scholarly journals Gouty tophus as a rare cause of a Hepple stage V osteochondral lesion of the talus

2021 ◽  
Vol 26 (1) ◽  
Author(s):  
Bo Tang ◽  
Cheng Fan
Keyword(s):  
Genetic Factors ◽  
Osteochondral Lesion ◽  
Visual Analogue Score ◽  
Cyst Formation ◽  
Acute Onset ◽  
Medial Malleolus ◽  
Ankle Pain ◽  
Case Presentation ◽  
Gouty Tophus ◽  
High Level

Abstract Background Talus osteochondral lesion is commonly associated with trauma, avascular necrosis or even genetic factors, but gouty tophus as a cause of Hepple stage V type talus osteochondral lesion is rare. Case presentation Here, we report a case of an 18-year-old man who complained of left medial deep ankle pain on ambulation. This young man had an extreme liking of sea food rich in purines and also sugar-sweetened drinks. He was diagnosed with a Hepple stage V type talus osteochondral lesion and was treated with medial malleolus osteotomy and an osteochondral graft. The talus osteochondral lesion was found to be a gouty tophus and was completely removed. Hypouricemic therapy was prescribed for 2 months, which allowed the patient to walk with a visual analogue score (VAS) score of 1. He was followed up for 12 months. Conclusions Young people with an extreme liking of sea food rich in purines and also sugar-sweetened drinks may be at a risk of developing gout. Acute onset of ankle atraumatic pain, swelling with a high level of serum uric acid and a talus osteochondral lesion with cyst formation should make physicians consider a diagnosis of gout.

scholarly journals Allopurinol-Induced Oral Lichenoid Drug Reaction with Complete Regression after Drug Withdrawal

2020 ◽  
Vol 7 (2) ◽  
pp. 18-25
Author(s):  
Alexandre Perez ◽  
Benjamin Lazzarotto ◽  
Jean-Pierre Carrel ◽  
Tommaso Lombardi
Keyword(s):  
Drug Reaction ◽  
Lichen Planus ◽  
Drug Withdrawal ◽  
Acute Onset ◽  
Complete Regression ◽  
Oral Manifestations ◽  
First Line ◽  
Drug Induced ◽  
Case Presentation ◽  
Oral Lichenoid Lesions

Background: Lichen planus is a chronic mucocutaneous inflammatory disease. Oral manifestations are common, and may remain exclusive to the oral mucosa without involvement of the skin or other mucosae. A differential diagnosis includes oral lichenoid drug reactions. Allopurinol, which is the first line hypo-uricemic treatment, is often quoted as being a possible offending drug, though oral reactions have rarely been reported. Case presentation: We describe a 59-year-old male gout patient, successfully treated with allopurinol, who developed acute onset of oral lichenoid lesions, involving bilaterally the buccal mucosa, the tongue and the labial mucosa. Histopathology was consistent with a lichen planus or a drug-induced lichenoid reaction. Improvement of the patient’s condition after withdrawal of allopurinol confirmed the lichenoid nature of the lesion. Remission was complete after a few weeks. Discussion: Although unusual, allopurinol may induce a lichenoid drug reaction. These reactions may mimic clinically and histopathologically idiopathic lichen planus. Improvement or complete regression of the lesions may be attempted to confirm the diagnosis. According to the latest WHO recommendations, these lesions have a potential for malignant transformation.

scholarly journals Primary small cell type of non-Hodgkin lymphoma of the colon: a case report

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Eyal Meir ◽  
Chovav Handler ◽  
Uri Kaplan ◽  
Doron Kopelman ◽  
Ossama A. Hatoum
Keyword(s):  
Case Report ◽  
Hodgkin Lymphoma ◽  
Small Cell ◽  
Primary Lymphoma ◽  
Cell Type ◽  
Rare Type ◽  
Case Presentation ◽  
Carcinoma Of The Colon ◽  
Non Hodgkin Lymphoma ◽  
High Level

