An Atypical Type of Monteggia Equivalent: A Case Report

Introduction:Management of Mmonteggia fractures has always been debatable; Nnumerous variants have been described in the literature since its first description in 1814. We report a new variant of classical Mmonteggia fracture in a 33-year-old male. Case Presentation: A 33-year old male was brought to the emergency room with an alleged history of assault and was managed with an external wound. Antero-Pposterior and lateral radiographs showed segmental ulna fracture and radial head dislocation. The Ppatient was managed surgically with open reduction internal fixation with reconstruction plate for segmental ulna and closed reduction of radial head was attempted after achieving an anatomical reduction of the ulna. Close attention was paid to the early post-operative mobilization of the elbow joint with the help of a Hinged elbow brace and terminal functional outcome re re-evaluated at 6six months with a DASH score of 11 and MAYO score of 92. Conclusion: We report a rare type 1 monteggia equivalent not described in the literature. Despite the variability of the monteggia equivalents, the principle of management remains the same. Early mobilization of the elbow is of utmost importance to avoid post-operative stiffness. Keywords: Atypical, Equivalent, Monteggia, Segmental.

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Temporary spanning plate across the elbow for complex fractures of the distal humerus

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04764-x ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Ashraf N. Moharram ◽

Mostafa Mahmoud ◽

Ahmed Lymona ◽

Ahmed Afifi ◽

Mostafa Ezzat ◽

...

Keyword(s):

Bone Loss ◽

Internal Fixation ◽

Early Mobilization ◽

Distal Humerus ◽

Open Reduction Internal Fixation ◽

Dash Score ◽

Level Of Evidence ◽

The Mean ◽

Therapeutic Study

Abstract Background Open reduction internal fixation (ORIF) is the gold standard management of fractures of the distal humerus. Stable fixation to allow early mobilization is not always possible in cases with comminuted fracture patterns and bone loss, with a high failure rate. We propose augmentation of internal fixation in these unstable situations with a spanning plate across the elbow to protect the fixation construct temporarily until bone union. Methods Eighteen patients with complex distal humeral fractures were managed with standard ORIF technique augmented with a temporary plate spanning across the elbow as an internal fixator. Cases included were either very distal, comminuted (6 cases) or insufficiency fractures (4 cases) or revision fixation cases (8 cases). The temporary spanning plate was removed as soon as signs of early radiographic union were detected. Results Seventeen patients were available for final follow up at a mean 28.3 months. The spanning plate was removed after 3.4 months on average. At the final follow-up, the mean elbow total arc of motion was 86.3°. The mean Mayo Elbow Performance Score (MEPS) was 80, and the mean Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) score was 27. Conclusion Spanning the elbow temporarily with a plate in adjunct to standard ORIF technique is both simple and effective in achieving fracture stability and union and minimizes failure rates after fixation of comminuted, very distal fractures, osteoporotic cases, or revision fixation cases with bone loss. Level of evidence Level IV, Therapeutic study

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Different Within-Host Viral Evolution Dynamics in Severely Immunosuppressed Cases with Persistent SARS-CoV-2

Biomedicines ◽

10.3390/biomedicines9070808 ◽

2021 ◽

Vol 9 (7) ◽

pp. 808

Author(s):

Laura Pérez-Lago ◽

Teresa Aldámiz-Echevarría ◽

Rita García-Martínez ◽

Leire Pérez-Latorre ◽

Marta Herranz ◽

...

Keyword(s):

