Psoriatic Onycho-Pachydermo-Periostitis

Psoriatic onycho-pachydermo-periostitis (POPP) is an unfamiliar and poorly recognised condition first described in 1989 by Fournie et al. It is a variant of psoriatic arthritis comprising the triad of onycholysis, soft tissue thickening and radiographically apparent periostitis. Whilst typically affecting the great toe, any of the digits of the hands and feet may be affected. A ‘drumstick’ appearance to the digits of the foot is the most common clinical presentation and can be extremely painful. Nail changes are another hallmark of POPP and can be mistakenly diagnosed as fungal infection leading to lengthy periods of incorrect treatment. In this article, we will outline the clinical presentation, imaging features, pathogenesis and treatment options for POPP. Currently, the existence of POPP is not widely known. Awareness of this unusual condition will allow early appropriate treatment and can aid in the diagnosis of indeterminate seronegative disease.

Comprehensive Management of Congenital Cataract in Dizygotic Twin Babies

Introduction: One of the leading causes of infant blindness is cataract. The prevalence of congenital cataract has been estimated in the range between 1 and 15 per 10.000 children globally. Congenital cataract in twin babies is a rare case. This case will report the outcome of comprehensive management of congenital cataract in dizygotic twin babies. Case presentation: Eight months old dizygotic twin babies came to our clinic with the primary complaint of whitish appearance in the pupil of both eyes since birth. They were born aterm with cesarean delivery. The birth weight was 2.700 g and 3.100 g respectively. They were the fourth and fifth children in the family. There was no family history of congenital cataract. The visual acuity of both eyes was positive response to light stimuli. The cataract was bilateral and dense on both babies. Fundus reflex and TORCH examinations were negative. Ultrasonography (USG) of the retina was normal on both babies. Conclusions: Isolated congenital cataract in twin babies is an unusual condition that should be treated comprehensively. Congenital cataract may cause deprivation amblyopia, refractive amblyopia, and permanent vision impairment. Early diagnosis and quick treatment, such as surgical timing and visual rehabilitation, are critical to perform successful management. Comprehensive care is required to monitor the visual result of cataract surgery.

Bilateral tapia syndrome after maxillomandibular advancement surgery

Lesions of the hypoglossal and laryngeal nerve, recurrent in its unilateral or bilateral extracranial pathways, cause a motor deficit in the tongue with transient, partial or total loss of speech, which may be associated with mild or severe dysphagia, characterizing Tapia syndrome. This unusual condition is usually related to airway manipulation during anesthetic-surgical surgery, and few cases in the literature are correlated with maxillofacial surgeries, which partly explains the ignorance of this complication by a significant number of professionals. We describe a case report of bilateral Tapia syndrome established after a procedure for maxillomandibular advancement. This is a 55-year-old male patient diagnosed with retrognatism and retromaxillism. The patient underwent a maxillomandibular advancement with nasotracheal intubation. He evolved with bilateral Tapia syndrome, recovering from the signs and symptoms of this complication, being reoperated to correct aesthetic results obtained in the first intervention that was below acceptable, not evolving after this second surgery with the syndrome. We conclude that preventive measures should be taken, such as avoiding sudden movements in the head region and prolonged hyperextension of the neck during surgery, minimizing the trauma of the tracheal cannula on the tissues covering the hypoglossal and recurrent laryngeal nerves.

Management of Gallbladder Empyema in a patient with Situs Inversus, Levocardia and Morbid Obesity: a Case Report.

Situs Inversus with levocardia is an unusual condition, in which the main organs of the thorax and abdomen are located in a reverse or enantiomorphic position in relation to the usual topography. It is estimated a prevalence of 1:10000 people with some Situs Inversus condition, but Situs Inversus with Levocardia is reported in only 1:22000 cases. The presence of acute cholecystitis in patients is an extremely rare event,however, one of its possible complications, Gallbladder Empyema can develop, causing an increase in severity and the need for surgical intervention. Since the inversion of abdominal organs proper to Situs Inversus with levocardia is commonly associated with the transposition of great vessels, fatally, as described in the literature of Vesicle empyema and Situs Inversus, it only occurred in patients with dextrocardia, not yet being reported in patients with Levocardia. We report a case of a female patient with pain in the left hypochondrium with Situs Inversus Viscerum, Levocardia, Empyema of Biliary Vesicles and Morbid Obesity.

