Rare Etiology of Odynophagia in a Female Adolescent

Herpes esophagitis (HE) is a rare condition in immunocompetent adolescents. However, it commonly occurs as a primary infection in younger individuals. Herein, we report a 16-year-old female patient who had a history of fever for 5 days, odynophagia, and orolabial herpes infection for 7 days. Clusters of painful vesicles on an erythematous base on the lips, gingiva, and palate were observed on physical examination. Further, esophagogastroduodenoscopy revealed diffuse linear ulcerations in the distal esophagus. The patient then received the following treatment: intravenous (I.V.) acyclovir 5 mg/kg three times a day, I.V. omeprazole 40 mg two times a day, and acyclovir 5% cream four times a day. After 8 days of admission, the patient was discharged. A follow-up esophagogastroduodenoscopy was performed 7 weeks after discharge, and the results revealed that the esophageal mucosa had a normal appearance. The effect of antiviral treatment against HE remains unknown in these patients. Nevertheless, it is believed to accelerate the healing process in individuals with esophageal mucosal barrier damage. To the best of our knowledge, this case of a female adolescent with an intact immune system is the sixth case of herpes simplex esophagitis to be reported in the literature.

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The fat anchor orchiopexy technique: results and outcomes from 150 cases surgical experience

Pediatric Surgery International ◽

10.1007/s00383-021-04919-w ◽

2021 ◽

Author(s):

Claudio Spinelli ◽

Alessia Bertocchini ◽

Gianmartin Cito ◽

Marco Ghionzoli ◽

Silvia Strambi

Keyword(s):

Undescended Testis ◽

Healing Process ◽

Day Surgery ◽

Post Surgery ◽

Post Operative Pain ◽

Surgical Wounds ◽

Bilateral Cryptorchidism ◽

Long Time ◽

History Of

Abstract Purpose The purpose of the study is to evaluate results and outcomes in a long-time follow-up period, by performing a novel testicular fixation procedure, known as “fat anchor orchidopexy” (FAO), for the treatment of palpable low inguinal undescended testis. Materials and methods We retrospectively reviewed all patients who underwent scrotal orchiopexy technique, from May 2013 to May 2019, at the Pediatric Surgery Division of Department of Surgical Pathology, University of Pisa (Italy). FAO (Spinelli’s technique) consists in anchoring the testicles to sub-scrotal fat with a single trans-scrotal incision. All the patients enrolled had history of unilateral or bilateral undescended testis. Data collected included patient’s age, operative times and complications. Results A total of 150 children with cryptorchidism were treated using a single trans-scrotal orchiopexy. Of them, 130 patients (86.7%) had unilateral undescended testis and 20 (13.3%) bilateral cryptorchidism. Mean patient’s age was 21 months (range: 14–28 months). All the procedures were planned in a day-surgery setting. Trans-scrotal orchiopexy was successful in all cases and no patients required an additional groin incision. No intraoperatively and postoperatively major complications were observed. Patients’ post-operative pain was mild (mean pediatric visual analog scale = 2). In all cases, the healing process was rapid and no surgical wounds infections were reported during the post-operative period, referring excellent cosmesis results. During a mean 48-month follow-up period, no testicular retraction, recurrence or testis atrophy was reported. Conclusion The original Spinelli’s technique (FAO) proves to be a safe and effective method for the treatment of palpable or distal-to-external-inguinal-ring testes. No immediate and delayed post-surgery complications were reported. In all cases, the anchored testicle remained in the scrotal position with normal vascularization. This novel surgical technique could give better options for scrotal fixation in case of low-lying cryptorchid testes.

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Dandy–Walker syndrome associated with syringomyelia in an adult: a case report and literature review

Journal of International Medical Research ◽

10.1177/0300060518808961 ◽

2019 ◽

Vol 47 (4) ◽

pp. 1771-1777

Author(s):

Nan Zhang ◽

Zhenyu Qi ◽

Xuewen Zhang ◽

Fangping Zhong ◽

Hui Yao ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Endoscopic Third Ventriculostomy ◽