Single Nucleotide Polymorphisms ◽

Evolutionary Dynamics ◽

Viral Evolution ◽

Special Focus ◽

Nucleotide Polymorphisms ◽

Single Nucleotide ◽

New Variant ◽

History Of ◽

Evolution Dynamics ◽

The Uk

A successful Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) variant, B.1.1.7, has recently been reported in the UK, causing global alarm. Most likely, the new variant emerged in a persistently infected patient, justifying a special focus on these cases. Our aim in this study was to explore certain clinical profiles involving severe immunosuppression that may help explain the prolonged persistence of viable viruses. We present three severely immunosuppressed cases (A, B, and C) with a history of lymphoma and prolonged SARS-CoV-2 shedding (2, 4, and 6 months), two of whom finally died. Whole-genome sequencing of 9 and 10 specimens from Cases A and B revealed extensive within-patient acquisition of diversity, 12 and 28 new single nucleotide polymorphisms, respectively, which suggests ongoing SARS-CoV-2 replication. This diversity was not observed for Case C after analysing 5 sequential nasopharyngeal specimens and one plasma specimen, and was only observed in one bronchoaspirate specimen, although viral viability was still considered based on constant low Ct values throughout the disease and recovery of the virus in cell cultures. The acquired viral diversity in Cases A and B followed different dynamics. For Case A, new single nucleotide polymorphisms were quickly fixed (13–15 days) after emerging as minority variants, while for Case B, higher diversity was observed at a slower emergence: fixation pace (1–2 months). Slower SARS-CoV-2 evolutionary pace was observed for Case A following the administration of hyperimmune plasma. This work adds knowledge on SARS-CoV-2 prolonged shedding in severely immunocompromised patients and demonstrates viral viability, noteworthy acquired intra-patient diversity, and different SARS-CoV-2 evolutionary dynamics in persistent cases.

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More than Pus – Primary Hepatic Epithelioid Angiomyolipoma Masquerading as Liver Abscess

Case Reports in Gastroenterology ◽

10.1159/000511886 ◽

2021 ◽

pp. 1-8

Author(s):

Wen Hao Justin Leong ◽

Xia Huang Andrew Tan ◽

Ennaliza Salazar

Keyword(s):

Liver Abscess ◽

Epigastric Pain ◽

Epithelioid Angiomyolipoma ◽

Rare Type ◽

Function Test ◽

History Of ◽

Cluster Of Differentiation ◽

Epithelioid Variant ◽

Minimal Fluid ◽

Mesenchymal Tumours

Hepatic angiomyolipomas (AML) are rare mesenchymal tumours of which the epithelioid type is a rare type with malignant potential. We report a case of primary hepatic epithelioid angiomyolipoma masquerading as liver abscess. A 46-year-old man presented with a 5-day history of fever with epigastric pain and nausea. On the night of admission, his temperature spiked to 39°C, his blood pressure was 135/79, his heart rate 98, his liver function test revealed albumin 37 g/L, bilirubin 25 μmol/L, ALP 298 U/L, ALT 247 U/L, and AST 344 U/L. The clinical suspicion was hepatobiliary sepsis and intravenous ceftriaxone was commenced. CT of the abdomen showed an ill-defined hypodense focus in segment 4A/8 (4.5 × 3.5 cm) with a minimal fluid component implying a developing abscess or phlegmon. The images were reviewed by a radiologist and showed minimal fluid for percutaneous drainage. MRI of the liver was performed to further characterize the lesion and revealed a solid mass with nodular areas of arterial enhancement and washout, suspicious of neoplasm. Ultrasound-guided liver biopsy of the lesion was performed. Histology showed a histiocyte-rich epithelioid neoplasm consistent with the epithelioid variant of AML. Immunohistochemical staining was positive for human melanoma black 45, melan-A and cluster of differentiation 68. He successfully underwent liver resection of segment 4A/8 after 6 weeks of antibiotics. To our knowledge, this is the first reported case in the literature of primary hepatic epithelioid angiomyolipoma masquerading as liver abscess.

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Hypnic headache: a rare type of primary headache disorder

BJPsych Open ◽

10.1192/bjo.2021.349 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S120-S120

Author(s):

Muhammad Sayed Inam ◽

Saifun Nahar ◽

Mohammad Zubayer Miah

Keyword(s):

