scholarly journals Cutaneous actinomycosis and long-term management through using oral and topical antibiotics: A case report

2018 ◽  
Vol 8 (4) ◽  
Author(s):  
Ali Hassan Najmi ◽  
Ibrahim Hassan Najmi ◽  
Mosa Mohmmed Hassan Tawhari ◽  
Khadija Hafed Sawadi ◽  
Khaled Ahamed Hassan Khbrani ◽  
...  
Keyword(s):  
Case Report ◽  
Bacterial Infection ◽  
Rare Entity ◽  
Central Hospital ◽  
Topical Antibiotics ◽  
Surgical Department ◽  
The Right ◽  
Local Examination ◽  
Term Management

Actinomycosis is a subacute or chronic suppurative bacterial infection which caused because of filamentous gram-positive, anaerobic to microaerophilic nonacid fast bacilli primarily of the genus Actinomyces that normally colonize the mouth, colon, and vagina. Primary cutaneous actinomycosis is a rare entity and is generally associated with trauma. A 61- year-old Yemeni male firstly presented to the surgical department in King Fahd Central Hospital with multiple swelling, petted lesions and boring of sensation in the right foot. Local examination showed multiple erythematous nodules and plaques with discharge in the right leg, and active sinus was not determined.

Long-term management of resistant, fistulazing Crohn's disease by ongoing 4-weekly infliximab therapy (a case report)

2005 ◽  
Vol 43 (05) ◽  
Author(s):  
R Schwab ◽  
P Lakatos ◽  
E Schäfer ◽  
J Weltner ◽  
A Sáfrány ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Case Report ◽  
Crohn's Disease ◽  
Infliximab Therapy ◽  
Term Management

scholarly journals EP22 A manifestation of severe sarcoid arthropathy in the distal interphalangeal joint

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Rajiv Ark
Keyword(s):  
Case Report ◽  
Lymph Nodes ◽  
Cardiac Sarcoidosis ◽  
Treatment Options ◽  
Nasal Discharge ◽  
Pulmonary Manifestations ◽  
Distal Interphalangeal ◽  
The Right ◽  
Little Finger

