Hoarding to the heart’s content: a case series and detailed case report of hoarding treatment in heart failure

Hoarding disorder (HD) is characterized by an accumulation of possessions due to excessive acquisition of, or difficulty discarding possessions. Evidence demonstrates an increased cardiovascular response in patients with HD. Cognitive-behavioral therapy modifications are described for HD patients with heart failure to compensate for fatigability, syncope and falls risk.

Right Sided Bochdalek Hernia with Ureteric Involvement – A Case Report and Review of Management Options

Ureteric herniation through a diaphragmatic defect in adults (Bochdalek hernia – BH) is rare, with less than 15 cases reported in the literature. Most patients present with non-specific abdominal symptoms with or without worsening of renal function, and therefore, the clinical picture can be masked [1]. Management of ureteric involvement ranges from conservative to reconstructive surgery. We report a case of an elderly (>80-year-old) patient who presented acutely with symptoms mimicking an acute abdomen and on imaging was found to have a BH associated with herniation of right ureter causing hydro-ureter. We managed the patient conservatively, and she improved symptomatically, which was evident from her follow-ups. We provide a detailed case report of this situation as well as discuss the literature on the topic to guide treatment decision-making.

Larygeotrache oseophageal cleft: a rare entity

<p>Larygeotrache oseophageal cleft is a rare anomaly in a newborn presenting with respiratory distress and choking with feeding symptoms identical with oesophageal atresia with or without tracheo-oesophageal fistula .It is an abnormal communication of the larynx and the trachea with the oesophagus occurring during fifth to seventh week of gestation as a result of circoid cartilage failing to fuse dorsally. LTOC varies greatly in anatomical extent and clinical severity; more severe forms in which the some or all of the tracheal cartilaginous rings are incomplete are fatal unless corrected surgically. LTOC occurs in less than 1/10,000 to 1/20,000 live births with slightly male predilection and has a autosomal dominant mode of inheritance. Routine chest X-rays and barium oesophagogram are usually not conclusive but bronchoscopy will delineate anatomy of cleft clearly. We present detailed case report of neonate with respiratory distress and choking on feeding and illustrating maneuvers at endoscopy and subsequent individualized surgical management of child.</p>

Creativity and Perversion: Waiting for the Muse

Although there is an extensive psychoanalytic literature on perversion, and numerous articles about creativity, few authors have explored relations between creativity and perversion. In particular, the role of childhood trauma and its impact on object relations has not been examined in patients with perversions whose creativity is blocked. In association with preoedipal anxieties and fantasies, childhood trauma can not only contribute to the development of perversion, but can also inhibit or distort the creative process by establishing an inner world characterized by the presence of a threatening internal bad object and the elusiveness of an internal good object. Though it is essential to help these patients establish an identification with the phallic father, an internal good maternal object, in the form of a muse, needs to be retrieved to bring inspiration and reduce the anxieties generated by an internal bad object, thereby facilitating the pursuit of authentic creative work. A detailed case report illustrates how this theoretical perspective guided the treatment approach to a male patient with macrophilia who was struggling to realize his creative potential.

Robot-assisted resection of gastric duplication cysts in a child: a detailed case report

Gastric duplication cysts (GDCs) represent 4-9% of alimentary tract duplications. Early diagnosis and surgical excision are essential to avoid morbidity or neoplastic degeneration. Roboticassisted excision of GDCs has never been described in childhood. We report an asymptomatic male patient with 2 gastric cystic masses at ultrasonography (US)-study (diameter 25mm and 8mm), increasing in size at follow-up. At 20 months of age, magnetic- resonance-imaging-scan confirmed 2 round gastric masses (44×35mm and 16×12mm, respectively). Two months later, an elective robotic-assisted excision of GDCs was completed without complications. The patient was discharged at day 6 after procedure. Histology confirmed the diagnosis of GDCs. At a 2-year follow- up, US-study did not evidence any issue. In this first reported case of robotic-assisted cystectomy for CGD in childhood, the procedure seems safe, effective, and feasible. This approach improves the movements of the surgical instruments with better 3- D visualization in comparison with the laparoscopic approach.