Abstract Introduction Primary lymphoma of the colon is exceedingly rare and comprises 0.2–1% of all colon tumors. The most common subtype of lymphoma in the colon is non-Hodgkin lymphoma. Symptoms are often nonspecific, and treatment varies between chemotherapy alone and a combination of surgery and chemotherapy. Case presentation We describe a case of a Ashkenazi Jew patient who presented in the typical way that carcinoma of the colon might present but turned out to have a very rare type of tumor in both its histology and its location. Conclusion There was apparent discordance between the relative bulkiness and gross appearance of the tumor with the unrevealing result of the biopsies, demanding a high level of suspicion as to the actual presence and possible type of such a tumor in the future.

The Fluctuation of Serum PTH Level of Type 2 Diabetes mellitus’ Patient on Oral Dapagliflozin

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Jiang G ◽  
◽  
Wenzhou Jiang ◽  
Jin Zhou ◽  
◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Insulin Injection ◽  
Diabetes Mellitus Patient ◽  
Sglt2 Inhibitors ◽  
Case Presentation ◽  
Risk Factor Management ◽  
Serum Pth ◽  
High Level ◽  
In The Beginning

Background: Sodium-Glucose co-Transporter 2 (SGLT2) inhibitors, a set of relatively new medicines treating type 2 diabetes showed a great number of merits in control of glycemia and cardiovascular risk factor management, but also attracted attention on bone fracture. One of those major effects on skeleton might be Parathyroid Hormone (PTH). Case Presentation: We present the case of a 68-year-old female patient with type 2 diabetes on insulin injection and oral acarbose therapy who was admitted with constant hyperglycemia to our hospital. In the beginning, she showed a high level of serum PTH. In the process of oral dapagliflozin treatment, PTH concentration firstly increased and then decreased to the normal range. Diagnostic tests are completed to exclude hyperparathyroidism. Conclusions: The use of SGLT2 inhibitors among diabetes and nondiabetic populations is increasing, a great deal of undiscovered influence, such as hormone and ion fluctuation needs further investigation.

scholarly journals Intraosseous uric acid tumor without joint involvement: case report

2021 ◽  
Vol 15 (2) ◽  
pp. 167-170
Author(s):  
Elcio Valloto Junior ◽  
Valter Penna ◽  
Vinícius Medina Guimarães ◽  
Vinícius Dino Pozzebon ◽  
Mariana Oliveira de Araújo
Keyword(s):  
Unusual Case ◽  
Bone Cyst ◽  
Postoperative Outcome ◽  
Joint Involvement ◽  
Medial Malleolus ◽  
Level Of Evidence ◽  
Previous Diagnosis ◽  
Gouty Tophus ◽  
Therapeutic Study ◽  
Histopathologic Findings

We report an unusual case of extra-articular gouty tophus in the left medial malleolus. A 33-year-old man with a previous diagnosis of chronic gout presented with mild, non-disabling ankle pain associated with gout attacks. Imaging and histopathologic findings were inconclusive. The tumor was surgically resected, and the cavity was filled with methyl methacrylate. Histopathology confirmed the diagnosis in a sample collected intraoperatively. Giant cell tumor and bone cyst were ruled out. The patient had a good postoperative outcome. Level of Evidence V; Therapeutic Study; Expert Opinion.

scholarly journals Corneal Perforation after Nd:YAG Capsulotomy: A Case Report and Literature Review

2019 ◽  
Vol 10 (1) ◽  
pp. 111-115 ◽  
Author(s):  
Maroun Khreish ◽  
Rana Hanna ◽  
Liron Berkovitz ◽  
Beatrice Tiosano
Keyword(s):  
Visual Acuity ◽  
Acute Onset ◽  
Systemic Scleroderma ◽  
Posterior Capsular Opacification ◽  
Corneal Perforation ◽  
Blurred Vision ◽  
Case Presentation ◽  
Corrected Visual Acuity ◽  
Nd:Yag Laser Capsulotomy ◽  
Corneal Laceration