Treatment Options ◽

Primary Headache ◽

Headache Disorder ◽

Lithium Carbonate ◽

Hypnic Headache ◽

Rare Type ◽

Falling Asleep ◽

History Of ◽

Waking Up ◽

Secondary Causes

ObjectiveHypnic Headache are is a very rare primary headaches that affect the elderly, with an average age of 60 years. Research in the areas of neurophysiology and treatment options for Hypnic Headache are necessary in order to better understand, and improve outcomes for this rare headache disorder.Case reportMr. X is a 70-year-old patient, has been presenting with the complaints of headache during sleep at night for the last 1 year. The Headache started after 3 to 4 hours after falling asleep. Due to headache, he wakes up from sleep around 03:00 to 04:00 am almost every night and his headache persist for 30 to 40 minutes. After waking up from sleep he keeps himself busy with religious activity and the headache gradually resolves. He then goes back to bed again.Mr. X also informed that, the headache is dull in nature and located in left temporo occipital region. It is not associated with photophobia, phonophobia, nausea, vomiting, tearing or discomfort in the leg. He gives no history of early morning headache or day time headache, sleep disorder, snoring or sleep apnea. He has no past history of trauma to the head, fainting attack, unconsciousness, weakness or paralysis of limbs, seizures or non-epileptic seizures. He is an non-smoker, non-alcoholic, non-hypertensive & non-diabetic person.On general examination, his heart rate is 70 beats/min, blood pressure 138/68 mm of Hg. There are no anemia, jaundice or oedema present in him. His both lung fields are clear. On neurological examinations there are nothing abnormality detected. His Serological investigations, CBC (Complete Blood Count) FBS (Fasting Blood Glucose), lipid profile are within normal limit. CT scan of the brain is normal. There are no cerebral atrophy or volume loss compatible with age.Mr. X was treated by several general practitioners with paracetamol, diclofenac sodium, mefenamic acid, tramadol hydrochloride. He used these drugs either singly or in combinations. But with this treatment there were no significant improvement occurs. Mr. X is scared and depressed for his sleep time headache.DiscussionHypnic headache is a very rare headache disorder. It occurs in age groups over 60 years. It is occur at night during in sleep and waking the patient up, hence the name of it “alarm clock headache”. It is commonly unilateral and lasts for 15 minutes to 4 hours. Hypnic headache commonly dull or throbbing in character and does not make the patient restless, unlike in Cluster Headache. After waking up from sleep, most patients engage in some activity. Hypnic headache is not associated with rhinorrhea, tearing and ptosis. Diagnosis is mainly clinical. Secondary causes headache must be excluded. International Classification of Headache Disorders 3rd Edition (ICHD-3)-beta provides diagnostic criteria for hypnic headache. Pathophysiology of hypnic headache is not clearly identified. Usual treatment options of Hypnic headache includes bed time coffee, lithium carbonate, indomethacin. Our patient fulfil all the criteria of Hypnic headache and he fells improvement with Indomethacin 50 mg in devided doses.ConclusionHypnic Headache is a very rare type of primary headache. It should be diagnosed only after other secondary causes of headache have been excluded. Caffeine, lithium carbonate, flunarizine, indomethacin, used to treat the patient of Hypnic Headache. Lack of study and awareness about these disorders can lead to delays in diagnosis and treatment. Clinical trials are needed to find out proper treatment, but it will be difficult to perform because of the rareness of this disorder.

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DOUBLE AORTIC ARCH

PEDIATRICS ◽

10.1542/peds.4.6.751 ◽

1949 ◽

Vol 4 (6) ◽

pp. 751-768

Author(s):

HERBERT E. GRISWOLD ◽

MAURICE D. YOUNG

Keyword(s):