Rare Condition ◽

Third Ventriculostomy ◽

Resonance Imaging ◽

Adult Case ◽

History Of ◽

Memory Deterioration

Dandy–Walker syndrome associated with syringomyelia is a rare condition, with few reports of adult cases. We describe an adult case of Dandy–Walker syndrome with concomitant syringomyelia. A 33-year-old man presented with a 3-month history of walking instability, numbness in the hands, memory deterioration, and urinary incontinence. A physical examination showed a positive Romberg sign. Brain computed tomography and magnetic resonance imaging showed hydrocephalus, a cyst in the posterior fossa, absence of the cerebellar vermis, hypoplasia of the corpus callosum and cerebella, and syringomyelia. All of these symptoms were consistent with the diagnosis of Dandy–Walker syndrome. Surgery involving arachnoid adhesiolysis and endoscopic third ventriculostomy was performed. At the 6-month follow-up, the symptoms were completely relieved. Magnetic resonance imaging showed that syringomyelia was greatly reduced and the hydrocephalus remained unchanged. Dandy–Walker syndrome with concomitant syringomyelia in adults is exceedingly rare. Early diagnosis and appropriate surgical treatment of this condition should be highlighted. Combined arachnoid adhesiolysis and endoscopic third ventriculostomy may be an effective approach.

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Impact of the M184V/I Mutation on the Efficacy of Abacavir/Lamivudine/Dolutegravir Therapy in HIV Treatment-Experienced Patients

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz330 ◽

2019 ◽

Vol 6 (10) ◽

Cited By ~ 7

Author(s):

Flaminia Olearo ◽

Huyen Nguyen ◽

Fabrice Bonnet ◽

Sabine Yerly ◽

Gilles Wandeler ◽

...

Keyword(s):

Primary Outcome ◽

Antiviral Treatment ◽

Composite Endpoint ◽

Hiv Treatment ◽

Hiv Positive ◽

Prior History ◽

History Of ◽

The Impact ◽

Hiv 1

Abstract Objective The impact of the M184V/I mutation on the virological failure (VF) rate in HIV-positive patients with suppressed viremia switching to an abacavir/lamivudine/dolutegravir regimen has been poorly evaluated. Method This is an observational study from 5 European HIV cohorts among treatment-experienced adults with ≤50 copies/mL of HIV-1 RNA who switched to abacavir/lamivudine/dolutegravir. Primary outcome was the time to first VF (2 consecutive HIV-1 RNA >50 copies/mL or single HIV-1 RNA >50 copies/mL accompanied by change in antiretroviral therapy [ART]). We also analyzed a composite outcome considering the presence of VF and/or virological blips. We report also the results of an inverse probability weighting analysis on a restricted population with a prior history of VF on any ART regimen to calculate statistics standardized to the disparate sampling population. Results We included 1626 patients (median follow-up, 288.5 days; interquartile range, 154–441). Patients with a genotypically documented M184V/I mutation (n = 137) had a lower CD4 nadir and a longer history of antiviral treatment. The incidence of VF was 29.8 cases (11.2–79.4) per 1000 person-years in those with a previously documented M184V/I, and 13.6 cases (8.4–21.8) in patients without documented M184V/I. Propensity score weighting in a restricted population (n = 580) showed that M184V/I was not associated with VF or the composite endpoint (hazard ratio [HR], 1.27; 95% confidence interval [CI], 0.35–4.59 and HR 1.66; 95% CI, 0.81–3.43, respectively). Conclusions In ART-experienced patients switching to an abacavir/lamivudine/dolutegravir treatment, we observed few VFs and found no evidence for an impact of previously-acquired M184V/I mutation on this outcome. Additional analyses are required to demonstrate whether these findings will remain robust during a longer follow-up.

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Topical Tacrolimus in the Treatment of Erosive Pustular Dermatosis of the Scalp

Journal of Cutaneous Medicine and Surgery ◽

10.2310/7750.2007.00027 ◽

2007 ◽

Vol 11 (6) ◽

pp. 222-225 ◽

Cited By ~ 18

Author(s):

Marta J. Cenkowski ◽

Shane Silver

Keyword(s):

Light Exposure ◽

Therapeutic Option ◽

Rare Condition ◽

Initial Therapy ◽

Topical Steroids ◽

Topical Tacrolimus ◽

History Of ◽

Prevention Of Relapse

Background: Erosive pustular dermatosis of the scalp (EPDS) is a rare condition characterized by chronic, sterile, pustular erosions leading to scarring alopecia. Although the etiology is unknown, it appears to be associated with ultraviolet light exposure and trauma. Histologic findings include nonspecific atrophy of the epidermis and chronic inflammation. Case History: A 71-year-old female presented with a 1-year history of a boggy, erythematous, friable plaque on the vertex of her scalp. A diagnosis of EPDS was made based on presentation, negative cultures, and histologic findings. Initial therapy with intralesional and topical steroids and oral antibiotics resolved the inflamed plaques; however, steroid-induced atrophy became prominent after 5 months of use. The treatment was discontinued, resulting in recurrence of disease. Topical tacrolimus 0.1% ointment was initiated, which has been successfully controlling the lesions with reversal of skin atrophy and clinical evidence of hair growth. Conclusion: This is the fourth reported case of the successful treatment of EPDS with topical tacrolimus for the resolution of atrophy and the prevention of relapse of inflammation. Although its long-term use warrants close follow-up for side effects, tacrolimus may constitute a novel therapeutic option for the treatment of EPDS.