Background: Nd:YAG capsulotomy is the treatment of choice for posterior capsular opacification after cataract surgery. We report a case of corneal perforation following Nd:YAG capsulotomy in a patient with systemic scleroderma. Case Presentation: A 69-year-old woman presented with acute onset of blurred vision 2 weeks following Nd:YAG laser capsulotomy for posterior subcapsular opacification. On examination, her best-corrected visual acuity was 1/120, and bio-microscopy revealed a central full-thickness corneal laceration. Conservative treatment consisted of topical ocular antibiotics, cycloplegics, hypotensive drops and a soft therapeutic contact lens. Her final visual acuity improved to 6/18 with resolution of the corneal laceration. Conclusion: The possibility of corneal perforation after Nd-YAG capsulotomy in patients with systemic scleroderma and connective tissue disease should be borne in mind when treating such patients.

scholarly journals A Case of Bilateral Hearing Loss

2020 ◽  
Vol 4 (4) ◽  
pp. 626-627
Author(s):  
Boris Ryabtsev ◽  
Matthew Slane
Keyword(s):  
Hearing Loss ◽  
Vertebral Artery ◽  
Artery Occlusion ◽  
Acute Onset ◽  
Resonance Imaging ◽  
Case Presentation ◽  
Bilateral Hearing Loss ◽  
Prominent Symptom ◽  
Computed Tomography Angiogram ◽  
Occipital Lobes

Case Presentation: A 53-year-old male presented to the emergency department with acute onset of bilateral hearing loss as well as vertigo and severe vomiting. The Head Impulse– Nystagmus–Test of Skew exam was indicative of a central neurologic process. Computed tomography angiogram of the head and neck revealed near-total bilateral vertebral artery occlusions in the second and third segments. The patient was admitted for further evaluation; subsequent magnetic resonance imaging revealed multiple areas of infarction in the cerebellar hemispheres, medulla, and occipital lobes. Discussion: This case describes a unique presentation of a posterior stroke. Common symptoms include vertigo, loss of balance, and vomiting. However, bilateral hearing loss as a prominent symptom is uncommon. Imaging revealed a rare finding of bilateral vertebral artery occlusion.

scholarly journals Hypertrophic olivary degeneration concomitant with bilateral middle cerebellar peduncles Wallerian degeneration following unilateral pontine infarction

BMC Neurology ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Bing Bao ◽  
Xiangbin Wu ◽  
Zhongbin Xia ◽  
Yaoyao Shen
Keyword(s):  
Wallerian Degeneration ◽  
Corticospinal Tract ◽  
Brain Magnetic Resonance Imaging ◽  
Acute Onset ◽  
Case Presentation ◽  
Hypertrophic Olivary Degeneration ◽  
Pontine Infarction ◽  
Cerebellar Peduncles ◽  
Magnetic Resonance Imaging Mri

Abstract Background Wallerian degeneration (WD) can occur in different projecting systems, such as corticospinal tract, dentate-rubro-olivary pathway, and corticopontocerebellar tract. However, the co-occurrence of hypertrophic olivary degeneration (HOD) and middle cerebellar peduncles (MCPs) degeneration secondary to unilateral pontine infarction in a single patient is extremely rare. Case presentation A 71-year-old man presented with acute onset of dizzness, slurred speech, and right-sided weakness. On the next day, his previous neurologic deficits deteriorated. Brain magnetic resonance imaging (MRI) revealed acute ischemic stroke of the left pons. After treatment with thrombolysis, antiplatelets, and rehabilitation training, his speaking and motor function improved moderately. At the 3-month follow-up, the MRI showed hyperintensity in the left medulla oblongata and bilateral MCPs on T2-weighted and FLAIR images, suggesting HOD as well as MCPs degeneration. Conclusions It is of great importance for us to know the anatomic knowledge of dentate-rubro-olivary and corticopontocerebellar pathways.

