Silicone-Induced Foreign Body Reaction: An Unusual Differential Diagnosis of Posterolateral Hip Pain

Background. Silicone injection is commonly used for soft tissue augmentation for esthetic purposes. It is not without complications. Case presentation. We present a case of a 31-year-old woman presenting with refractory left lateral hip pain. Magnetic resonance imaging of the patient's pelvis revealed innumerable small low signal foci throughout the gluteus maximus and overlying subcutaneous fat bilaterally consistent with injectable material, possibly silicone. Conclusions. This case report emphasizes that silicone-induced granulomatosis must be considered in the differential diagnosis of hip pain when evaluating a patient who has had access to plastic surgery or clandestine operators.

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Semilobar holoprosencephaly with cebocephaly associated with maternal early onset preeclampsia: a case report

The term holoprosencephaly was proposed by DeMyer and Zeman. It is a developmental defect of the embryonic forebrain with heterogeneous etiology including genetic and environmental factors. It is commonly asso...

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Deep neck infection and descending mediastinitis as lethal complications of dentoalveolar infection: two rare case reports

We report two cases of innocuous dentoalveolar infections which rapidly progressed to deep neck abscesses complicated by descending mediastinitis in a resource-constrained rural mission hospital in the Cameroon.

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Pediatric neuroanesthesia

Purpose of review Pediatric neuroanesthesia is a fascinating, yet challenging branch of anesthesia. This review highlights some of the recent insights into pediatric neuroanesthesia from the past 18 months. Recent findings Although there are incontrovertible evidences in animals suggesting that prolonged exposure to general anesthesia causes long-term neurological impairment, the translational relevance of these findings in humans is debatable. Early surgery for pediatric drug-refractory epilepsy is supported by emerging literature, but poses unique perioperative problems for the treating neuroanesthesiologist. Similarly, minimizing intraoperative blood loss and blood transfusion concerns every anesthesiologist managing small children. The usefulness of tranexamic acid in children is further enhanced by some studies in spine surgeries. Some pertinent issues related to intraoperative neuromonitoring are also discussed in the text. Summary There are several logistical and ethical problems of carrying out high-quality prospective studies in children but important findings on prevention of anesthetic neurotoxicity; minimizing intraoperative blood loss, intraoperative neurophysiological monitoring, examining optimal doses and choices of anesthetic agents in epilepsy surgery have been published recently. Correspondence to Dr Girija P. Rath, MBBS, MD, DM, Professor, Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences (AIIMS), New Delhi, India. Tel: +91 9810602272; e-mail: girijarath@yahoo.co.in Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Management of prematurely erupted teeth in newborns

The majority of natal and neonatal teeth are prematurely erupted primary teeth, whereas few are supernumerary in origin. They most commonly occur in mandibular central incisor region and often can lead to difficulty to the mother during breast feeding and tongue ulceration in newborn. Moreover, since majority of these have poorly developed roots and are mobile, there is always a fear of aspiration into respiratory passage. Extraction therefore is the most commonly rendered treatment for these teeth. This paper comprises cases of natal and neonatal teeth describing about their clinical characteristics and sequel. This paper has also highlighted the factor which needs to be considered during the management of natal/neonatal teeth and protocol followed at our centre.

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MRI diagnosis of megarectum in pregnant women

Description

A 33-year-old pregnant woman presented at 9 weeks' gestation for a voluntary abortion after an unwanted pregnancy. She had a history of long-standing abdominal distension and childhood constipation, and also a non-complicated pregnancy with normal vaginal delivery few years ago. The clinical examination revealed a distended abdomen. Ultrasound showed a great non-characterisable pelvic abdominal mass repressing pelvic organs, pushing forward and to the right the bladder and to the left the uterus. It also shows an early viable intrauterine pregnancy and no other intra-abdominal abnormalities (figure 1). MRI with multiplanary acquisitions shows that the pelvic mass seen on ultrasound examination has been a large rectum containing a giant fecaloma revealing a megarectum (figure 2). Therapeutic discontinuation of pregnancy was realised then the patient was operated. She had a mucosal proctectomy associated to a sigmoidectomy with colorectal anastomosis.1 The operative sequences were simple. This entity...

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Catheterisation of a persistent left superior vena cava

We present a case of a 62-year-old woman with end-stage renal disease who displayed a persistent left superior vena cava detected following placement of haemodialysis catheter through the left internal jugular vein (IJV). The diagnosis was confirmed by left internal jugular vein cathetogram, computed tomography (CT) thorax and transthoracic echocardiography. The catheter was removed without immediate complications. She remained well during the outpatient follow-up.

