scholarly journals Rice Bodies In The Wrist

2021 ◽  
Author(s):  
Maurice Gillijns ◽  
Wim Vandesande
Keyword(s):  
Carpal Tunnel Release ◽  
Knee Joints ◽  
Adequate Treatment ◽  
Rice Bodies ◽  
Patient Reported ◽  
Atypical Cells ◽  
History Of ◽  
Flexor Pollicis Longus Tendon ◽  
The Right ◽  
Flexor Digitorum

Abstract Rice bodies are a rare finding in medicine and remain to be a challenge to provide adequate treatment. As occurrence varies over multiple rheumatic as well as infectious diseases, multiple hypotheses have been made about their origin. While rice bodies are most frequently reported in the shoulder and knee joints, flexor tendon synovitis with accompanying rice bodies is more rare. We report a case of extensive flexor tenosynovitis with rice bodies in the wrist in a 90-year old patient with seronegative rheumatoid arthritis. The patient reported a 5 month history of painful swelling of the right wrist. Ultrasound showed pronounced swelling of the synovial tissue of the flexor digitorum tendons as well as the flexor pollicis longus tendon. Laboratory test were negative for rheumatology tests with normal CRP and sedimentation rates. T2 weighted MRI demonstrated an extensive synovitis reaching from the distal forearm into the hand with inclusions, better known as rice bodies. Synovectomy including carpal tunnel release was performed with dissection of the mass revealing an extensive synovitis with a multitude of rice bodies. Histopathology showed lymphohistiocytic infiltrates consistent with rheumatoid nodules, no atypical cells were discovered. After surgery the patient regained full function of the wrist within two weeks without any remaining pain or mass in the affected limb.

Lyme disease atypically presenting with a singular symptom: Unilateral chorioretinitis

2020 ◽  
pp. 112067212096205
Author(s):  
Erol Havuz ◽  
Seda Güdül Havuz
Keyword(s):  
Visual Acuity ◽  
Lyme Disease ◽  
Retinal Vasculitis ◽  
Ocular Involvement ◽  
Ischemic Optic Neuropathy ◽  
Sudden Loss ◽  
Patient Reported ◽  
History Of ◽  
Verification Test ◽  
The Right

Background: Lyme disease, caused by Borrelia burgdorferi, is a spirochetal disease. Lyme disease-related ocular findings may also provide important clues. Ocular involvement is most commonly seen as uveitis, chorioretinitis, conjunctivitis, keratitis, episcleritis, papillitis, panuveitis, ischemic optic neuropathy, papilledema, and retinal vasculitis. Case: A 27-year-old male patient was admitted with a history of fatigue, malaise, and sudden loss of vision in his left eye for 3 days. The best visual acuity was found 20/20 in the right eye and 20/400 in the left eye. Fluorescein fundus angiography showed no pathological findings in the right eye; but hyperfluorescence that was compatible with choroiditis foci was seen in the left eye. Optical coherence tomography (OCT) showed choroidal thickening in the left eye compared to the right eye. Lyme IgM antibody was found to be positive, explaining choroiditis etiology, while IgG values were found to be negative. Western blot verification test was positive. The patient was treated with 2 × 100 mg doxycycline (21 days) with a diagnosis of Lyme disease, prednol 1 mg/kg/day (10 days) for choroiditis. Omeprazole tablets were given 1 × 1 during the period of cortisone intake. On the third day of treatment, visual acuity increased to 20/200 and continued to increase until reaching 20/20 in the second week. Conclusions: Lyme disease is rare, but must be kept in mind when investigating the etiology of chorioretinitis and retinal vasculitis. The patient reported here is, to our knowledge, the second case reported in literature that shows atypical clinic for Lyme disease with unilateral chorioretinitis without Erythema chronicum migrans (ECM).

scholarly journals Successful treatment of highly recurrent facial baroparesis in a frequent high-altitude traveler: a case report

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Jason P. Caffrey ◽  
Jason W. Adams ◽  
Isabel Costantino ◽  
Kristin Klepper ◽  
Elina Kari ◽  
...  
Keyword(s):  
High Altitude ◽  
Successful Treatment ◽  
Rare Condition ◽  
Pressure Equalization ◽  
Seventh Cranial Nerve ◽  
Commercial Airline ◽  
Bone Segment ◽  
Patient Reported ◽  
History Of ◽  
The Right