Abstract Case report - Introduction In 2011 a gentleman in his 50s presented with nasal blockage and bloody discharge. He was diagnosed with sarcoidosis and after 9 years of failed strategies to control his disease, he developed dactylitis. X-ray of the hands showed severe arthropathy in the distal interphalangeal joints. This case demonstrates an uncommon extrapulmonary manifestation of sarcoidosis. Although most of his follow up was with a respiratory clinic, his main symptoms were not due to interstitial lung disease, highlighting the importance of a multidisciplinary approach. To reduce the need for steroids, several DMARDs were tried illustrating that there are limited treatment options. Case report - Case description This gentleman presented in June 2011 with left epiphora, bloody nasal discharge and fatigue. He had no family history of sarcoidosis and was of Caucasian ethnicity. He was referred by his GP to Ophthalmology and ENT. Septoplasty showed a 95% blockage at the lacrimal sac. A biopsy was performed, and histology showed a nasal sarcoid granuloma. He was referred to the respiratory team who requested a high-resolution CT scan showing sizeable lymph nodes. One inguinal node was biopsied confirming sarcoid granulomas before starting treatment. Calcium was briefly raised, and serum ACE was initially 123. He was started on 40mg of prednisolone for 6 weeks, which was tapered to 20/25mg on alternating days. There was a recurrence of his nasal discharge; steroids were increased again but he developed symptoms of muscle weakness from long term steroid use. He was referred to an interstitial lung disease clinic at a tertiary centre where he was investigated for cardiac sarcoidosis with MRI due to ventricular ectopics. Hydroxychloroquine was started to reduce the steroid use however he developed symptoms of tinnitus, so it was stopped. Methotrexate, Azathioprine and Leflunomide were all trialled to however they did not have any impact on controlling his disease. His Prednisolone was slowly reduced by 1mg a month. When he had recurrence of his symptoms, he was given IV methylprednisolone. Nine years after his first presentation he presented with stiffness of the right thumb base. This progressed to dactylitis and slight fixed flexion deformity of right index finger and left little finger. An x-ray of his hands showed disease in the distal interphalangeal joints bilaterally with severe changes in the left little finger. The effects of long-term steroids led him to request a letter to support early retirement. Case report - Discussion The main rationale for changing treatment options was to reduce the prednisolone dose. Steroids were the only treatment option that showed evidence of controlling his disease when the dose was between 25mg and 40mg a day. Each of the DMARDs that were trialled had a different side effect profile and did not show any evidence of suppressing disease as symptoms recurred. Dose changes later in treatment fluctuated, reflecting a balancing act between disease recurrence and side effects of long-term steroids. There are many extra pulmonary manifestations of sarcoidosis that were investigated in this case. The first being the nasal granuloma, which can occur in sarcoid patients with symptoms of epistaxis, crusting, congestion, and pain. There were granulomatous changes seen in the hila as well as other lymph nodes such as the inguinal region; inguinal lymphadenopathy can lead to pain in the groin area. In addition to this it was important to exclude uveitis with ophthalmology review as he had symptoms of epiphora. Uveitis can be diagnosed in ophthalmological assessment of sarcoid patients in the absence of ocular complaints. Cardiac sarcoidosis was excluded with an MRI at a specialist heart and lung centre due to ventricular ectopics. Cardiac sarcoidosis can lead to heart block, arrhythmias, and congestive cardiac failure. Finally, he developed sarcoid arthropathy, review of his radiological images over time showed extensive damage to the joints of the hand. This gentleman had poor outcomes due to limited treatment options for his disease. Being restricted to long term steroid as the mainstay of treatment led to early retirement due to fatigue and muscle weakness. Conversely, under dosing steroids led to recurrence in symptoms. His disease is still not controlled as shown by an evolving sarcoid arthropathy. Case report - Key learning points An illustration of sarcoid arthropathy is also shown in this case. Sarcoid arthropathy is an uncommon manifestation of the disease primarily affecting joints in the hands and feet. In this case the distal interphalangeal joints and proximal interphalangeal joints were affected. The first symptom of arthropathy was stiffness of the base of the right thumb in 2017, this could fit with an osteoarthritic picture and could be mistaken for it in undiagnosed sarcoidosis. The most severe disease was in the DIP of the left little finger, which is not commonly affected. An oligoarthritic pattern with involvement of the ankle is seen more often. This is also an unusual case of sarcoidosis as there was no family history of the disease and his ethnicity did not predispose him to the condition. He also had a few uncommon extra pulmonary manifestations of sarcoidosis. The importance of a multidisciplinary approach in managing sarcoidosis was demonstrated in this case. Most of his follow up was with a respiratory clinic. However, respiratory symptoms were not the main issue during the patient journey; early ENT and rheumatology input was significant in managing his disease. Although pulmonary lymph nodes were enlarged, they did not affect his lung function.

scholarly journals Benign tumors of the heart: Myxoma of the right atrium - a case report

2018 ◽  
Vol 75 (5) ◽  
pp. 512-515 ◽  
Author(s):  
Sasa Hinic ◽  
Jelena Saric ◽  
Predrag Milojevic ◽  
Jelena Gavrilovic ◽  
Tijana Durmic ◽  
...  
Keyword(s):  
Case Report ◽  
Body Position ◽  
Atrial Myxoma ◽  
Right Atrial ◽  
Benign Tumors ◽  
Non Invasive ◽  
Right Atrial Myxoma ◽  
The Right

Introduction. Myxoma is the most common primary benign heart tumor. The most frequent location is the left atrium, the chamber of the heart that receives oxygen- rich blood from the lungs. Myxomas usually develop in women, typically between the ages of 40 and 60. Symptoms may occur at any time, but most often they are asymptomatic or oligosymptomatic for a long period of time. Symptoms usually go along with body position, and are related to compression of the heart cavities, embolization and the appearance of general symptoms. The diagnosis of benign tumors of the heart is based on anamnesis, clinical features and findings of the tumor masses by use of non-invasive and invasive imaging methods. Extensive surgical resection of the myxoma is curative with minimal mortality. Long term clinical and echocardiographic follow-up is mandatory. Case report. We reported a case of a 62-year-old male, presented with 15 days of intermittent shortness of breath, dizziness and feeling of heart palpitations and subsequently diagnosed with right atrial myxoma based on transthoracic echocardiography . The patient was emergently operated in our hospital. Long-term followup did not reveal recurrence. Conclusion. Our case was an atypical localisation of right atrial myxoma. Whether the intracardiac mass is benign or malignant, early surgery is obligatory in order to prevent complications.

