her liver enzymes were more than 5-times the upper normal limit and her kidney function deteriorated acutely and rapidly over a short period, with evident acute renal parenchymal disease on abdominal ultrasound. Conclusion: Given the nature of rapid resolution of all organ-related insults and no other confirmed diagnosis and with the support of Naranjo and Roussel Uclaf Causality Assessment Method scales, this is probably the first case of cefixime-induced hepatotoxicity and acute renal failure.

Background: Technetium-99m Pentavalent Dimercaptosuccinic acid (99mTc(V)-DMSA) scintigraphy exhibit a crucial role in the preoperative assessment of residual or recurrence Medullary Thyroid Carcinoma (MTC). Case Presentation: 99mTc(V)-DMSA scintigraphy was performed in a patient with histopathologically proven MTC expressing high level of calcitonin using a locally formulated kit. Marked uptake of the radiotracer was observed by the locally metastatic foci. The same patient was then subjected to somatostatin receptor scintigraphy (OctreoScan) and the results were found comparable. Both the scanning was completed within 24hrs with good quality images. Conclusion: In-house preparation from renal DMSA kit, better resolution, good stability and easy procedure with minimum cost make 99mTc(V)-DMSA, a good imaging agent for visualization of medullary thyroid carcinoma in the centers where 99mTc-EDDA/HYNIC-Tyr3-Octreotide is not available.

Background: Dental elements can be maintained when the endocrine retreatment adequately indicated. The growth of endodontic techniques and materials has minimized the indication of surgical procedures even for teeth with intra-canal posts. Case presentation: A 34-year-old male patient related uncomfortable sensation and swelling under his upper lip associated with maxillary right central incisor tooth. After radiographic examination, the presence of a smoothly tapered post and an over-extended root canal filling associated with a periapical radiolucency and radiolucency on the distal part of the coronal third of the maxillary right central incisor tooth. The mesial margin of the crown did not fit well. Conclusion: Understanding the patients, treatment- and tooth-related prognostic predictors can assist the clinicians in appropriate case selection for apical surgery against treatment alternatives.

Background: Accessory breast tissue is residual breast tissue that persists due to the failure of regression of mammary streaks in embryogenesis. It is essential to diagnose accessory breast tissue because it can harbor all the pathological conditions that can occur in normally located breast. Cases of accessory breast with benign cystic changes, mastitis, abscesses, fibroadenomas, and carcinomas are documented. Duct ectasia is, however, a rare occurrence in accessory breast and only a few cases have been previously reported. Case Presentation: A 38 year female, presented with marked and extensive duct ectasia involving almost whole of the right breast parenchyma and bilateral accessory axillary breasts with infrequently observed findings on mammography and ultrasonography. Conclusion: This case report highlights the imaging features of duct ectasia involving the accessory axillary breasts which is a rare occurrence. Awareness of imaging features of this entity may help in early diagnosis to allow adequate management and also to prevent its complications like the formation of abscesses and fistulae.

Cervical Ectopic pregnancy is an extremely rare condition with potential grave consequences if not diagnosed and treated early enough. We present a case with clinical detail and sequential ultrasound images of early cervical ectopic pregnancy with a history of two previous cesarean sections. The cervical ectopic pregnancy was successfully diagnosed on ultrasound, treated with dilation and curettage followed by methotrexate without any complications. We discuss the differential diagnosis, imaging findings, complications and treatment options of the case. Morbidity and fertility of patient can be preserved by timely accurate diagnosis

Background: Peripheral nerve sheath tumors (PNST) on the basis of some features can be categorized as benign or malignant by ultrasonography (USG) and magnetic resonance imaging (MRI). Case presentation: We report a case of 28 years old male presented with a huge swelling in his right forearm. While the features of MRI directed the diagnosis towards neurofibroma (NF), some of the features of USG were in favor of malignant PNST (MPNST). Finally the histopathology (HP) and immunohistochemistry (IHC) features were found to be consistent with that of MPNST. Conclusions: This case is an example of additive value of USG over MRI in identification of MPNSTs that can be helpful for appropriate management.

Background: Hypertrophic pyloric stenosis (HPS) is a common cause of gastrointestinal obstruction in childhood. Case presentation: We report a three month old male child with vomiting and weakness that had been started three days before being referred to the hospital. We used ultrasonography to examine this patient and, while the results from the laboratory tests were normal; abdominal ultrasound examination showed HPS with hiatus hernia and abnormal mesenteric vessels pathway. Conclusion: We concluded that hypertrophic pyloric stenosis with presentation in thorax is a rare condition that can be diagnosed with meticulous ultrasound scanning of diaphragmatic hiatus, pyloric canal and mesenteric vessels pathway.

Background: Several studies have demonstrated the feasibility of pre-hospital US in patients with trauma, cardiac arrest and respiratory insufficiency. It should be rapid, problem based and the use of specific protocols (FAST, FEEL, RUSH) prevents delays. Case presentation: We present a case of a 50 years old man with a syncope while he was working. When the ambulance arrived, he was hemodynamically unstable, referred dorsal lumbar pain, an asymmetry of the radial pulses was found, and the electrocardiography didn't register any ST segment alterations. A pre-hospital US showed a dilation of the ascendant aorta and a floating flap inside the aortic arch and the abdominal aorta. The CT scan confirmed a dissection from the aortic bulb to the left femoral artery and the patient was transported rapidly to the nearest heart and thoracic surgeries. Conclusion: The evaluation of the aorta should be considered a new indication of pre-hospital ultrasound.

ABSTRACT Background: In certain situations, the radiologist may be the first physician to suggest the presence of paediatric abnormality. The need of early diagnosis of potentially life- threatening emergency conditions is now becoming one of the important contributions of ultrasound to the referring clinician. Our case presentation demonstrates the value sonographic diagnosis of meconium peritonitis. Case description: We present a case of term infant who was diagnosed to have echogenic bowel with few specks of peritoneal calcification and loculated ascites. Early detection with ultrasound led to immediate surgical intervention and patient recovered without any immediate or long term complications. Conclusion: Meconium peritonitis (MP) is a chemical peritonitis caused by fetal intestinal perforation which occurs mostly in utero. Its incidence is extremely rare, but serious neonatal morbidity or even mortality can occur if the diagnosis is not made until after birth. Prenatal diagnosis is essential in prompting early postnatal surgical intervention, and also improving neonatal outcome.