Abstract Background Facial baroparesis is a palsy of the seventh cranial nerve resulting from increased pressure compressing the nerve along its course through the middle ear cavity. It is a rare condition, most commonly reported in barotraumatic environments, in particular scuba diving and high-altitude air travel. We report here an unusual case of highly frequent baroparesis, workup, and successful treatment. Case presentation A 57-year-old Caucasian male frequent commercial airline traveler presented with a 4-year history of recurrent episodes of right-sided facial paralysis and otalgia, increasing in both frequency and severity. Incidents occurred almost exclusively during rapid altitude changes in aircraft, mostly ascent, but also during rapid altitude change in an automobile. Self-treatment included nasal and oral decongestants, nasal corticosteroids, and warm packs. Temporal bone computed tomography (CT) scan revealed possible right-sided dehiscence of the tympanic bone segment; audiogram and magnetic resonance imaging of the internal auditory canals were unremarkable. After a diagnosis of facial nerve baroparesis was made, the patient underwent myringotomy with insertion of a pressure equalization tube (PET) into the right tympanic membrane. Despite re-exposure to altitude change multiple times weekly post-treatment, the patient reported being symptom-free for more than 6 months following intervention. Conclusions Prompt PET insertion may represent the preferred treatment for individuals who suffer recurrent episodes of facial baroparesis. Education regarding this rare condition may prevent unnecessary testing and treatment of affected patients. Future studies should explore the pathophysiology and risk factors, compare therapeutic options, and provide follow-up data to optimize the management of affected patients.

scholarly journals Bilateral anterior interosseous nerve syndrome with 6-year interval

2018 ◽  
Vol 6 ◽  
pp. 2050313X1877741
Author(s):  
Thomas Tyszkiewicz ◽  
Isam Atroshi
Keyword(s):  
Complete Recovery ◽  
Interphalangeal Joint ◽  
Wrist Arthroscopy ◽  
Flexor Pollicis Longus ◽  
Active Flexion ◽  
Anterior Interosseous Nerve ◽  
History Of ◽  
Anterior Interosseous Nerve Syndrome ◽  
Flexor Pollicis Longus Tendon ◽  
The Right

Flexor pollicis longus paralysis related to idiopathic anterior interosseous nerve syndrome is well known, but few reports exist on bilateral disease. A 24-year-old man with no personal or family history of neurological disease developed isolated total loss of active flexion of the right thumb’s interphalangeal joint after undergoing a wrist arthroscopy. Surgical exploration 5 weeks after onset showed flexor pollicis longus tendon to be intact; anterior interosseous nerve decompression was done with no abnormalities found. Because of persistent paralysis, electromyography was performed showing findings consistent with anterior interosseous nerve syndrome. After 7 months without recovery, the patient underwent tendon transfer. After 6 years, the patient presented with left-sided isolated flexor pollicis longus paralysis and electromyography indicated anterior interosseous nerve syndrome. Examination 9 months after onset showed persistent complete flexor pollicis longus paralysis but by 15 months spontaneous complete recovery had occurred. Anterior interosseous nerve syndrome can occur bilaterally and is likely to resolve completely without intervention but recovery may take longer than a year.

Differential Diagnosis and Treatment in a Patient With Posterior Upper Thoracic Pain

2006 ◽  
Vol 86 (2) ◽  
pp. 254-268 ◽  
Author(s):  
Stacie J Fruth
Keyword(s):  
Differential Diagnosis ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Trigger Points ◽  
Diagnosis And Treatment ◽  
Thoracic Pain ◽  
Patient Reported ◽  
History Of ◽  
The Right ◽  
Upper Thoracic

Background and Purpose. Determining the source of a patient's pain in the upper thoracic region can be difficult. Costovertebral (CV) and costotransverse (CT) joint hypomobility and active trigger points (TrPs) are possible sources of upper thoracic pain. This case report describes the clinical decision-making process for a patient with posterior upper thoracic pain. Case Description. The patient had a 4-month history of pain; limited cervical, trunk, and shoulder active range of motion; limited and painful mobility of the right CV /CT joints of ribs 3 through 6; and periscapular TrPs. Interventions included CV / CT joint mobilizations, TrP release, and flexibility and postural exercises. Outcomes. The patient reported intermittent mild discomfort after 7 physical therapy sessions. Examination findings were normal, and he was able to resume all preinjury activities. Discussion. This case suggests that CV /CT mobilizations and active TrP release may have been beneficial in reducing pain and restoring function in this patient. [Fruth SJ. Differential diagnosis and treatment in a patient with posterior upper thoracic pain. Phys Ther. 2006;86:254-268.]

scholarly journals PERIDURAL CATETER RUPTURE DURING ANESTHETIC ACT

2020 ◽  
Vol 7 (3) ◽  
pp. 56-58
Author(s):  
Ana Flávia de Oliveira Castro ◽  
Clara Rebeca Meneses Moura ◽  
Pedro Durán Marques de Souza ◽  
Rafaela Soares Azevedo Mundim Rios ◽  
Vantuir José Domingos da Mota ◽  
...  
Keyword(s):  
Epidural Catheter ◽  
Previous History ◽  
Infectious Complications ◽  
Diagnostic Methods ◽  
Axial Tomography ◽  
Thoracic Epidural ◽  
Patient Reported ◽  
History Of ◽  
The Subject ◽  
The Right