Aortic Arch ◽

Double Aortic Arch ◽

Rare Type ◽

Radiographic Findings ◽

Descending Aorta ◽

Vascular Abnormalities ◽

History Of ◽

The Right ◽

The Given ◽

Right Descending Aorta

The anatomic nature of a double aortic arch is described. Reference is made to the history of the malformation. The clinical picture and radiographic findings described by various authors are discussed. Two cases are reported which demonstrate two types of double aortic arch, One, a relatively common type, had a large right arch with a retro-esophageal component and a left descending aorta; the second, a rare type, had a large left arch with a retro-esophageal component and a right descending aorta. Further, one was an infant who had symptoms of constriction whereas the other was an adult who had no symptoms referable to the double aortic arch. Analysis is made of these cases and 47 other cases reported in the literature. This analysis reveals that: 1. There is a striking correlation between the occurrence of symptoms and the age and duration of life, but there is no correlation between the occurrence of symptoms and the type of double aortic. 2. A double aortic arch in which both components are patent throughout is more likely to produce symptoms than a double aortic arch in which one component is partially obliterated. The process of obliteration does not appear to give rise to symptoms. 3. There is considerable variation in the relative sizes of the components of a double aortic arch. The right component is usually the larger; part of the left component may be obliterated. To date, no case has been reported of obliteration of part of a persistent right Component. 4. A double aortic arch occurs more commonly with a left descending aorta than with a right descending aorta. 5. It is unusual for a double aortic arch to be associated with a malformation of the heart. The association of a double aortic arch with other vascular abnormalities is less rare. The two principal problems raised by the demonstration of a retro-esophageal vessel are discussed. The first concerns the nature of the malformation; the second concerns the advisability of operation in the given individual.

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Primary pulmonary angiosarcoma

BMJ Case Reports ◽

10.1136/bcr-2021-244578 ◽

2021 ◽

Vol 14 (11) ◽

pp. e244578

Author(s):

Muhammad Kashif Rana ◽

Owais Rahman ◽

Aiden O’Brien

Keyword(s):

Pulmonary Arteries ◽

Rare Type ◽

Pulmonary Artery Sarcoma ◽

Pulmonary Angiogram ◽

Primary Pulmonary Artery Sarcoma ◽

History Of ◽

Ct Pulmonary Angiogram ◽

The Right ◽

Specific Symptoms ◽

Large Primary

Primary pulmonary angiosarcoma is a rare type of malignant vascular tumour with poor prognosis. Diagnosis is often late due to non-specific symptoms and low clinical suspicion for angiosarcoma. A 72-year-old man presented to hospital with a 6-month history of mild progressive dyspnoea, with associated cough, episodes of presyncope and weight loss. CT pulmonary angiogram (CTPA) was reported as a large saddle pulmonary embolism extending into both the right and left pulmonary arteries. Further Multidisciplinary team meeting (MDM) discussion, and review of CTPA and subsequent investigations revealed a large primary pulmonary artery sarcoma which was later confirmed histology. The patient was referred to the cardiothoracic surgeons and underwent left radical pneumonectomy.

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Late Recurrence in Ovarian Dysgerminoma Presenting as a Primary Retroperitoneal Tumor: A Case Report and Review of the Literature

Case Reports in Pathology ◽

10.1155/2020/4737606 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Yuichiro Sato ◽

Tohru Hayashi ◽

Hidetaka Yamamoto ◽

Ichiro Niina ◽

Naoya Kuroki ◽

...

Keyword(s):

Clinical History ◽

Late Recurrence ◽

Retroperitoneal Tumor ◽

Retroperitoneal Mass ◽

Review Of The Literature ◽

Rare Type ◽

History Of ◽

Node Metastases ◽

Ovarian Dysgerminoma ◽

Primary Retroperitoneal

Ovarian dysgerminoma is a rare type of germ cell tumor. The majority of patient relapses occur within 2 years of diagnosis. Here, we report the case of a 74-year-old woman with a history of ovarian dysgerminoma 39 years earlier. The patient visited the hospital presenting with heartburn. An abdominal computed tomography (CT) revealed a right retroperitoneal mass, and a primary retroperitoneal tumor was suspected. She underwent surgical resection of the retroperitoneal tumor. Histological examination confirmed a metastatic dysgerminoma to the retroperitoneum. Postoperative CT showed paraaortic and cervical lymph node metastases. The patient was treated with bleomycin, etoposide, and cisplatin chemotherapy. This case demonstrates the difficulties that may be encountered in the differential diagnosis of a retroperitoneal mass and underlines the necessity for understanding a patient’s clinical history.

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A unique case of congenital transmesocolic hernia with malrotation in a 25-year-old female: a case report

Journal of Surgical Case Reports ◽

10.1093/jscr/rjz280 ◽

2019 ◽

Vol 2019 (10) ◽

Author(s):

Aghyad Kudra Danial ◽

Muhamad Zakaria Brimo Alsaman ◽

Rama Zazo ◽

Muhammad Mazketly ◽

Mohammad Nour Kitaz ◽

...

