Surgical therapy for herlyn-werner-wunderlich (HWW) syndrome cases

Introduction: One of the rare forms of Mullerian congenital ducts is Herlyn-Werner-Wunderlich (HWW) syndrome. HWW syndrome is usually found at puberty with nonspecific symptoms. Pelvic pain can be found both acute and chronic, dysmenorrhoea, as well as hematometra and hematocolpos. Early detection and treatment results in a good prognosis with fertility preservation. Case presentation: Two cases of Herlyn-Werner-Wunderlich (HWW) syndrome surgically performed were reported at Dr. Sardjito Yogyakarta Indonesia Central General Hospital in 2017-2018. Both cases are still children and at the age of puberty. The chief complaint in both cases it was reported to have the same main complaint, abdominal pain, with the condition having never experienced menstruation yet. On further examination it is known that pain is caused due to hematometra and hematosalping that occur in both cases. The first case with hematometra in the right hemiuterus and right hematosalpinx, while second case with hematometra in the uterus didelphys and bilateral hematosalpinx. One case with a normal vagina, and the other case of vaginal agenesis. There was previous history of surgery in both of cases. There are abnormalities in the urinary tract that occur together with these genital abnormalities. Surgical therapy is carried out with the main goal being to drain menstrual blood from hematometra and hematosalpinx. In first case which has a vagina within the normal range (9 cm long) and the inferior area of the right hemiuterus which is bulging toward the vagina, an area can be identified for the drainage incision to drain the entire hematometra and hematosalpinx. In the second case with vaginal agenesis, neovagina which is made by sigmoid colon vaginoplasty surgery can be a way of menstrual blood flow for a lifetime. Conclusion: Clinical manifestations of Herlyn-Werner-Wunderlich (HWW) syndrome cases can be classified into 2 groups, complete and incomplete. Surgical treatment is based on the condition of the uterus and vagina. In the condition of cervical agenesis but with a normal vagina, surgery can be done by making an incision in the drainage of the uterine cervical tissue. If vaginal agenesis is obtained, vaginoplasty surgery can be performed, and one of the options is sigmoid colon vaginoplasty.

Download Full-text

Levator palpabrae superioris myositis as an unusual cause of unilateral ptosis—case report

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-021-00469-2 ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Ahmed M. Abdrabou

Keyword(s):

Previous History ◽

Good Prognosis ◽

Oculomotor Nerve Palsy ◽

Ophthalmological Examination ◽

Bilateral Ptosis ◽

Mri Findings ◽

Upper Eyelid ◽

Unilateral Disease ◽

The Right ◽

Mri Study

Abstract Background Ptosis can be a manifestation of a more serious situation. Hence, the analysis of the complaint and the search for etiology are crucial in such cases. Ptosis has many causes; some of them lead to unilateral ptosis while others cause bilateral ptosis. For instance, myasthenia gravis is a cause of bilateral ptosis while oculomotor nerve palsy induces unilateral disease. Proper evaluation of the patient and identification of the cause are important to achieve accurate management and good prognosis. Case presentation A 47-year-old male patient attended the ER complaining of dropping the right eye lid of 2 days’ duration. There was no associated pain or diplopia. On examination, the extraocular muscles’ (EOM) motility was intact, normal pupil and corneal reflexes, and there was swelling of the upper eyelid. Ophthalmological examination revealed normal anterior and posterior chambers as well as the vitreous and retina. The patient had a previous history of traumatic intracranial hemorrhage that was resolved without surgical intervention. He also had diabetes mellitus and hypertension. The patient was transferred to the MRI unit to perform MRI study of the brain and orbit with MRA and IV contrast administration. MRI findings confirmed the diagnosis of LPS myositis, and the patient received medical treatment and improved. Conclusion Proper radiological diagnosis leads to accurate management and achieves rapid recovery and optimal patient care.

Download Full-text

Melioidosis in Bihar, India: unearthing the first of many?

Access Microbiology ◽

10.1099/acmi.0.000260 ◽

2021 ◽

Vol 3 (9) ◽

Author(s):

Isra Halim ◽

Prathyusha Kokkayil ◽

Ravi Kirti ◽

Rajeev Nayan Priyadarshi ◽

Asim Sarfraz ◽

...