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Atypical presentation of cat scratch disease: Parinauds oculoglandular syndrome with facial nerve paresis

A 28-year-old man presented to our clinic over the course of 3 weeks with symptoms that progressed from mild headaches to fever, fatigue, myalgia and an enlarged right preauricular lymph node with ipsilateral conjunctivitis and upper eyelid weakness. Our differential included Epstein Barr Virus/Cytomegalovirus mononucleosis, bacterial conjunctivitis and lymphoma. We evaluated with CBC, EBV IgM Ab, lactate dehydrogenase level and a CMV IgG Ab which were all within normal limits. During his third visit, we discovered our patient had been scratched by two stray kittens he had adopted 2 months prior. We confirmed the diagnosis with a positive Bartonella henselae IgG level and diagnosed him with cat scratch disease presenting as Parinaud's oculoglandular syndrome. He was treated with a 5-day course of Azithromycin 250 mg with definitive improvement.

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Squamous cell carcinoma of scrotum mimicking as scrotal abscess

Description 

A 60-year-old man was referred to our urology department with complaints of non-healing scrotal wound for the last three months. He initially presented to a primary care centre with complaints of painful scrotal swelling and discharging scrotal wound for 15 days. The discharge card given to the patient mentioned that the patient was provisionally diagnosed as scrotal abscess and underwent incision and drainage. On local examination, an irregular appearing, ulcerated scrotal wound with everted margins was present (figure 1). The local examination of inguinal region and general physical examination was normal. Routine blood/urine investigations were within normal limits. Wedge biopsy from wound margins was performed under local anaesthesia. The histopathology came as a surprise to us as it revealed proliferating squamous epithelial cells disposed of as nests and solid masses suggestive of well-differentiated squamous cell carcinoma (figure 2). Further workup including contrast-enhanced CT abdomen/pelvis and chest X-ray...

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Hungry bone syndrome secondary to prostate cancer successfully treated with radium therapy

A 50-year-old man with a history of prostate cancer with extensive bone metastasis and hypocalcaemia presented with muscle aches and cramps. Physical exam was significant for Chvostek's and Trousseau's sign. Laboratory assessment was consistent with profound hypocalcaemia. This was believed to be due to hungry bone syndrome secondary to advanced prostate cancer. He was treated with intravenous calcium, vitamin D and calcitriol. He also received three doses of radium²²³ therapy. After therapy, hypocalcaemic episodes resolved. Follow-up after 2.5 years showed continued resolution of hypocalcaemia.

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IgG4-related disease coexisting with autoimmune haemolytic anaemia

An 85-year-old man presented with a pale appearance and generalised pruritic papules. Laboratory investigations disclosed eosinophilia, autoimmune haemolytic anaemia, mixed hyperbilirubinaemia, cholestasis and elevated serum IgG4 levels. Abdominal sonography and CT showed progressive dilatation of biliary trees, with diffuse pancreatic enlargement and a subtle capsule-like low-density rim around the pancreatic head and body. Endoscopic retrograde cholangiopancreatography found no stone-related biliary obstruction, while endoscopic transpapillary biopsy demonstrated chronic inflammation only. Nevertheless, the diagnosis of IgG4-related disease with coexisting autoimmune haemolytic anaemia was presumed. The clinical picture and laboratory abnormalities improved after administration of moderate dose of methylprednisolone.

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Perimesencephalic non-aneurysmal subarachnoid haemorrhage

Description 

A 51-year-old woman, without any relevant personal or family history, presented to the emergency department with acute severe occipital headache.

She has no focal neurological deficits or meningeal signs on examination.

Her funduscopy was normal.

Routine bloods including full blood count, renal profile, coagulation screening and cardiac enzymes were unremarkable.

Her baseline chest X-ray and ECG were also normal.

An initial non-contrast CT of the brain was reported as normal.

However, her subsequent CSF analysis at 12 hours post onset of symptoms revealed the presence of red blood cells (14 800/cmm in Tube 1 and 15 000/cmm in Tube 3) and xanthochromia, which raised the suspicion that a careful check of the CT images is needed.

The subtle perimesencephalic haemorrhage was seen on the subsequent review of the axial view (figure 1A) and sagittal view (figure 1B) of the CT brain, with a characteristic distribution of cisternal...

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Hypomelanosis of Ito with gynaecomastia and dental anomaly

Hypomelanosis of Ito is a rare neurocutaneous syndrome. Cutaneous involvement is characterised by streaks and swirls of hypopigmentation arranged in a Blaschkoid pattern. Neural involvement along with other systemic features are seen. We report a case of a 13-year-old boy who presented with the characteristic skin involvement of hypomelanosis of Ito, mental retardation, teeth abnormalities and gynaecomastia along with psoriasis.

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Laws of attraction: management of magnetic foreign body ingestion

Description 

An 11-year-old girl with global developmental delay presents with a 4-day history of nausea, vomiting and abdominal pain after the ingestion of multiple foreign bodies. She was haemodynamically stable with no gross abnormalities on laboratory tests. An abdominal X-ray was obtained which demonstrated two radio-opaque foreign bodies in the left lower quadrant without free air (figure 1A). On physical examination the patient had significant point tenderness in the left lower quadrant with guarding. The decision was made to proceed to the operating room where a diagnostic laparoscopy was performed. On entering the abdomen, there was no significant free fluid or gross contamination. After running the bowel, two magnets were identified in adjacent loops of small intestine with evidence of bowel wall ischaemia in-between. Approximately 15 cm of jejunum was inspected and the foreign bodies which included two magnets and an earring (figure 1B) were...

