PD-1/PD-L1-negative tracheal mucoepidermoid carcinoma: A case report and systematic review of the literature

Background: Tracheal mucoepidermoid carcinoma is a rare form of non-small cell lung carcinoma and is defined as a tumor characterized by a combination of squamous, mucus-secreting, and intermediate cell types. This carcinoma is usually located in the lobar or segmental bronchus. Currently, surgery is the preferred treatment for this disease, which includes pneumonectomy, lobectomy, and sleeve lobectomy. Case presentation: A 50-year-old Chinese male presented with cough, shortness of breath and hemoptysis, and the effect of antibiotic therapy was not good. Subsequently, the airway occupied lesion was found by chest CT, and he was transferred to our hospital for surgical resection. Histologically, the tumor contained squamous epidermal cells, mucoepidermoid cells and intermediate cells. Immunohistochemistrically, the tumor cells were positive for p63, CK5/6, CK7 and Ki67. However, the tumor is generally negative for TTF-1 and neuroendocrine markers. The patient had no recurrence 15 months after the surgery. Conclusions: We report a rare case of mucoepidermoid carcinoma in the distal trachea in which the surgery was difficult and could not be performed like a traditional pulmonary resection. We first provide a comprehensive description of airway management and anesthesia intubation. After surgery, we reviewed the literature and found that PD-1/PD-L1 detection had never been reported in tracheal mucoepidermoid carcinoma. Therefore, we studied the PD-1/PD-L1 pathway in this patient, and the results were negative, which may indicate that potential adjuvant therapy with immune checkpoint inhibitors (ICIs) is not useful in this case.

Conus myelitis associated with Covid 19 infection – a rare complication

Covid 19 pandemic has taken away millions of lives. Our understanding of this disease, till to date, is not complete. This disease has a wide variety of neurological manifestations. Acute transverse myelitis is one such rare neurological complication of Covid 19. The exact etiology is not clear. Auto immunity might be one of the possible mechanisms. We report a case of 39-year-old lady, who had recent history of high-grade fever and cough. This was followed by weakness of both legs and in- ability to pass urine. SARS-CoV-2 (PCR) from nasopharyngeal swab was positive. She was found to have features of acute non compressive myelopathy. MRI brain and MRI cervical spine with contrast was normal. MRI dorso lumbar spine with contrast was suggestive of diffuse hyper intensity of conus medullaris with contrast enhancement suggestive of conus myelitis. CSF analysis ruled out infection and autoimmune causes. She was pulsed with high dose steroids. There was some transient improvement in symptoms. Learning points: 1) Physicians should not consider Covid as a respiratory illness only. It can present with a variety of extra pulmonary manifestations. 2) Acute transverse myelitis is a rare complication of Covid 19 infection. Timely recognition and treatment can prevent permanent neurological damage and residual disability. 3) Conus myelitis might not present with classic upper motor neuron signs. Any new onset bladder dysfunction in a setting of a recent covid infection should be taken seriously and requires urgent imaging of the spine.

Mesothelial Cyst in a Young Female: Case report and literature review

Mesenteric cysts are rare intra-abdominal benign tumors (1 in 100,000 cases in adults) with various clinical presentations. [1,2] They commonly originate from the small bowel mesentery, although a proportion has been found to originate from the mesocolon, and retroperitoneum. [1,3] The formation of mesenteric cysts depends on the histologic origin, where they could be classified into cysts of lymphatic origin, cysts of mesothelial origin, cysts of enteric origin, cysts of urogenital origin, dermoid cysts and pseudocysts. [4,5] Diagnosis is extremely difficult since. The Mesenteric cyst is usually asymptomatic, but if symptomatic, abdominal pain (82%), nausea and vomiting (45%), constipation (27%) are the most common presenting symptoms. [2,3] The clinical finding of abdominal mass is encountered in more than 61% of the patients. [2,3]. As this condition is very rare and its symptomatology can resemble any other abdominal diseases, diagnosis is extremely difficult and incorrect preoperative diagnosis is often made. Hence, performing physical examination and conducting radiological investigations such as ultrasonography (USG) and computed tomography (CT) are important in making a correct diagnosis. [2,3] As well as cases of mesothelial cysts, they are typically asymptomatic but occasionally, their symptoms are vague and non-specific. [6,7] As mentioned above, imaging modalities such as USG, CT and magnetic resonance imaging (MRI) are great in identifying the character, size, location, surrounding tissues and the wall and content of the cysts. [7] Surgery is the treatment of choice, as a complete resection with negative borders is curative and often prevents recurrence. [3] We report a case of a young female patient who presented with a vague abdominal symptoms and a large cystic mass in lower abdomen. After proper evaluation, surgical exploration revealed a large simple mesothelial cyst.