Keyword(s):

Transverse Colon ◽

Medical Literature ◽

Clinical Manifestations ◽

Previous Surgery ◽

Unique Case ◽

Rare Type ◽

Unusual Phenomenon ◽

History Of ◽

Hernia Orifice ◽

Ladd’S Procedure

Abstract Congenital transmesocolic hernia of the transverse colon is a very rare type of internal hernia. In addition, intestinal malrotation is very rare in adults. Most of these patients do not have clear clinical manifestations. Incidence of congenital transmesocolic hernia of the transverse colon along with malrotation is an unusual phenomenon in medical literature and clinical practice. Here, we report a unique case of a 25-year-old woman diagnosed with transmesocolic hernia of the transverse colon and malrotation of the small intestine, without any history of trauma or previous surgery. The patient underwent surgery, where the hernia orifice was closed and Ladd’s procedure was performed.

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Does the Coronoid Always Need to Be Fixed in Terrible Triad Injuries of the Elbow? Mid-Term Postoperative Outcomes Following a Standardized Protocol

Journal of Clinical Medicine ◽

10.3390/jcm9113500 ◽

2020 ◽

Vol 9 (11) ◽

pp. 3500

Author(s):

Beom-Soo Kim ◽

Du-Han Kim ◽

Seok-Ho Byun ◽

Chul-Hyun Cho

Keyword(s):

Operative Treatment ◽

Radial Head ◽

Lateral Collateral Ligament ◽

Type I ◽

Dash Score ◽

Terrible Triad ◽

Collateral Ligament ◽

Recurrent Instability ◽

Standardized Protocol ◽

Coronoid Fractures

The purpose of this study was to investigate mid-term outcomes and complications after operative treatment according to a standardized protocol for terrible triad injuries. Twenty-four patients that were treated by a single surgeon with a standardized surgical protocol were retrospectively reviewed. After the complete reconstruction of radial head and/or lateral collateral ligament (LCL) complex through a lateral approach, coronoid process, and/or medial collateral ligament (MCL) complex through a medial approach were fixed if the elbow is unstable. For coronoid fractures, only type III were fixed in four cases (16.7%). Twenty-two LCL (91.7%) and five MCL (20.8%) complexes were repaired. At the final follow-up, the mean MEPS and Quick-DASH score were 91.5 and 17.3, respectively. There was no recurrent instability after operation in all cases. This study revealed that operative treatment that was based on our standardized protocol for terrible triad injuries yielded satisfactory mid-term clinical and radiographic outcomes without any recurrent instability. These results suggest that Type I and II coronoid fractures in terrible triad injuries do not need to be fixed if the radial head and ligamentous complex are completely reconstructed.

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Intensity of Regulations as a Cause of the Informal Sector

Journal of South Asian Development ◽

10.1177/0973174120954622 ◽

2020 ◽

Vol 15 (2) ◽

pp. 135-154

Author(s):

Khurrum S. Mughal ◽

Friedrich G. Schneider ◽

Zafar Hayat

Keyword(s):

Informal Sector ◽

Informal Economy ◽

Shadow Economy ◽

Control Variable ◽

Government Control ◽

Yearly Variation ◽

New Variant ◽

History Of ◽

Currency Demand ◽

And Control

It is argued in the literature that the intensity of regulations and control in an economy is a determinant of the informal sector which however is ignored in most of its estimates. This article uses a new variant of the currency demand approach where ‘unemployment’ and ‘intensity of government control’ are used to estimate a shadow economy, alongside a the traditional tax variable. We choose Pakistan since it has a significant share of its activities in the informal sector along with the history of various political and dictatorial regimes. Further, there are examples of bureaucratic control leading to corruption in the economy. It provides an opportunity to study the nexus between regulation intensity and informal economy and present a case study for other developing countries exercising control over the economy through the large size of its public sector. The results show that the intensity of the control variable has statistically and economically significant role in increasing the shadow economy, almost equivalent to the tax coefficient. Once the yearly variation in our estimates is mapped with various political regimes, it seems that the validity of estimates is reinforced considering policy inconsistencies and prominent events of each regime.

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