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Status epilepticus as presenting manifestation of H1N1 infection

International Journal of Epilepsy ◽

10.1016/j.ijep.2014.06.002 ◽

2015 ◽

Vol 02 (02) ◽

pp. 084-086 ◽

Cited By ~ 1

Author(s):

Aastha Takkar ◽

Manoj Goyal ◽

Manish Modi ◽

Parampreet Kharbanda ◽

Lakshminarayana Yaddanapudi ◽

...

Keyword(s):

Status Epilepticus ◽

Antiviral Treatment ◽

Neurological Complications ◽

Clinical Findings ◽

Convulsive Status Epilepticus ◽

H1n1 Pandemic ◽

H1n1 Infection ◽

Serological Tests ◽

History Of

Abstract Background During the global H1N1 pandemic, neurological complications were reported in approximately 6–10% of children suffering from H1N1 infection, but only rarely in adults. Generalized convulsive status epilepticus (GCSE) as a presenting manifestation of H1N1 infection in an adult is exceedingly rare and has not been reported in literature. We report a patient who presented to us with GCSE as a presenting manifestation of H1N1 infection who improved following appropriate antiviral treatment. Methods and results This 20-year-old gentleman presented to us with history of fever followed by GCSE of 24 h duration. He was treated symptomatically and was evaluated in detail. He was diagnosed to be suffering from H1N1 infection based on appropriate serological tests. After start of antiviral therapy, he improved and is doing well at 4 months follow up. Conclusion This case report further expands the spectrum of clinical findings associated with sporadic H1N1 infection. A possibility of H1N1 infection should be considered in all patients who present with GCSE without any obvious cause so that appropriate diagnostic tests and treatment can be carried out at the earliest.

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Ultrasound Is Not Useful in Monitoring Lipedematous Alopecia: A Clinical, Trichoscopic, Histologic, and Ultrasound Analysis of 2 Cases

Skin Appendage Disorders ◽

10.1159/000520506 ◽

2021 ◽

pp. 1-7

Author(s):

Sydney A. Weir ◽

Olufolakemi Awe ◽

Michelle L. Robbin ◽

Tiffany T. Mayo

Keyword(s):

Treatment Response ◽

Hair Growth ◽

Rare Condition ◽

Symptom Assessment ◽

Symptom Improvement ◽

Lichen Planopilaris ◽

Routine Clinical Examination ◽

History Of ◽

Subcutaneous Layer

Introduction: Lipedematous scalp (LS) is a rare condition characterized by thickened adipose tissue in the subcutaneous layer of the scalp resulting in a soft, spongy, or thick consistency of the scalp. When associated with hair loss, this condition is called lipedematous alopecia (LA). Various imaging modalities have been used to diagnose LS and LA along with histopathology. Case Presentation: We present 2 cases of LS: a 56-year-old female with a 1-year history of hair thinning, pain, and tenderness at the vertex scalp and a 60-year-old female with a 5-year history of lichen planopilaris presenting with a 1-year history of itching and soreness on the crown of her head. Ultrasound (US) was used for diagnosis, treatment response surveillance, routine clinical examination, and symptom assessment. Follow-up US revealed no improvement in scalp thickness in either case despite symptom improvement and visual improvement in hair growth. Discussion/Conclusion: US has been reported as a helpful tool in the diagnosis of LS; however, treatment response was better approximated by hair growth and symptom alleviation. We found that once the diagnosis with made with US, clinical monitoring is adequate as symptom improvement and hair growth may not correlate with a change in scalp thickness.

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A Rare Case of Pregnancy Complicated by Bladder Exstrophy and Uterine Prolapse

ACTA MEDICA IRANICA ◽

10.18502/acta.v59i9.7559 ◽

2021 ◽

Author(s):

Leila Pourali ◽

Hamidreza Ghorbani ◽

Atiyeh Vatanchi ◽

Sedigheh Ayati ◽

Ghazal Ghasemi ◽

...