BEYOND PSEUDO-ACCOMODATIVE CORNEA LASIK (PAC LASIK). A PERSONAL INSIGHT

Laser in-situ keratomieleusis (LASIK) is a common intervention for young, active, ametropic individuals to improve their visual acuity. pseudo-accommodative cornea (PAC), a variant of LASIK, to correct ametropia among presbyopic patients is proven in maintaining good distant vision; yet, the satisfactory spectacle free reading vision is limited to the ageing progression. However, successful treatments do not guarantee patient’s satisfaction. Assesment of the objective topographic indicators, visual acuity, higher order abrasion, and contrast sensitivity; revealed the clarification of a mild headache as a personal subjective experience after the treatment. The role of the persistent, dominant eye, the brain perception, seems to be critical factor to a patient’s satisfaction. To a certain degree, the interplay amongst the optical part and it’s supporting tissue, within and between the eyeballs, as well as its relationship to the neurosensory parts of the visual systems after Lasik surgery have not yet been assessed and reported elsewhere.

Case of severe head trauma caused by a car accident

According to the literature, the term “poly-trauma” was first used by Tscherne et.al, in 1966 for patients who demonstrated a combination of at least two “severe head, chest or abdominal injuries” or “one of them in association with an extremity injury. Trauma, despite all efforts to control its impact, is now a recurrent cause of high incidence of mortality and morbidity worldwide. Studies show that road traffic injuries are currently the leading cause of death among people aged between 1 and 45-years old. Only 21 countries in the WHO (World Health Organization), European Region have implemented legislative changes regulating drink-driving, with blood alcohol test limits varying between ≤0.02 g/dl and ≤0.05 g/dl. INTRODUCTION: It is well known that poly-trauma is a challenge for the clinician, regardless of specialization. In this regard, we wanted to present this case to raise an alarm on the approach to poly-trauma, which involves, in addition to the pre-hospital, hospital and follow-up stages, the follow-up of victims after discharge, in an attempt to identify possible causes of death and their prevention. CASE PRESENTATION: In this clinical case, we present the outcome of a 44-year-old patient who presented to the emergency room with multiple trauma injuries resulting from a road traffic accident. During her admission to the neurosurgery department of the Emergency “Sfântul Apostol Andrei”, Clinical Hospital of Galati, the patient underwent numerous clinical and imaging investigations, which provided findings statistically associated with increased mortality and morbidity rates. CONCLUSION: The management of patients presenting with poly-trauma is continuous, dynamic and extremely challenging in terms of the staff involved, the multidisciplinary team that will monitor the patient’s progress. All this is a goal that can only be achieved through good interdisciplinary and inter-hospital communication, providing standards of care and quality-oriented cooperation, increasing efficiency through the use of existing resources, regulating the financial aspects of inter-hospital transfers, cooperating in a common system of continuous training.

Identification of Interictal Paroxysmal Diffuse Sharp Activity with Eye Closure in Patients with Generalized Epilepsy

Interictal EEG recordings of patients with generalized epilepsy have known interictal abnormalities such as generalized spike and wave activity during photic stimulation and hyperventilation, interictal spike and wave or diffuse sharp activity [1]. We report three patients with confirmed generalized epilepsy who’s interictal recordings showed paroxysmal diffuse sharp 10 Hz activity in all leads with eye closure following eye blinking. This pattern was not associated with interictal generalized spike and wave activity, clinical change in the patient or did not follow seizure activity. Abnormal eye movement with generalized spike and wave activity has been described in Jeavon’s syndrome, eyelid myotonia and Sunflower syndrome. However, our patients did not meet criteria for any of these diagnoses. Therefore, we feel that our finding of paroxysmal diffuse sharp alpha activity is a novel finding in these patients with primary generalized epilepsy and may be a newly reported marker for patients with primary generalized epilepsy. Recognition of PDSA activity and further study of this pattern is encouraged.

Autologous Tenocyte Implantation (ATI) and the Use of Collagen Scaffolds: a Case Report of a Novel Surgical Treatment for Gluteal Tendon Repair

Background: Ortho-biological therapies such as platelet-rich plasma and autologous tenocyte implantation injections are hypothesized to introduce cellular mediators such as growth factors into tendons, promoting natural healing. Methods: This case introduces a 63-year-old female with an extensive history of lateral hip pain and treatment refractory tendinopathy with tearing. She underwent open surgery to repair the gluteus medius tendon, using supplementary autologous tenocyte implantation (ATI) in conjunction with a Celgro (Orthocell, Perth, Australia) collagen scaffold. Level of evidence: 4 Results: She had normal function in the hip at 12 months. MRI scans post-operatively at 12 months showed a marked reduction in inflammation, an intact tendon and a reduction in atrophic changes in the muscle belly. Conclusion: Surgical repair of a large degenerate tear of the gluteus medius tendon, augmented with autologous tenocyte implantation in a collagen scaffold led to an excellent patient outcome and MRI findings demonstrated tendon healing with improved tendon structure and reduced inflammation.