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Papillary thyroid cancer nodal metastases mimicking a slow-flow lymphatic malformation

Description 

A 28-year-old Caucasian man was referred to the head and neck clinic with a 2-year history of a right-sided neck lump, which had started to cause discomfort. Physical examination revealed two discrete non-tender neck masses in the region of the right sternocleidomastoid muscle, with no bruit or palpable pulse.

CT demonstrated multiple right-sided thin-walled cystic lesions within the upper to lower jugular chain and posterior triangle (levels II–V) forming a multiloculated cystic lesion measuring 10 cm in craniocaudal dimension. Ultrasound assessment suggested a multiloculated cystic mass with thin walls and no intralesional flow, extending along the posterior margin of the right sternocleidomastoid muscle, posterolateral to the right internal jugular vein. The thyroid and major salivary glands appeared unremarkable. Fine-needle aspiration cytology (FNAC) proved inconclusive. The abnormality was presumed to be a slow-flow lymphatic malformation; however, injection sclerotherapy did not result in resolution, confirmed on an MRI scan performed...

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Gastrointestinal beriberi: a forme fruste of Wernickes encephalopathy?

Gastrointestinal symptoms, such as anorexia, nausea, vomiting and abdominal pain, are very common in patients with Wernicke's encephalopathy (WE). Mild thiamine deficiency may have only gastrointestinal symptoms. We are reporting two patients with thiamine deficiency who predominantly had gastrointestinal symptoms. Case 1: a 38-year-old man had gastrointestinal problems for about 2–3 years. It gradually became severe. The patient came to the neurology outpatient department for his recent-onset vertigo and headache. Clinical examinations fulfilled Caine's criteria of WE. Gastrointestinal symptoms responded dramatically to intravenous thiamine. Case 2: a 21-year-old woman developed drug-induced hepatitis and gastritis. Associated nausea, vomiting and abdominal pain progressively increased over the weeks. The patient responded only to intravenous thiamine administration.

We suggest that a suspicion for gastrointestinal beriberi should arise if gastrointestinal symptoms (anorexia, nausea, vomiting and abdominal pain) are refractory to the usual therapies.

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Plane palsy: a case of transient facial weakness during an aircraft flight

Changes in atmospheric pressure have been reported to cause a transient lower motor neuron weakness of the facial nerve. We report the case of a passenger on an international flight who developed a unilateral facial weakness after take-off which resolved within 45 min. The effect is thought to be due to an ischaemic neuropraxia of the facial nerve caused by increased middle ear pressure compressing the facial nerve in an exposed facial canal. The condition has been commonly reported in scuba-divers but less frequently in airline passengers. Treatment is not necessary.

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Arterial fragility in kyphoscoliotic Ehlers-Danlos syndrome

Pathogenic variants in the lysyl-hydroxylase-1 gene (PLOD1) are responsible for the kyphoscoliotic type of Ehlers-Danlos syndrome (EDS). The disease is classically responsible for severe hypotonia at birth, progressive kyphoscoliosis, generalised joint hypermobility and scleral fragility. Arterial fragility is an important feature of the disease, but its characterisation remains limited. We report the clinical history of a 41-year-old woman who presented repeated arterial accidents, which occurred in previously normal medium size arteries within a limited time span of 2 years. Molecular investigations revealed compound heterozygosity for two PLOD1 gene deletions of exons 11–12 and 14–15. Arterial fragility is an important characteristic of kyphoscoliotic EDS. It manifests as spontaneous arterial rupture, dissections and dissecting aneurysms which may occur even during early childhood. This fragility is particularly likely to manifest during surgical intervention. Early medical management and surveillance may be indicated, but its modalities remain to be defined.

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Respiratory failure caused by lipoid pneumonia from vaping e-cigarettes

A young female vaper presented with insidious onset cough, progressive dyspnoea on exertion, fever, night sweats and was in respiratory failure when admitted to hospital. Clinical examination was unremarkable. Haematological tests revealed only thrombocytopenia, which was long standing, and her biochemical and inflammatory markers were normal. Chest radiograph and high-resolution CT showed diffuse ground-glass infiltrates with reticulation. She was initially treated with empirical steroids and there was improvement in her oxygenation, which facilitated further tests. Since the bronchoscopy and high-volume lavage was unyielding, a video-assisted thoracoscopicsurgical biopsy was done later and was suggestive of lipoid pneumonia. The only source of lipid was the vegetable glycerine found in e-cigarette (EC). Despite our advice to quit vaping, she continued to use EC with different flavours and there is not much improvement in her clinical and spirometric parameters.

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