Keyword(s):

Clinical Manifestations ◽

Clinical Suspicion ◽

Radiological Features ◽

First Case ◽

Insidious Onset ◽

Ankle Joints ◽

The World ◽

Resource Poor ◽

Empirical Antibiotics ◽

The Right

Melioidosis, a disease with protean clinical manifestations, is prevalent in many parts of India, with established endemic hotspots on the southern coast of the country. However, it is still underdiagnosed in many resource-poor regions of the country. We report what is, to the best of our knowledge, the first case of melioidosis diagnosed and treated in Bihar, an economically underdeveloped state in East India. The patient, a 52-year-old diabetic male, presented to the outpatient department with a fever of insidious onset along with pain and restriction of movement in the right shoulder joint and right knee joint, and swelling and tenderness of bilateral ankle joints. Radiological features were suggestive of multiple joint and organ abscesses. A diagnosis of disseminated septicaemic melioidosis was confirmed microbiologically. The patient improved clinically following aggressive treatment with meropenem and cotrimoxazole. The case highlights the need for increased clinical suspicion of melioidosis and adequate diagnostic facilities, as well as the need for early institution of appropriate empirical antibiotics in suspected cases of melioidosis in this region of the world.

Download Full-text

Inflammatory Pseudotumor of Omentum Containing Gas Misdiagnosed as Perforation of Hollow Organs

10.21203/rs.3.rs-934231/v1 ◽

2021 ◽

Author(s):

Shiwen Nie ◽

Yadong He ◽

Shuo Zhang ◽

Fenghong Cao

Keyword(s):

Inflammatory Pseudotumor ◽

Epigastric Pain ◽

Treatment Plan ◽

Abdominal Cavity ◽

White Blood Cells ◽

Previous History ◽

Clinical Manifestations ◽

Emergency Operation ◽

Good Prognosis ◽

Pathological Examination

Abstract BackgroundInflammatory pseudotumors that grow on the omentum are relatively rare, and inflammatory pseudotumor most often involves the lung. As far as we know, the inflammatory pseudotumor of omentum, which is in the shape of beaded vesicles and contains gas, has never been reported in the literature. Case presentationwe report a 45-year-old Chinese woman who complained of epigastric pain with hematemesis for 9 hours, physical examination showed subxiphoid tenderness, previous history of gastric ulcer and repair of gastric perforation, laboratory examination showed slight increase of white blood cells and decrease of hemoglobin. Computed tomography showed dotted free gas in the abdominal cavity, and the perforation of the hollow organs was considered. The pathological results after emergency operation showed that histiocyte aggregation with multinucleated giant cell reaction could be seen in the omental tissue. Immunohistochemistry :ER (-), PR (-), PAX-8 (-), CK (mesothelial+), MC (mesothelial+), CR (mesothelial+), CD68 (histiocyte+), SMA (smooth muscle+). The abdominal pain was relieved after surgical resection of the tumor, and recovered well after symptomatic treatment.ConclusionInflammatory pseudotumor of omentum containing gas is easily diagnosed as perforation of hollow organs, with few clinical manifestations of acute abdomen, mostly non-specific, and a good prognosis. Understanding its clinicopathological features and pathological examination methods are helpful to diagnose the disease, so as to choose an appropriate treatment plan, and whether surgical treatment is better than conservative treatment remains to be further studied. The disease should be distinguished from perforation of hollow organs, but the source of gas is unknown. It may have something to do with past medical history.

Download Full-text

Inflammatory Pseudotumor in the Nasal Cavity and Sinuses: A Case Report and Associated Literature Review

Ear Nose & Throat Journal ◽

10.1177/0145561320924489 ◽

2020 ◽

pp. 014556132092448

Author(s):

Jing Li ◽

Maohua Wang ◽

Wangwei Li ◽

Yuejin Tao ◽

Xinyi Shi

Keyword(s):

Nasal Cavity ◽

Nasal Obstruction ◽

Inflammatory Pseudotumor ◽

Plasma Cells ◽

Clinical Manifestations ◽

Good Prognosis ◽

Benign Condition ◽

Ocular Symptoms ◽

Facial Swelling ◽

The Right

Inflammatory pseudotumor (IP) is a clinically aggressive but histologically benign condition of unknown cause. It rarely appears in the nasal cavity and sinuses. Here, we describe a 24-year-old female with the main symptom of right nasal obstruction. Examinations showed dilation in the right maxillary sinus and a pale neoplasm in the nasal cavity. The neoplasm was completely excised under endoscope. Postoperative pathology showed significant proliferation of plasma cells and lymphocytes, indicating the presence of IP. No recurrence was found during 20 months of follow-up. Only 28 cases (10 males and 18 females, average 41.04 years) have been reported on Pubmed. The main clinical manifestations were nasal obstruction, epistaxis, facial swelling and pain, eyeball protrusion, diplopia, and other ocular symptoms. Inflammatory pseudotumor always erodes the surrounding bone and requires active treatments. Surgery is the optimal option with a good prognosis.