Successful treatment for intra-abdominal bleeding due to spontaneous rupture of huge liver cyst using transcatheter arterial embolization: a case report

Background: Non-parasitic simple liver cysts are one of the most common benign hepatic lesions. Although most liver cysts are asymptomatic and remain silent throughout the patient’s life, extremely large cysts can become symptomatic by direct compression to adjacent organs. Herein, we report a case of a spontaneously ruptured simple liver cyst, which is a rare presentation of a benign liver cyst. The patient’s liver cyst re-ruptured and was treated with transcatheter arterial embolization (TAE). Case report: A 62-year-old man presented to our hospital complaining of acute-onset lower abdominal pain. He had undergone laparoscopic fenestration of a huge liver cyst in another hospital 2 years prior. Computed tomography (CT) scan showed spontaneous rupture of a large liver cyst. Laparoscopic exploratory laparotomy showed no signs of ongoing intra-abdominal bleeding from the liver cyst; therefore, the operation was completed with peritoneal lavage. The patient was discharged from our hospital on postoperative day 5. Twelve days after the initial presentation, the patient was re-admitted to our hospital complaining of recurrence of lower abdominal pain. CT scan showed an enlargement of the previously ruptured liver cyst, with intra-abdominal bleeding and massive hematoma in the cyst. Extravasation of the cyst’s wall was also detected. Under the diagnosis of intra-abdominal bleeding from the artery in the wall of the huge cyst, emergent TAE was performed. Although the exact spot of extravasation was not detected, the anterior segment branch of the right hepatic artery, which corresponds to extravasation shown on the CT scan, was embolized. The patient was discharged from our hospital after 7 days, and the liver cyst remained stable without abdominal pain for more than 2 months. Conclusions: This case highlights a rare presentation of spontaneous rupture of a liver cyst with massive bleeding and the efficacy of TAE for the conservative treatment of ruptured liver cysts.

The emergence of bladder dysfunction secondary to lupus cystitis in a patient with established lupus nephritis: the first case from Pakistan

Lupus cystitis is an uncommon manifestation of systemic lupus erythematosus (SLE). We describe the case of a 23-year-old woman with lupus that complained of abdominal pain, vomiting, and diarrhea for one week. Two years back, she was brought with an affirmative history that satisfied the clinical criteria of SLE which was renal biopsy-proven (class V membranous lupus nephritis). On radiologic workup, she was found to have bilateral hydronephrosis and a thick-walled bladder with diverticula. Immunosuppressive therapy was commenced however augmentation cystoplasty had to be opted for as the symptoms did not subside with medical therapy alone.

Detection of SARS-CoV-2 by real time Reverse Transcriptase-Polymerase Chain Reaction assay in pleural effusion

SARS-CoV-2 (severe acute respiratory syndrome-coronavirus-2) is a novel coronavirus identified for the first time in Wuhan (China) in 2019, responsible of the current pandemic infection known as Coronavirus-19 disease (COVID-19). Wide range of clinical presentation of COVD -19 has been observed, from asymptomatic carriers to ARDS. The common signs and symptoms of SARS-CoV-2 infection include fever, fatigue, dry cough, and dyspnoea; the severity of the disease is due to the impairment of the respiratory function. The radiological findings include a large variety of lesions; bilateral interstitial pneumonia is the most concerning presentation of COVID-19. Pleural involvement has been described in a minority of cases: pleural thickening had been observed in 32% of cases whereas pleural effusion is uncommon being described in only 5%. Furthermore, pleural involvement has been significantly associated with a worse prognosis. Coronavirus 2 (SARS-CoV-2), beyond the nasopharyngeal swab, has been detected in other samples; up to now, data about RT-PCR specific results in the pleural fluid of patients suffering from coronavirus disease 2019 5 (COVID-19) are very limited. The current gold standard for diagnosis is nucleic acid detection by real time Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) in nasopharyngeal swab. In this report, a case of a positive RT-PCR for Sars-Cov-2 in the pleura fluid and in the naso- pharyngeal swab of a patient affected by bilateral interstitial pneumonia and severe respiratory failure is described. As the presence of SARS-Cov-2 in the pleural fluid seems to be associated to a poor prognosis, physicians should carry out the specific RT-PCR assay both in the nasopharyngeal swab and in the pleural sample also when the fluid amount is very scarce and not recognizable in the chest X ray. Furthermore, the analysis of multiple samples allows to increase the test reliability.