The Diagnosis of Unilateral Diaphragmatic Paralysis Using M-mode: A Case Report from Palestine

Background: Diaphragmatic paralysis is one the causes of dyspnoea and difficulty in breathing. There are many causes of diaphragmatic paralysis, especially trauma and iatrogenic injury of phrenic nerve. Usually, diaphragmatic paralysis diagnosis depends on fluoroscopic examination of diaphragmatic displacement during sharp sniffs. However, due to disadvantages of fluoroscopic examination, the trend for less radiation examination by using ultrasound is increasing especially using M-mode for detection of diaphragmatic motion during respiration. Case: A new-born baby boy with uneventful pregnancy and normal delivery with good general condition, developed severe respiratory distress at 3rd day of life and was diagnosed to have bilateral pneumothorax. Bilateral chest tubes were inserted with improvement of his condition. The baby then started to develop desaturation with serial chest x-rays done and showed elevated left hemi-diaphragm. Suspicion toward left hemi-diaphragm paralysis increased and due to his general condition, fluoroscopic examination was difficult. So that, Ultrasound with M-mode was used with diagnosis of the patient with left hemi-diaphragmatic paralysis. Conclusion: Ultrasound and the using of M-mode in detection of diaphragmatic motion is one of the most important and applicable diagnostic procedure for diagnosis of diaphragmatic weakness and paralysis.

Hepatoblastoma in a 14-months old child

In children, commonest liver tumor is hepatoblastoma. We present a 14-month-old male child who presented with abdominal distension and loose stool. Radiological imaging revealed solid hepatic mass. Hematological investigations revealed anemia, thrombocytosis and high Serum alpha fetoprotein (AFP) level. Ultrasound (USG) guided FNAC confirmed the mass to be hepatoblastoma. CT scan revealed hepatoblastoma PRETEXT stage III. The patient underwent 6 cycles of neoadjuvant chemotherapy and responded to POSTTEXT stage II. Left hemi-hepatectomy was done with clear resectin margins. Complete surgical excision of the mass after preoperative chemotherapy remains the mainstay of the treatment of locally advanced hepatoblastoma.

Prognosis and Management of Communicating and Non-communicating Hydrocele

Hydrocele can be found as a collection of fluid within the testicular tunica vaginalis. According to the etiology and pathophysiology of the disease, it can be classified into primary and secondary. Furthermore, primary hydrocele might include the closed or non-communicating, the communicating type, the congenital and or neonatal type. Many management approaches have been proposed for both the communicating and non-communicating hydrocele with different post-operative and prognostic outcomes. In this literature review, we have discussed the current management approaches and prognosis of communicating and non-community hydrocele. Adequate diagnosis of the condition is the first step to achieve favorable management outcomes. Although the reported management outcomes are reported to be effective in the literature, the surgical approaches seem to be superior. However, many side effects might be associated with these operations. Estimates show that following varicocelectomy procedures, ipselateral (left) hemi-scrotal varicocele is the most common condition to occur, which might even develop following the procedure by several months and years (in some cases). Further investigations are still needed because the current evidence is largely based on case reports and small case series investigations. Therefore, larger studies are needed to help draw effective management protocols and enhance the outcomes and prognosis.

Paramedian Supracerebellar Infratentorial Approach for Pontine Cavernoma: 2-Dimensional Operative Video

We describe the case of a 26-yr-old male who presented with headaches, dizziness, and left hemi-hypoesthesia in addition to being COVID-19 positive. The patient was found to have a large hemorrhage in the right dorsolateral pons that was found to be due to a pontine cavernous malformation. The patient underwent a right-sided paramedian supracerebellar infratentorial approach for resection of this lesion with preservation of the developmental venous anomaly. We present the operative video with a specific focus on approach selection, anatomic illustrations, and technical nuances. The literature on the timing of brainstem cavernoma surgery is reviewed.1-4 The patient's postoperative clinical course and postoperative imaging are reviewed. The patient gave informed consent for the procedure and verbal consent for being part of this submission and the publication of their image.

Discharging loin sinus: Unusual manifestation of ruptured horseshoe kidney

We present a 20-year-old man with a chronic discharging sinus in the left loin arising from a horseshoe kidney with a large pelvicalyceal calculus on its left side. The left moiety was non-functional, so a left hemi-nephrectomy, together with excision of the whole fistula tract, was carried out. Histopathology was suggestive of chronic interstitial nephritis. Patients with horseshoe kidney are prone to development of renal stones and their associated complications. The unfamiliar anatomy of horseshoe kidneys may increase the complexity of any surgical procedure. Radiological investigations are pivotal in identification of the underlying renal pathology; they may also delineate a fistula tract as in our case.

940 Mesenteric Haematoma Complicated by A Perforated Sigmoid Diverticulum Following Extracorporeal Shockwave Lithotripsy

A 78 year old female presented with sudden onset lower abdominal pain, vomiting and fresh rectal bleeding. She had undergone extracorporeal shockwave lithotripsy (ECSL) for a left renal stone two weeks earlier and was taking Rivaroxaban for atrial fibrillation. A CT Abdomen & Pelvis revealed a large mesenteric haematoma and a contained sigmoid perforation secondary to compressive forces of the haematoma on the sigmoid artery, resulting in ischaemia. While mesenteric angiogram-guided embolisation initially controlled the active sigmoid artery bleed, the patient clinically deteriorated the following day warranting a laparotomy. This revealed an ischaemic sigmoid colon with contained faeculent material within the mesentery. An extended left hemi-colectomy with end-colostomy was performed. Despite optimal critical care input, the patient developed multi-organ failure and passed away one week later. Mesenteric haematoma should be considered as a rare complication in patients with sudden onset abdominal pain following ECSL; especially with concurrent anti-coagulation use.