Download Full-text

Primary meningococcal septic arthritis associated with joint calcium oxalate crystals: A case report and review of the literature

Modern Rheumatology Case Reports ◽

10.1093/mrcr/rxab049 ◽

2021 ◽

Author(s):

Erik Cimé-Aké ◽

Fabián Carranza-Enríquez ◽

José Joel Hurtado-Arias ◽

Wallace Rafael A Muñoz-Castañeda ◽

Benjamín Medina-Fonseca ◽

...

Keyword(s):

Synovial Fluid ◽

Septic Arthritis ◽

Calcium Oxalate ◽

Clinical Manifestations ◽

Upper Respiratory Tract ◽

Review Of The Literature ◽

Calcium Oxalate Crystals ◽

Oxalate Crystals ◽

First Case ◽

The Right

ABSTRACT Primary meningococcal septic arthritis (PMSA) is an extremely rare local infection by Neisseria meningitidis in the absence of meningitis or meningococcaemia syndrome. A 30-year-old healthy, immunocompetent man presented with arthralgia, fever, chest rash, and significant swelling of the right knee. On admission, a disseminated maculopapular and purpuric rash, oligoarthritis, neutrophilia, and elevated acute phase reactants were documented. Following arthrocentesis of the right knee, isolation of N. meningitidis and the presence of calcium oxalate crystals in the synovial fluid were reported. The diagnosis of PMSA was made. Histological analysis of the skin lesion showed leucocytoclastic vasculitis. He was treated with intravenous ceftriaxone plus open surgical drainage and ambulatory cefixime with adequate response. After 1 month, he presented resolution of the pathological process. We performed an extensive review of the literature, finding that the key elements supporting the diagnosis of PMSA are prodromal upper respiratory tract symptoms and skin involvement prior to or synchronous with the arthritis. Also, the most frequently involved joint is the knee. This report is the first case of a patient presenting with PMSA associated with calcium oxalate crystals in the synovial fluid. Herein, we discuss the most frequent clinical manifestations, the unusual histological features, the recommended treatment, and the reported prognosis of this rare entity.

Download Full-text

A Case of Fitz-Hugh-Curtis Syndrome Complicated by Appendicitis Conservatively Treated with Antibiotics

Clinical Medicine Insights Case Reports ◽

10.4137/ccrep.s11522 ◽

2013 ◽

Vol 6 ◽

pp. CCRep.S11522 ◽

Cited By ~ 6

Author(s):

Itsuro Kazama ◽

Toshiyuki Nakajima

Keyword(s):

Abdominal Pain ◽

Genital Tract ◽

Clinical Manifestations ◽

Wall Thickening ◽

Low Grade ◽

Genital Tract Infection ◽

Lower Quadrant ◽

First Case ◽

The Right ◽

Fitz Hugh Curtis Syndrome

A 27-year-old woman developed a low grade fever and increased vaginal discharge that persisted for 2 weeks. Intermittent abdominal pain in the right upper quadrant had been experienced over the previous few days. Due to her clinical manifestations and typical abdominal computed tomography (CT) findings, including hepatic capsular enhancement and hepatomegaly, a diagnosis of Fitz-Hugh-Curtis syndrome was made. The early empirical use of antibiotics, azithromycin and levofloxacin, partially improved her symptoms. However, the low grade fever persisted and additional abdominal pain developed in the right lower quadrant. Based on the radiological evidence of an enlarged appendix with wall thickening, a diagnosis of appendicitis was additionally made, which was thought to occur secondarily to the genital tract infection. Following the administration of antibiotics ceftriaxone and cefditoren pivoxil, her symptoms were completely resolved without the need for any surgical intervention. Here, we report the first case of Fitz-Hugh-Curtis syndrome complicated by appendicitis, which was conservatively managed with antibiotic treatment alone. In this case, the overgrowth of pathogens within the genital tract and their direct penetration into the appendix was thought to be responsible for the development of appendicitis.

Download Full-text

Traumatic perforations of tympanic membrane: our experience

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20185300 ◽

2018 ◽

Vol 5 (1) ◽

pp. 131

Author(s):

Anuja Bhargava ◽

Syed M. Faiz ◽

Mohammad Shakeel ◽

Nafas J. Singh ◽

Kumar Gaurav

Keyword(s):

Domestic Violence ◽

Middle Ear ◽

Clinical Presentation ◽

Previous History ◽

Good Prognosis ◽

Common Etiology ◽

History Of ◽

The Right ◽

Inferior Quadrant ◽

Pathology Data

Background: The aim of the study was to evaluate various etiological factors, clinical presentation in patients presenting with Traumatic ear perforations.Methods: 27 patients were taken in our study who reported within two weeks of history of trauma with no previous history of middle ear pathology. Data was collected and patients were treated. Results: 27 patients were studied (11 males and 16 females); age ranging from 15 years to 56 years. Laterality of trauma was found to be more in left ear. Aural Fullness & pain in ear were the most common presenting complaints. Most common etiology was found to be assault and poster inferior quadrant was found to be most commonly involved.Conclusions: Traumatic perforations have a very good prognosis if they are treated at the right time. We would also like to stress on the fact that domestic violence is still prevalent in our society leading to patients of traumatic perforation.

