Primary Localised Amyloidosis of the Urethra: A Case Report

Primary localised amyloidosis of the urethra is a rare entity with only 50 cases reported in the literature. The deposition of fibrillary proteins can lead to a range of symptoms. Importantly, the clinical and cystoscopic features may mimic urethral malignancy (haematuria, voiding difficulties, and a palpable urethral mass), and so thorough investigation is required in order to exclude malignancy, and to identify features of generalised amyloidosis which has a poor prognosis. Once diagnosed the prognosis of localised amyloidosis is excellent, although disease recurrence is possible. We describe a case of primary localised urethral amyloidosis presenting with visible haematuria and a urethral stricture and reviewed the literature regarding management of this rare condition.

A Modified Reconstruction Technique of Chest Wall after Radical Resection of Chondrosarcoma Underlying the Breast

Chest wall tumors are uncommon and include a variety of Cartilaginous, bony, and soft tissue lesions. The clinical presentation varies from asymptomatic to chest pain or ulcerating chest mass. Retro mammary chondrosarcoma of the chest wall can present as a painless breast mass and may be mistaken for a breast tumor. A careful clinical examination and relevant investigations are a cornerstone to plan an appropriate surgical procedure.

A “Floating Glenoid” after a Reverse Total Shoulder Arthroplasty: A Case Report with Literature Review

A shoulder replacement for cuff tear arthropathy was the original indication of the reverse total shoulder arthroplasty (rTSA). However, over time, this particular concept of shoulder arthroplasty has found new indications for other pathologies such as complex proximal humeral fractures and irreparable rotator cuff tears with rotator cuff arthropathy. Retensioning of the deltoid muscle is a vital step during this procedure in order to restore active elevation however, this can be potentially problematic since it results in anatomical changes and often times increases the stress forces across the acromion. We experienced a rare case of an 84-year-old female presenting with an extensive fracture resulting in a “floating glenoid” after reverse total shoulder arthroplasty via a deltopectoral approach. In our case, the patient presented with gradual onset pain in the posterior shoulder with point tenderness over the acromion, which worsened during active joint movement. The patient was definitively managed with surgical removal of the glenoid implants and conversion to a hemiarthroplasty. While there are existing strategies for preventing fractures of this nature, further research is still necessary to establish best management guidelines of these fracture complications associated with rTSA in order to achieve optimal outcomes.

Video Assisted Anal Fistula Treatment (VAAFT) for Treating a Complex Posttraumatic Anal Fistula: Case Report

Introduction: Anal fistula is an abnormal pathway that connects the anorectal tract to the perianal skin. The Park’s classification describes four different types of anal fistulas depending on their links with the sphincter apparatus. In this paper, we report an interesting case of post-traumatic complex trans-sphincteric fistula treated with VAAFT procedure. Case Presentation: A 60-year-old-male patient, from an accidental fall, developed a gluteal abscess with a high trans-sphincteric anal fistula and a secondary tract leading to a large second abscess located in the right ischiorectal fossa. An abscess incision was done, and a draining seton was placed in another Institution. The patient came to our Hospital and underwent surgery using Video Assisted Anal Fistula Treatment (VAAFT) procedure. Conclusions: VAAFT is an effective and safe procedure for complex anal fistula, even when they have a post-traumatic origin.

Modified Y Splitting of Lateral Rectus in Treatment of Abnormal Vertical Eye Movements Combined with Globe Retraction in Duane Retraction Syndrome

Duane retraction syndrome is the most frequently seen restrictive ocular motility disorders. It is clinically presented with limitation of horizontal movement, variable amounts of upshoots or downshoots and globe retraction combined with narrowing of the palpebral aperture on attempted adduction. An 8-year-old patient presented with severe restriction of abduction, reciprocal upshots or downshoots, and globe retraction combined with the palpebral fissure narrowing of on adduction. After the modified Y splitting of LR and recession of both horizontal rectus operation, all cosmetically disfiguring clinical features disappeared. In this case report modified Y splitting procedure and its long-term efficacy is presented.

Cholesterol Granuloma as a Late Complication of Endoscopic Sinus Surgery

Introduction: To date there are five reports referring to cholesterol granuloma of the sphenoid sinus. This is the first case where cholesterol granuloma is presented as a late complication after successful removal of a mucocele through functional endoscopic sinus surgery (FESS) and associated with convergence insufficiency. Case Report: A 67-year-old carpenter presented with binocular diplopia and frontal headache. A mucocele of the left sphenoid sinus was removed endoscopically leading to the resolution of his symptoms. Eight months later he presented with similar symptoms and findings. Following a revision FESS, cholesterol granuloma was diagnosed. Discussion: Haemorrhage within the sphenoid sinus, obstruction in the sinus ostium and fibrous tissue formation may explain the postoperative formation of cholesterol granuloma. Convergence insufficiency could be attributed to mechanical failure or denervation of eye muscles. Conclusion: Cholesterol granuloma should be included in the differential diagnosis, when recurrence of a sphenoid sinus mucocele is suspected.