scholarly journals A rare case of bilateral obstructive megaureter with a giant uretal ureterocele on the left

2020 ◽  
Vol 24 (3) ◽  
pp. 205-209
Author(s):  
G. N. Rumyantseva ◽  
V. N. Kartashev ◽  
Marina V. Dolinina ◽  
I. B. Osipov ◽  
A. I. Osipov ◽  
...  
Keyword(s):  
Left Kidney ◽  
Boarding School ◽  
Term Treatment ◽  
Ectopic Ureterocele ◽  
Surgical Department ◽  
Long Term Treatment ◽  
Obstructive Megaureter ◽  
The Right ◽  
Medical University

The article discusses a case of 4-year-old patient with a bilateral obstructive megaureter of a non-functioning left kidney and with the opening of this kidney ureter into the urethra with extravasal location of a giant ureterocele. The malformation of the urinary system was accompanied by a comorbid disease of bronchopulmonary system in the form of tuberculosis of the lungs and intra-thoracic lymph nodes. At the age of one month, due to decompensation of the only functioning right kidney, urine was withdrawn by applying a ureterostomy. Later, a proximal lateral cutaneous ureterostomy was put because of social reasons (mother refused of her baby). In two months, the next step was performed - a ureterocystoneostomy by the Cohen’s antireflux technique. After a long-term treatment for tuberculosis in clinics of Tver and St. Petersburg, at the age of 4, the girl was operated on at the first surgical department at St-Petersburg State Pediatric Medical University. Laparoscopic nephroureterectomy on the left with conversion to lower-middle laparotomy and resection of the terminal part of the left ureter with a giant ectopic ureterocele as well as closure of the ureterocutaneostomy on the right were performed. After stabilization, the child was transferred to a children’s boarding school in Tver, and currently is supervised by pediatric urologists and TB specialists.

scholarly journals Treatment of penile lichen sclerosus with topical corticosteroids for over 25 years’ duration: A case report

2018 ◽  
Vol 6 ◽  
pp. 2050313X1879504 ◽  
Author(s):  
Matthew Howard ◽  
Anthony Hall
Keyword(s):  
Case Report ◽  
Relevant Literature ◽  
Lichen Sclerosus ◽  
Short Review ◽  
Short Term ◽  
Topical Corticosteroids ◽  
Long Term Follow Up ◽  
Term Management

Topical corticosteroids are currently recommended only for short-term management of flares of lichen sclerosus, with efficacy in halting disease progression. Given the chronic nature of this condition, there is a lack of literature surrounding the chronic effects of topical corticosteroids on the male genitalia with many dermatologists avoiding prescribing long term. This case report aims to provide anecdotal observation for the long-term use of topical corticosteroids and details the long-term follow-up of an individual who used potent and superpotent topical corticosteroids for over 25 years without significant demonstrable side effects. A short review on relevant literature is provided.

scholarly journals Leiomyosarcoma of the Right Ovarian Vein: a Case Report with Multimodality Management and Long-Term Follow-Up

2019 ◽  
Vol 10 (3) ◽  
pp. 523-526
Author(s):  
Virendra Rajpurohit ◽  
Pooja Mehta ◽  
Nirupama Kothari ◽  
Sanjay Nathani
Keyword(s):  
Case Report ◽  
Ovarian Vein ◽  
Long Term Follow Up ◽  
The Right

scholarly journals Ring-stripping retrograde common carotid endarterectomy: case report

2002 ◽  
Vol 120 (5) ◽  
pp. 154-157 ◽  
Author(s):  
Eduardo Toledo de Aguiar ◽  
Alex Lederman ◽  
Patrícia Matsunaga
Keyword(s):  
Case Report ◽  
Carotid Endarterectomy ◽  
Artery Bypass ◽  
Tertiary Care ◽  
Retrospective Case ◽  
Total Occlusion ◽  
Cervical Incision ◽  
The Common ◽  
The Right