PEMODELAN KASUS GIZI BURUK PADA BALITA DI PROVINSI BALI TAHUN 2018 MENGGUNAKAN REGRESI SPLINE

Malnutrition associated with an unusual condition of the patient's nutritional status because the body weight index and age are not suitable, where body weight should be positively correlated with age. According to data from the Bali Health Department, malnutrition cases found in 2016 is 3,4% while in 2017 it founded 3,8%. This research uses spIine regression with malnutrition cases of children under 5 years old in Bali Province. To compare basis truncated spIine and B-SpIine, this study using the minimum value of Generalized Cross Validation (GCV) and Mean Square Error (MSE) of each basis. B-SpIine quadratic modeI with four knots is the best model.

Recurrent leiomyomatosis peritonealis disseminate: a case report

Leiomyomatosis peritonealis disseminata (LPD), a rare and unusual condition affecting mainly women of reproductive age, causes peritoneal and subperitoneal nodules formed by smooth muscle. Very few cases have been diagnosed since the disease was first described. We present a 42year old female who was managed for infertility and uterine myomata at a Municipal hospital in Ghana. Following a pelvic ultrasound diagnosis of multiple uterine myomata the patient was booked for myomectomy. At surgery to remove her myomata, the patient was found to have several peritoneal nodules some of which were attached to peritoneum, omentum and the surface of bowel loops in addition to a uterine myoma. The disease has since recurred twice after two laparotomies. The diagnosis was made by histopathology of ultrasound-guided biopsy of the nodules, and she has since been on GnRH analogue treatment. LPD simulates peritoneal carcinomatosis; thus, a good history, clinical evaluation, radiological imaging, and histopathologic analysis must be accurately diagnosed. Surgeons’ and Radiologists’ knowledge of the condition is fundamental to ensuring correct diagnosis and appropriate treatment and to minimising the probability of malignant transformation.

Simultaneous Pneumopericardium and Pneumomediastinum following pericardiocentesis: an unusual condition

An 80-year-old lady was referred to our cardiology emergency department with complaints of increasing shortness of breath since 45 days earlier, which had gradually worsened over the last week. She had a history of chronic obstructive pulmonary disease, diabetes mellitus, hypertension and chronic kidney disease

Laparoscopic Management of Primary Omental Torsion

Primary omental torsion is an unusual condition, known for its rarity and for the particularity of being intraoperatively diagnosed, in nearly all cases. At the clinical evaluation, this pathology commonly mimics other etiologies of acute abdomen. Hemoperitoneum and necrosis of the omentum are rarely associated with the omental torsion, but when the association is found, then it means that the vascular injuries are irreversible and the required surgical procedure may be far more complex than simple devolvulus. In search of the treatment of choice, laparoscopy proved its effectiveness as a diagnostic and therapeutic tool, while the open surgery approach can be described in many cases as being too invasive. A 37-year-old female patient presented with the generic symptoms of acute appendicitis. Surgical treatment was initiated. During laparoscopy, the abdomen was attentively explored, highlighting the presence of a twisted omentum with hemoperitoneum and necrosis. Omental excision and peritoneal drainage were performed. The evolution was favorable. Another check-up was done at 6 months postoperatively, displaying no signs or symptoms of relapse.

Dejérine-Roussy syndrome associated with unilateral thalamic glioma

Context: Déjérine-Roussy Syndrome is a rare entity that occurs after an ischemia located in the ventral posterolateral nucleus, and it is characterized by hemiplegia, superficial hemianesthesia, mild hemiataxia and astereognosis, pain on the paretic side and choreoathetosis movements. This unusual condition can be caused by haemorrhage or neoplasm. Thalamic tumors make up less than 5% of all intracranial tumors. The rare clinical presentation of a thalamic tumor is a diagnostic and therapeutic challenge for neurology and neurosurgery practice and generally requires treatment without biopsy. Case report: A 54-years-old man presented complaining of burning and tingling paraesthesias, decreased sensitivity in left dimidium, associated with decreased visual acuity in the left eye. Physical examination showed complete left hemiparesis provided grade 4-, normoreflexia with athetoid movements of the left arm and hand, painful, thermal hemihipoesthesia and epicritic touch, allodyne in the left hemibody, pressure sensitivity present globally, visual campimetry by confrontation with heteronymous hemianopia without changes in the cranial nerves. Magnetic Resonance Imaging of the Skull Base showed an oval mass, with hyposignal in T1 and hypersignal in T2 and FLAIR, with peripheral contrast uptake in the thalamus and nuclei from the right base. The patient showed good clinical-surgical evolution after surgery with Glasgow Outcome Scale 4 and modified Rankin scale 2. Anatomical Pathology confirmed low-grade glioma. Conclusions: Early diagnosis and immediate therapy can delay a fatal outcome or decrease treatment-related morbidity.