Keyword(s):

Rare Case ◽

Uterine Prolapse ◽

Bladder Exstrophy ◽

Perinatal Outcomes ◽

Rare Condition ◽

Labor Pain ◽

Uterine Contractions ◽

History Of ◽

Emergent Cesarean Section

Uterine prolapse and bladder exstrophy (BE) during pregnancy is a rare condition. The aim of this study was to present a rare case of pregnancy complicated by both bladder exstrophy and uterine prolapse. A 39-year-old pregnant woman (gravida 2, para 1) presented to the maternity department at 39 weeks of gestation with labor pain. Physical examination showed regular uterine contractions; the cervix was completely out of the vaginal opening with dilatation of 3 cm and effacement of 30%. She had a history of multiple surgeries for correction of bladder exstrophy and also suffered from uterine prolapse. In active labor, abnormal fetal heart rate tracing happened, so an emergent cesarean section was planned, and a healthy neonate with the normal Apgar score was born. At regular follow-up until four months after delivery, there was no sign or symptom of uterine proplase. Multidisciplinary management of patients with BE and uterine prolapse may result in optimal perinatal outcomes. Uterine prolapse may disappear after delivery, even in the complicated case of bladder exstrophy.

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Spontaneous Resolution of Atraumatic Intrauterine Ping-Pong Fractures in Newborns Delivered by Cesarean Section

Journal of Child Neurology ◽

10.1177/0883073811410058 ◽

2011 ◽

Vol 26 (11) ◽

pp. 1449-1451 ◽

Cited By ~ 5

Author(s):

Luca Basaldella ◽

Elisabetta Marton ◽

Kimon Bekelis ◽

Pierluigi Longatti

Keyword(s):

Cesarean Section ◽

Rare Condition ◽

Spontaneous Resolution ◽

Neurological Deficits ◽

Cephalopelvic Disproportion ◽

Spontaneous Vaginal Delivery ◽

Ping Pong ◽

History Of ◽

External Trauma

Two cases of spontaneous intrauterine ping-pong fractures are reported in newborns delivered by cesarean section. Skull fractures occurred with no evidence of extrinsic trauma or cephalopelvic disproportion. Subsequent clinical follow-up at 6 and 12 months revealed normal skull reshaping and growth, with no associated neurological deficits. Spontaneous intrauterine ping-pong fractures in newborns delivered by cesarean section is a distinctly rare condition. These 2 cases demonstrate that, even without complicated spontaneous vaginal delivery or history of external trauma, congenital ping-pong fracture of the skull can occur. The existence of this clinical condition and its spontaneous resolution is important knowledge that can assist in the prepartum and postpartum management of children with this pathology.

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INTRAOSSEOUS XANTHOMA OF THE DISTAL RADIUS — A CASE REPORT

Hand Surgery ◽

10.1142/s0218810414720149 ◽

2014 ◽

Vol 19 (02) ◽

pp. 223-226 ◽

Cited By ~ 1

Author(s):

Kannan Karuppiah Kumar ◽

Yorell Manon-Matos ◽

Sunil Thirkannad

Keyword(s):

Case Report ◽

Distal Radius ◽

Bone Tumors ◽

Rare Condition ◽

Malignant Bone Tumors ◽

History Of

An intraosseous xanthoma is a very rare condition. It has an aggressive appearance on radiographs mimicking primary or metastatic malignant bone tumors. We report a case of intraosseous xanthoma of the distal radius in a 51-year-old male with no history of hyperlipidaemia. To the best of our knowledge, this condition has not been reported so far in the wrist and forearm region. The lesion was successfully excised and at last follow-up, there were no signs of recurrence and patient has been symptom-free.

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Multiple Congenital Bilateral Trigger Digits in a 2-Year-Old Child: Case Report

The Open Orthopaedics Journal ◽

10.2174/1874325001307010075 ◽

2013 ◽

Vol 7 (1) ◽

pp. 75-77 ◽

Cited By ~ 3

Author(s):

V De Luna ◽

V Potenza ◽

L Garro ◽

P Farsetti ◽

R Caterini

Keyword(s):

Bacterial Infections ◽

Rare Condition ◽

Trigger Finger ◽

Left Hand ◽

Right Hand ◽

History Of ◽

One Year ◽

The One ◽

The Right

Trigger finger is a rare condition in children. In this paper, we report on a 2-year-old boy with multiple congenital bilateral trigger digits. The patient had no history of perinatal trauma, viral or bacterial infections, or metabolic disorders. The patient was treated with physiotherapy for one year. At the one-year follow-up, the boy presented with six trigger fingers (3 on the right hand, 3 on the left hand). Neither thumb was involved. The six trigger fingers were treated surgically: first, the right-hand trigger fingers and, six months later, those of the left hand. After each operation, a 4-week brace in extension was applied to the operated hand. The symptoms were completely resolved after surgical treatment. Many authors have recommended surgical release for the treatment of trigger finger in children; empirical treatment with physiotherapy may be an option when symptoms present or appear at an older age.

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