Year 2023, Volume 7 - Issue 1

Background: Vascular ring is a rare diagnosis in adults as the majority is diagnosed in symptomatic infants or young children. Only a few cases are documented in the literature of dysphagia in adults caused by a vascular ring. It is not uncommon for an adult diagnosed with vascular rings to have asthma in his medical history. Case Presentation: A 61-year-old woman presented with dysphagia with a medical history of slight asthma and left hemithyroidectomy. After extensive workup, it was determined to be the result of a right-sided aortic arch with a left-sided arteriosum ligament, a left aberrant subclavian artery with Kommerell's diverticulum, and a ventral left common carotid artery. Conclusion: A right-sided aorta with a left-sided arteriosum ligament is a vascular ring and should be recognized as such. Although rare in adults, one should be triggered to think of a vascular ring in patients with dysphagia, especially with mild asthma and reflux complaints.

Background: Buccal mucosa metastasis is rare in breast cancer patients. Case Presentation: A 50-year-old female breast cancer patient with invasive lobular carcinoma (ILC) in his eight years follow-up period presented with a swelling in the right eye. Head and neck MRI was showed soft tissue formation with dimensions of 59x31 mm was detected in the axial plane, extending from the level of the right infratemporal fossa to the right buccinator muscle and right maxillary sinus in front of the alveolar process. In the right periorbital region, there was a thickness increase of up to 1 cm in the thickest part of the globe, which was evident in the anterolateral. In addition, there was no bone destruction in the right infratemporal region in maxillofacial CT, and no additional organ metastasis was detected in PET-CT performed for systemic scanning. In the histopathological examination of the tissue, carcinoma infiltration was detected. Radiotherapy was applied to the right buccal and orbital region of the patient as 30 Gy in 12 fractions (2.5 Gy per fraction) with volumetric modulated arc therapy technique and then 15 Gy in 6 fractions (2.5 Gy per fraction) boost radiotherapy with the adaptive technique were applied. At the follow-up 2 months later, clinical response was observed in the patient, and significant regression of the lesion was observed in facial and orbital MRI. At the 15th month follow-up of the patient, clinical and radiological remission continues. All clinical complaints regressed. Conclusion: ILC is a subtype of breast cancer that is characterized by unusual metastasis. Therefore, during the follow-up of these patients, it is necessary to monitor both laboratory values and clinical complaints very carefully.

Background: Multiple sclerosis (MS) is a neurological disorder that affects 2.5 million people worldwide. MS exemplifies the interface between neurology and psychiatry in a trajectory of neuro and psycho-pathologies that can conflate with the diagnosis of primary psychotic disorders. The protean nature of its neuropsychiatric manifestations could delay the diagnosis and management of such a challenging condition. Case Presentation: We present the case of a 52-year-old female who developed first episode of psychosis at the age of 48 years. There was no history of previous mental illness in either the patient, or in any family member. She had been formally diagnosed with a relapsing and remitting type of MS, at the age of 30 years. Six years later, she discontinued the recommended disease modifying therapy (DMT) which resulted in worsening of her MS and late onset schizophrenia-like symptoms. Her affect, however, was warm and interactive, and she exhibited a sense of general wellbeing and serenity, describing her psychosis as being "magical" despite the severity of her condition. Treatment of her psychiatric condition with depot psychotropic medication resulted in dramatic improvement of her psychosis with regain of insight, hence compliance on DMT and containment of her MS. Conclusion: Comorbid psychiatric and MS manifestations may be challenging regarding the diagnosis and management of either condition. Professionals in these fields, therefore, need to be aware of the relative high prevalence of mental health disorders in MS patients and that these may pre or post-date the diagnosis of MS, with the potential to confound the clinical picture.

Background: Female reproductive tract abnormalities are generally encountered in 4%-7% of women. Various combinations have been described in the literature. Our case reports a rare female genital tract anomaly of the distal vagina combined with uterus didelphys. Case Presentation: A 15-year-old girl with lower vaginal atresia associated with uterus didelphys presented with cyclical progressively worsening abdominal pain and primary amenorrhea. Pelvic ultrasound (US) and magnetic resonance imaging (MRI) illustrated two separated uterine cavities associated with a distended fluid-filled structure ending in a blind pouch at the lower margin of the vagina. Conclusion: The presence of congenital anomalies of the female urogenital system may be suspected in the case of cyclical abdominal pain in young girls with primary amenorrhea. The use of US as a primary approach is recommended. MRI is preferred to specify the height and extent of vaginal aplasia as long as to guide the choice of the most appropriate surgical technique.

Background: Conventional biochemistry parameters employ the use of photometry and enzymatic reactions which reduce the possibility of analytical errors. On contrary, tests performed with immunoassay are known to be more prone to analytical interferences and may subsequently yield incorrect values. Case presentation: We present two cases investigated due to very high levels of vitamin D in the serum that exceeded the measurable limit of the analyzer. Protein electrophoresis showed a monoclonal peak, revealing elevated immunoglobulin G and elevated immunoglobulin M respectively. Gold standard analysis of vitamin D using liquid chromatography-mass spectrometry revealed normal vitamin D concentrations in both cases. Further, bone marrow puncture revealed a diagnosis consistent with multiple myeloma and Waldenstroms macroglobulinemia. Conclusion: Falsely elevated levels of vitamin D exceeding the maximum measurable limit is highly suspicious. Although analytical interference in immunoassay is limited, we should keep in mind that results obtained by this method are more prone to analytical errors.