Diagnosis and treatment of anterior ankle impingement: state of the art

2020 ◽  
Vol 5 (5) ◽  
pp. 295-303
Author(s):  
Pedro Diniz ◽  
Duarte André Sousa ◽  
Jorge Pablo Batista ◽  
Nasef Abdelatif ◽  
Helder Pereira
Keyword(s):  
Soft Tissue ◽  
Conservative Treatment ◽  
Plantar Flexion ◽  
Weight Bearing ◽  
Osteochondral Lesion ◽  
Osteochondral Lesions ◽  
X Rays ◽  
Ankle Pain ◽  
Ankle Impingement ◽  
Anterior Ankle Impingement

The aim of this paper is to discuss anterior ankle impingement (AAI) regarding diagnosis, interventions, techniques and future perspectives. AAI is a pain syndrome due to soft tissue or bony impingement. Impingement caused by soft tissues is frequently found in the anterolateral compartment of the ankle, whereas impingement caused by bony spurs is generally located in the anteromedial compartment. Typical complaints are chronic ankle pain, limited dorsiflexion and swelling. The most important feature is recognisable tenderness on palpation, which helps distinguish this condition from an osteochondral lesion, which is characterised with deep ankle pain. Although the diagnosis is mainly based on clinical assessment, imaging is helpful for differential diagnosis and preoperative planning. Standard X-rays, using anteroposterior, lateral and an anteromedial oblique view for detecting bony spurs, are sufficient to make the diagnosis. CT can be used to accurately assess the extent and size of a bony spur. MRI is useful to evaluate soft tissue lesions and exclude concomitant pathology, like osteochondral lesions or stress fractures. Conservative treatment is the first-line treatment. In cases where conservative treatment has been unsuccessful, surgery may be indicated. Arthroscopic debridement is considered the gold standard to treat AAI. Rehabilitation protocol includes full weight-bearing and exercises to stimulate active dorsiflexion-plantar flexion and avoid stiffness.

Genetic susceptibility of CYP1A1 gene and risk of pesticide exposure in prostate cancer

2020 ◽  
Vol 29 (4) ◽  
pp. 429-440
Author(s):  
Amar Abhishek ◽  
Nasreen Ghaji Ansari ◽  
Vishwajeet Singh ◽  
Rahul Janak Sinha ◽  
Prabhakar Mishra ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Stress Level ◽  
Genetic Factors ◽  
Pesticide Exposure ◽  
High Stress ◽  
P Value ◽  
Specific Pcr ◽  
Cyp1a1 Gene ◽  
High Stress Level ◽  
High Level

BACKGROUND: The etiology of prostate cancer (PCa) is multi-factorial including environmental and genetic factors. Present study evaluates the association between level of pesticides, stress level and CYP1A1 gene polymorphism with PCa patients. METHODS: A case control study was conducted with 102 PCa patients and age match symptomatic (n= 107) and asymptomatic benign prostatic hyperplasia (BPH, n= 70) patients. Pesticide level was characterized by Gas Chromatography. The oxidative stress and scavenging mechanisms were determined by biochemical method. Two polymorphisms of CYP1A1 gene, rs4646903 and rs1048943, were analyzed by polymerase chain reaction (PCR) followed by restriction fragment length polymorphism and allele specific PCR method. RESULTS: Higher level of pesticide namely beta-hexachlorocyclohexane (β-HCH), Malathion, Chlorpyrifos and Fenvalerate were found in PCa group (all p value: < 0.05). Kruskal Wallis H test depicted that level of β-HCH and Malathion significantly correlated with higher grade of PCa (all p< 0.05). The PCa Patients with simultaneously low antioxidant activity and high stress level tended to suffer worst clinical outcomes. Dominant model of rs4646903 and rs1048943 suggested that substitution is associated with a higher risk of PCa (OR: 2.2, CI: 1.6–3.8, p: 0.009 and OR: 1.95, CI: 1.1–3.4, p: 0.026; respectively) and this risk was also influenced by smoking and pesticide exposure. CONCLUSION: Environmental and genetic factors are reported to raise risk; person with high level of these pesticides especially in high risk genotype might be more susceptible to PCa.

Sign in / Sign up

Export Citation Format

Share Document