CONTEXT: Total occlusion of the common carotid is rare and the indications and techniques for surgical treatment are still a matter of controversy. OBJECTIVE: To demonstrate the feasibility of retrograde common carotid endarterectomy. DESIGN: Retrospective case report study. SETTING: Tertiary care private hospital. PARTICIPANTS: Three patients underwent ring-stripping retrograde common carotid endarterectomy. Their ages were 81, 68 and 65 years. All were hypertensive with generalized atherosclerosis, two had diabetes mellitus, and one had undergone coronary artery bypass some years earlier and had non-dialytic chronic renal insufficiency. Symptoms of brain ischemia were present in two patients. All patients had total occlusion of the common carotid, extending from the origin to the bifurcation and localized in the right common carotid in two cases. In two cases the internal carotid artery was also occluded. MAIN MEASUREMENTS: Postoperative early mortality and stroke rate, and the medium and long-term endarterectomy patency. RESULTS: There were no deaths. One patient had a transient ischemic attack. All endarterectomies were patent after eight months, four years and seven years of follow-up. CONCLUSION: There is low mortality, and the procedure can be done through only one cervical incision. Tandem lesions of the carotid arteries can be treated together. It is suitable for long total occlusions of the common carotid, and long-term patency.

Long-Term Management with Octreotide or Cabergoline in Ectopic Corticotropin Hypersecretion: Case Report and Literature Review

2010 ◽  
Vol 16 (5) ◽  
pp. 829-834 ◽  
Author(s):  
Oscar Bruno ◽  
Karina Danilowicz ◽  
Marcos Manavela ◽  
Daniela Mana ◽  
Maria Rossi
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Term Management

scholarly journals A maxillary ameloblastic fibrosarcoma tumor: a rare case report from Syria

2020 ◽  
Vol 2020 (8) ◽  
Author(s):  
Amjad Soltany ◽  
Ghazal Asaad ◽  
Rami Daher ◽  
Mouhannad Dayoub ◽  
Ali Khalil ◽  
...  
Keyword(s):  
Case Report ◽  
Soft Tissue ◽  
Rare Case ◽  
Soft Tissue Sarcomas ◽  
Surgical Excision ◽  
Low Grade ◽  
Rare Case Report ◽  
Ameloblastic Fibrosarcoma ◽  
The Right

Abstract Ameloblastic fibrosarcoma (AFS) is a rare, aggressive malignant odontogenic tumor. AFS is seen most frequently in second and third decades of life. We are reporting a case of a low grade AFS in a 21-year-old male complaining of a painless swelling in the right side of the maxilla. The patient was treated with surgical excision followed by radiotherapy, which is considered the most effective approach for most of soft tissue sarcomas. AFS has a high-reported recurrence rate (up to 37%); therefore, long-term surveillance for recurrence is crucial.

scholarly journals An Unusual Transorbital Penetrating Injury and Principles of Management

2014 ◽  
Vol 7 (4) ◽  
pp. 310-312 ◽  
Author(s):  
AndrewPeter Dekker ◽  
AbdelHamid El-Sawy ◽  
DariusStephen Rejali
Keyword(s):  
Visual Acuity ◽  
Case Report ◽  
Multidisciplinary Approach ◽  
Penetrating Injury ◽  
Significant Morbidity ◽  
Low Velocity ◽  
Cranial Fossa ◽  
The Right ◽  
Ethmoid Sinuses

The objective of this study was to present an unusual low velocity transorbital penetrating injury. The study design was a clinical record (case report). A 38-year-old gentleman tripped and fell face first onto the wing of an ornamental brass eagle. This penetrated the inferomedial aspect of the right orbit, breaching the lamina papyracea to extend into the ethmoid sinuses and reaching the dura of the anterior cranial fossa. The foreign body was removed in theater under a joint ophthalmology and ENT procedure. The patient was left with reduced visual acuity in the right eye but no other long-term sequelae. Transorbital penetrating injury presents unusual challenges to investigation and management requiring a multidisciplinary approach to prevent significant morbidity and mortality. If managed well the prognosis is good.

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