Year 2023, Volume 7 - Issue 2

Background: Sutural bones or wormian bones (an unusual anatomical variant associated with inadequate closure of suture) are extra intrasutural irregular isolated bones that occur additionally at the center of ossification of the skull; along sutures, around sutures or between the cranial sutures formed by bones of the skull vault. Case Presentation: This report displays a case of the presence of an unusual sutural bone at the bregma of the skull of a cadaver during maceration; hence revealing and supporting the possibility of variations in ossification centers and skull matrix which could aid neurosurgeons, orthopedics, and radiologists in their practices. Conclusion: The human bregmatic sutural bone presented in this report is a rare occurrence. Considering its location in the skull,it is the first kind reported in Nigeria and Africa as well as one of the few cases reported across the Globe.

Background: Invasive ductal carcinoma (IDC) of the breast is the most common type of breast cancer in women. Imaging by mammography and/or ultrasonography and histo-pathological examination are collectively used to confirm a diagnosis of IDC. However, the standard imaging modalities are resource intensive and hence, have limited feasibility in resource-limited countries. Thermalytix, an affordable, radiation-free test is a novel Artificial Intelligence (AI)-powered breast cancer detection tool that has shown effectiveness in detecting breast cancer in both symptomatic and asymptomatic women. Case Presentation: We describe two cases of symptomatic women who, on Thermalytix, were identified with a lesion suspicious of malignancy and confirmed as IDC on further evaluation by standard of care imaging and tissue diagnosis. Conclusion: Thermalytix, a new AI-based computer diagnostic solution (Computer diagnostic solution), has the potential to identify breast malignancies such as IDC.

Background: Cyclic vomiting syndrome (CVS) is a rare disorder in which a patient suffers from recurrent episodes of nausea and vomiting. Onset usually occurs early in childhood, later it might progress into a chronic condition highly affecting on the quality of life. No solid treatment protocol is available to treat CVS. There are many cases in which no improvements are observed after years of trying different treatment regimens. Case Presentation: Here we report a 15-year-old female who was diagnosed as a patient of CVS at the age of 7. She was admitted to the medicine ward within 3 hours of onset in the last year. The patient possesses a history of a unique pattern of onset. She has been hit by the recurrence of the disorder almost once in 8-11 months, lasting for 10-14 days, manifesting as intense nausea, and vomiting once in every 20-40 minutes followed by irregular asymptomatic intervals. Various treatment regimens of unsatisfactory outcome were applied on this patient over the years. After analyzing her previous treatment protocols, we decided to try something new and aggressive, moving with palonosetron and haloperidol, a combination that was never applied on this patient. Conclusion: The outcome was ‘magical' according to the parents of the patient marked by declining of the symptom immediately and complete relief within the next 72 hours, the earliest ever after having onset for this particular patient's past history of encountering CVS.

Background: The diaphragm is a major muscle of respiration that is innervated by the phrenic nerve. Dysfunction of this muscle could lead to respiratory failure of varying degrees, depending on whether the bilateral diaphragms or a unilateral diaphragm (i.e., hemidiaphragm) are affected. Such respiratory dysfunction could be so severe as to result in symptomatic hypercapnia requiring medical and/or surgical intervention for amelioration. Diaphragmatic paralysis occurs when underlying pathology results in a failure of the phrenic nerve to control diaphragmatic function; however, in some cases, there are no known precipitating pathologic etiologies. Diaphragmatic paralysis is an uncommon presentation in the clinical setting that often leads to delayed diagnosis. Case Presentation: This report depicts a case of acute-onset dyspnea due to spontaneous idiopathic hemidiaphragm paralysis. A 71-year-old Caucasian man presented via telemedicine to his primary care physician with complaints of dyspnea ongoing for 2 days. The patient subsequently underwent multiple tests, including a course of antibiotics, multiple imaging studies, and several visits to the emergency department. Despite extensive lab and imaging studies, the diagnosis of hemi-diaphragmatic paralysis was delayed for several months before a final diagnosis by the pulmonary medicine clinic. Conclusion: This case portrays the significance of looking deeper beyond the typical cardiopulmonary etiologies in patients with unexplained acute dyspnea. It specifically highlights the importance of working up the respiratory muscles, especially the diaphragm, as the possible origin of acute unexplained dyspnea so as not to significantly delay diagnosis.

Background: Chylopericardium is a rare entity characterized by the accumulation of chylous fluid in the pericardial cavity. Lymphangioleiomyomatosis (LAM) is a rare, progressive systemic disease with prominent features of lung cysts, abdominal tumors, and the development of chylous effusions, usually in the thorax and/or abdomen. Chylopericardium in association with LAM is exceedingly rare, with only a few cases reported in the literature. Case Presentation: We report a case of a 61-year-old woman with chronic dyspnea and bilateral cystic lung disease who presented with a 1-week history of acutely worsening dyspnea. At presentation, she was tachycardiac and hypoxemic, an electrocardiogram detected sinus tachycardia, and a chest radiograph was indeterminate for a small right apical pneumothorax or an apical bulla. An urgent echocardiogram revealed a large pericardial effusion with features of cardiac tamponade, necessitating urgent pericardiocentesis. Analysis of the pericardial fluid confirmed the presence of chylopericardium and a diagnosis of LAM was made. Oral Sirolimus was started and at 1 year of follow-up, the patient has successfully avoided repeat pericardiocentesis. Conclusion: This case describes a rare presentation of a rare disease and suggests that treatment with sirolimus may potentially be effective in reducing the accumulation of chylopericardium in LAM.