ABSTRACT: Epidural catheter rupture is a condition rarely described in the literature, being considered rare. The reports on the subject present discussions about the possible causes and consequences in the anesthetic act. Discussions about complications are even rarer, of which neurological symptoms, pain, inflammation, root avulsion or infectious complications. Thus, this clinical case describes an event of epidural catheter rupture in a patient during preoperative analgesia, treated by surgery. Data were obtained through a review of the medical record, interview with the patient, photographic record of the diagnostic methods and review of the literature. Patient A. C., female, 28 years old, 55 kg, 1.64 m, GIPI, with previous history of pain in right hypochondrium, associated with nausea and vomiting, diagnosed with choledocholithiasis and taken to the surgical center for conventional cholecystectomy. During insertion of the catheter for anesthesia in the thoracic epidural space, the patient reported paresthesia in the right lower limb. When withdrawing needle-catheter assembly under resistance, there was rupture of the same. It was decided to perform imaging tests, which showed a catheter fragment in the computed axial tomography. Since the patient was symptomatic, an emergency surgical procedure was performed. Keywords: epidural anesthesia; complications; epidural catheter; break.

scholarly journals Case report of fibrous dysplasia in a pediatric patient: importance of adequate treatment to avoid malignization

2021 ◽  
Author(s):  
João Victor Bezerra Ramos ◽  
João Lucas Pordeus de Menezes ◽  
Louyse Jerônimo de Morais ◽  
Maurus Marques de Almeida Holanda
Keyword(s):  
Fibrous Dysplasia ◽  
Malignant Transformation ◽  
Adequate Treatment ◽  
Long Term Follow Up ◽  
History Of ◽  
Daily Headache ◽  
The Right ◽  
Temporal Bones

Background: Fibrous dysplasia is a congenital and benign bone tumor. There may be malignant transformation in some cases, with a mortality rate of 53.6%. Objectives and Methods: To describe a patient with fibrous dysplasia in childhood in the parietal and temporal bones, and to report the importance of surgical correction to prevent malignant transformation. The case was studied and came from a referral hospital – João Pesssoa, PB. Results: History of daily headache and bulging in the temporal and parietal regions on the right. Computed tomography revealed lesions in the aspect of “ground glass”. Surgery was performed with exposure of two lesions, with craniectomy, followed by cranioplasty. Such an approach should be recommended, since malignant transformation occurs in up to 1% of cases, but after radiotherapy this rate can reach 44% of cases, mainly osteosarcoma. In this case, the anatomopathological study revealed a diagnosis of fibrous dysplasia and the patient has been followed up for 20 years without recurrences, which are common in adolescence. Conclusions: It is important to make a differential diagnosis with malignant diseases, in addition to contraindicating radiotherapy to prevent malignant transformation; long-term follow-up is essential to avoid relapses and / or complications resulting from the disease.

scholarly journals DHE-Induced Peripheral Arterial Vasospasm in Primary Raynaud Phenomenon: Case Report

2018 ◽  
Vol 9 (2) ◽  
pp. 113-115
Author(s):  
Jane Khalife ◽  
Clinton G. Lauritsen ◽  
John Liang ◽  
Syed O. Shah
Keyword(s):  
Migraine Treatment ◽  
Raynaud Phenomenon ◽  
Doppler Study ◽  
Arterial Vasospasm ◽  
Patient Reported ◽  
History Of ◽  
Status Migrainosus ◽  
Computed Tomography Angiogram ◽  
Peripheral Arterial ◽  
The Right

Dihydroergotamine (DHE) is primarily a serotonin 5HT1B and 5HT1D receptor agonist used for acute migraine treatment. It is associated with acute vasoconstriction mediated through the 5HT1B receptor and is contraindicated in patients with history of cardiac disease and peripheral vascular disease. We present a case of acute peripheral arterial vasospasm in a patient with primary Raynaud phenomenon while receiving inpatient treatment for status migrainosus with intravenous (IV) DHE. The patient is a 35-year-old female with a history of chronic migraine and primary Raynaud phenomenon. After 15 doses of IV DHE, the patient reported paresthesias of the right hand and was noted to have absent right radial and ulnar pulses to palpation. Portable arterial Doppler study demonstrated abnormal flat line pulse volume recordings (PVRs) in the right second, third, and fourth digits, with markedly dampened PVR in the right thumb and fifth finger along with no ulnar PVR detectable at the wrist. Duplex revealed bilateral severely diminished flow in the right ulnar and radial arteries without acute occlusions. Computed tomography angiogram of right upper extremity visualized arteries through the mid-forearm but not distally. Dihydroergotamine was discontinued, and the patient was started on oral amlodipine and aspirin. Repeat Doppler ultrasound 3 days later revealed normal arm and digital waveforms bilaterally consistent with resolution of vasospasm. This case highlights a potential complication of IV DHE therapy. Risk may be increased in patients with primary Raynaud phenomenon. We suggest cautious use of IV DHE in this population.