Teaching Review on Approach of Esophageal Intubation as Complications in Emergency Airway Management

Background: Intubation is daily process in hospitals, it’s insertion of tube to secure an airway, nonemergent intubation is done in well controlled circumstances, while emergent intubation is not. Most emergency intubated are cardiac or respiratory arrest patients. Intubation helps to secure airway for patient breathing, also could protect from aspiration. Most common complications are: esophagus intubation and hypotension. This research will be divided into two main topics, emergency intubation as a whole, and unrecognized esophagus intubation as a complication. Emergency intubation discuss: knowledge about the procedure, equipment needed, airway assessment, preoxygenation, difficulties and risks, outcomes. While Unrecognized esophagus intubation will be discussed as complication in ER settings, point to clear: Epidemiology, tools of detection, equipment, human and environmental bias and consideration for cardiac arrest patients. Finishing with a conclusion and recommendation. Therefore, we aim to look into the common pitfalls that both medical students and new physicians face in the recognition, diagnosis, and Emergency Airway Management. Targeted Population: Airway cardiorespiratory arrest patients who are requiring urgent management in the ED, with emergency physicians for teaching approach protocol. Aim of the Study: Appropriate for assessment and priorities for Airway cardiorespiratory arrest patients by training protocol to emergency physicians. Based on patients’ causes of Airway injuries. Methods: Collection of all possible available data about the Esophageal Intubation as Complications in the Emergency department. By many research questions to achieve these aims so a midline literature search was performed with the keywords “critical care”, “emergency medicine”, “principals of airway management”, “Esophageal Intubation as Complications”. Literature search included an overview of recent definition, causes and recent therapeutic strategies. Results: All studies introduced that the initial diagnosis of Esophageal Intubation as Complications is a lifesaving conditions that face patients of the emergency and critical care departments. Conclusion: Intubation in emergency settings require a good preparation, available equipment (e.g. ready cart for all time), and supportive anatomical airway of the patient. Following a checklist will improve outcomes, prevent malpractice and complications. Preoxygenation and RSI play major roles for successful intubations with decrease risk of complications. Follow procedure steps, and expect difficult intubation for any patient, so consider LEMON mnemonic to evaluate risk of difficulty, and after 3 attempts try a different technique or equipment. More training and education are essential to decrease congenital and equipotential mistakes/errors.

Omental Infarction: A Review of 3 Cases

Omental infarction is an unusual cause of abdominal pain presenting in both adults and children; though it is rare in both [1, 2]. The difficulty is in the initial diagnosis where it can present in a number of different ways and may mask an underlying surgical condition [3, 4]. Most cases are managed without surgery, however; continuing or worsening pain may push a surgical approach. We present 3 cases of omental infarction, all with characteristic radiological findings. One had accompanying radiological features of acute appendicitis, another continued abdominal pain and the third with symptoms responding well to analgesia. The first and second patients required laparoscopic intervention, while the third was managed conservatively.

Operative Removal of 154 Objects in Chronic Compulsive Foreign Body Ingestion

Intentional foreign body ingestion presents as a chronic surgical challenge. We encountered a severe case of ingestion that had failed endoscopic retrieval secondary to the size, shape, and quantity of structures encountered. Open gastrostomy with removal of objects with care to prevent future hostile abdomen was performed with 154 total objects removed at completion. We report a lesson in approaching a clinical problem with thought to approach for the preservation of anatomical structures in potential future interventions.

Ileocecal Intussusception in an Adult Secondary to a Colon Adenocarcinoma: A Case Report and Literature Review

Intussusception is defined as telescoping of a proximal segment of the gastrointestinal tract into a distal segment caused by an organic lesion usually on the bowel that functions as a guiding point been pulled towards a distal segment due to normal peristalsis. It is rare in adults, and it represents only 5% of all intussusceptions which for the most part has been reported in the rectosigmoid colon and mostly diagnosed during surgery. We present a patient with intermittent abdominal pain and intermittent mild symptoms of bowel obstruction who reveals in imaging studies an ileocecal intussusception and due to his age, loss of weight, and a palpable tumor, a malignancy as the cause of intussusception was suspected. The histopathological study reported a colon adenocarcinoma. Although it is possible to reduce an intussusception, this should be avoided in adults due to a high malignancy rate and a perforation risk of the piece that might cause tumor cell dissemination. Taking in consideration what has been reported in literature and the colon cancer epidemiology, we should always keep in mind the possibility of a malignant tumor in a colonic intussusception finding, regardless if it is diagnosed during preoperative by imaging studies in a scheduled patient or if it is found during an emergency laparotomy.