Download Full-text

Popliteal artery thrombosis secondary to a tibial osteochondroma

VASA ◽

10.1024/0301-1526/a000101 ◽

2011 ◽

Vol 40 (3) ◽

pp. 251-255 ◽

Cited By ~ 4

Author(s):

Gruber-Szydlo ◽

Poreba ◽

Belowska-Bien ◽

Derkacz ◽

Badowski ◽

...

Keyword(s):

Case Report ◽

Magnetic Resonance Angiography ◽

Popliteal Artery ◽

Doppler Ultrasonography ◽

Histopathological Examination ◽

Previous History ◽

Plain Radiography ◽

Artery Thrombosis ◽

History Of ◽

The Right

Popliteal artery thrombosis may present as a complication of an osteochondroma located in the vicinity of the knee joint. This is a case report of a 26-year-old man with symptoms of the right lower extremity ischaemia without a previous history of vascular disease or trauma. Plain radiography, magnetic resonance angiography and Doppler ultrasonography documented the presence of an osteochondrous structure of the proximal tibial metaphysis, which displaced and compressed the popliteal artery, causing its occlusion due to intraluminal thrombosis..The patient was operated and histopathological examination confirmed the diagnosis of osteochondroma.

Download Full-text

Adult-to-Adult Living-Donor Liver Transplantation

Swiss Surgery ◽

10.1024/1023-9332.9.5.227 ◽

2003 ◽

Vol 9 (5) ◽

pp. 227-236 ◽

Cited By ~ 3

Author(s):

Majno ◽

Mentha ◽

Berney ◽

Bühler ◽

Giostra ◽

...

Keyword(s):

Liver Transplantation ◽

Living Donor ◽

Living Donor Liver Transplantation ◽

Therapeutic Option ◽

Donor Liver ◽

Donor Liver Transplantation ◽

Multidisciplinary Program ◽

First Case ◽

Living Donor Transplantation ◽

The Right

Living donor liver transplantation is a relatively new procedure in which the right side of the liver is harvested in a healthy donor and transplanted into a recipient. After the first case in 1994, over 3000 cases have been done worldwide. This review summarizes the reasons why the procedure is needed, describes its main technical aspects, highlights the boundaries in which it can be done safely, summarizes the current experience worldwide and describes the main points of the program in our unit. We argue that living-donor transplantation is a viable alternative to a long time on the waiting list for several patients, and it can be performed safely and successfully provided that all precautions are undertaken to minimize the risks in the donor and to increase the chances of a good outcome in the recipients. If these prerequisites are met, and within the framework of a structured multidisciplinary program, we believe that living-donor liver transplantation should be funded by health insurances as a recognized therapeutic option.

Download Full-text

Primary Gastrointestinal Stromal Tumor of the Liver with Cystic Changes

Case Reports in Gastroenterology ◽

10.1159/000495604 ◽

2019 ◽

Vol 13 (1) ◽

pp. 58-65

Author(s):

Takashi Tashiro ◽

Fumihiro Uwamori ◽

Yukiomi Nakade ◽

Tadahisa Inoue ◽

Yuji Kobayashi ◽

...

Keyword(s):

Liver Tumors ◽

Past History ◽

Brain Infarction ◽

Arterial Phase ◽

First Case ◽

Positron Emission ◽

Cystic Changes ◽

Multiple Bone Metastases ◽

The Right ◽

Cells Of Cajal

Gastrointestinal stromal tumors (GISTs) are known to originate specifically from the intestinal cells of Cajal located in the gastrointestinal mesenchyme. GISTs developing outside of the digestive tract have barely been reported. We encountered a first case of large primary GISTs in the liver with cystic changes. A 63-year-old man with a past history of brain infarction visited our hospital. The computed tomography (CT) revealed a 6-cm and a 10-cm mass in the right and the caudal lobe of the liver, respectively. These tumors have marginal enhancement in the arterial phase; however, they presented as hypodense in the internal tumor sites. Both liver tumors had cystic changes. Gastrointestinal examinations using endoscopy revealed no other gastrointestinal tumors, and [18F]-fluoro-2-deoxy-D-glucose positron emission tomography/CT revealed multiple bone metastases in addition to the liver tumors. The liver tumor specimens were composed of spindle cells, and the immunohistochemical staining for c-Kit and for DOG1, as discovered on GIST, was positive. The patient was diagnosed with primary hepatic GIST with cystic changes.

Download Full-text