scholarly journals Reduction en masse of inguinal hernia after self-reduction: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Khosrow Najjari ◽  
Hossein zabihi Mahmoudabadi ◽  
Seyed Zeynab Seyedjavadeyn ◽  
Reza Hajebi
Keyword(s):  
Case Report ◽  
Inguinal Hernia ◽  
Ct Scan ◽  
Lower Quadrant ◽  
Case Presentation ◽  
Delay In Diagnosis ◽  
Patient Reported ◽  
History Of ◽  
Old Persian ◽  
The Right

Abstract Background Reduction en mass (REM) is one of the rare complications of inguinal hernia reduction. Although REM can be detected on the basis of specific computed tomography (CT) scan findings, many radiologists are not familiar with its radiological appearance because of the scarcity of this complication, which may cause a delay in diagnosis. Case presentation The patient reported in this article was a 50-year-old Persian man with a history of inguinal hernia, who had been referred with the periumbilical pain that radiated to the right lower quadrant and developed following hernia replacement by the patient himself. REM diagnosis was based on clinical examination and CT scan findings, and surgical treatment was performed by the Lichtenstein repair and mesh implantation. Conclusions Although REM usually occurs after reduction with compression in the inguinal hernia, this unique case report highlighted the possibility of REM after self-reduction. Surgeons and radiologists should consider REM in patients with a history of inguinal hernia presenting with intestinal obstruction symptoms, even without any apparent signs of hernia in the physical examination.

scholarly journals Successful Medical Management of a Retroperitoneal Abscess: A Difficult Diagnosis in Pyrexia of Unknown Origin

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
U. G. H. Ishan ◽  
M. C. K. Thilakasiri ◽  
P. N. Weeratunga ◽  
R. D. Lanerolle
Keyword(s):  
Medical Management ◽  
Unknown Origin ◽  
Definitive Treatment ◽  
Retroperitoneal Abscess ◽  
Delay In Diagnosis ◽  
Pyrexia Of Unknown Origin ◽  
Patient Reported ◽  
History Of ◽  
The Right ◽  
Tract Infections

Retroperitoneal abscesses are uncommon conditions with occult and insidious presentations. There is often a lack of abdominal signs and ultrasound findings, causing a delay in diagnosis and definitive treatment, leading to poor patient outcomes. We report a case of right-sided retroperitoneal abscess of a 28-year-old female patient with diabetes mellitus. Prior to admission, the patient reported a vague 2 weeks history of right-sided back and abdominal pain and dysuria. She presented to our medical ward with suspected pyelonephritis with right-sided renal abscess. A retroperitoneal abscess involving the right renal fossa was revealed on an urgent CT scan. The patient underwent percutaneous ultrasound-guided pigtail catheter drainage. Patient clinically and biochemically improved with medical management gradually over 2 weeks. This case report highlights the importance of investigating for recurrent urinary tract infections of diabetics which are often overlooked in general practice.

scholarly journals Rare case of a liposarcoma in the brachial plexus

2016 ◽  
Vol 98 (7) ◽  
pp. e106-e108 ◽  
Author(s):  
D Kosutic ◽  
K Gajanan
Keyword(s):  
Brachial Plexus ◽  
Low Grade ◽  
Connective Tissues ◽  
Adequate Treatment ◽  
Long Term Follow Up ◽  
History Of ◽  
Axillary Mass ◽  
Painless Mass ◽  
The Right ◽  
Slow Growing

Introduction A liposarcoma is a rare cancer of connective tissues that resemble fat cells under light microscopy. Case History A 73-year old female patient presented to our tertiary cancer centre with an eight-year history of a large, slow-growing painless mass in the right axilla. Magnetic resonance imaging showed a lipomatous, well-circumscribed mass of dimension 30 × 16 × 10cm extending towards the right clavicle and causing deformation to the right chest wall and right breast. Surgery revealed a large tumour that had stretched all three cords of the brachial plexus. Histopathology was consistent with a diagnosis of a low-grade liposarcoma. After a period of neuropraxia, the patient returned to normal activities 4 months after surgery. Conclusions Although extremely rare, low-grade liposarcomas of the brachial plexus should be considered in the differential diagnosis of a slow-growing axillary mass. Referral to a tertiary sarcoma centre is essential for an appropriate diagnosis, adequate treatment, and long-term follow-up.

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