Postoperative hemiparesis following tonsillectomy

Abstract

We report a rare complication following a routine elective tonsillectomy. A 32-year-old woman woke up from general anaesthesia with left sided hemiparesis. She underwent extensive investigations, which were normal. At follow-up neurology clinic she was given a new diagnosis of hemiplegic migraine and commenced on treatment. This case draws attention to a rare cause of postoperative hemiparesis. Hemiplegic migraine is a differential diagnosis for postoperative motor deficit after exclusion of an acute neurological or metabolic event.

http://bit.ly/2I1DC8D

Laryngeal ulceration in Behçet’s disease: the role of centres of excellence in the UK

Abstract

Introduction

Behçet's disease (BD) is a rare complex multisystem inflammatory condition characterized by the triad of symptoms: aphthous ulcers of the mouth and genitalia and uveitis.

Case report

We present the case of a 31-year-old Caucasian male who had a prolonged journey from first presentation until diagnosis of BD. For 11 years, he presented symptoms affecting the oral cavity and oropharynx, with worsening odynophagia and dysphagia and ultimately, development of stridor. Flexible laryngoscopy showed significant laryngopharyngeal ulceration and scarring. Treatment was with colchicine, corticosteroids and azathioprine and supervised by one of three newly established BD Centres of Excellence in the UK.

Discussion

Although uncommon, ENT manifestations in patients with BD should be taken into consideration to allow for early recognition and treatment of what can become a life-threatening condition. In such situations, early referral to a BD Centre of Excellence is essential to provide confirmation of diagnosis and supervision of treatment.

http://bit.ly/2GhLgKG

A rare case of small bowel obstruction secondary to activated charcoal administration

Abstract

Intestinal obstruction is a rare complication of the administration of activated charcoal. We describe a 22-year-old patient who had received multiple-dose activated charcoal for carbamazepine intoxication. The patient presented with sudden-onset abdominal pain after discharge from the emergency room, and abdominal imaging examinations revealed findings consistent with small bowel obstruction. Laparoscopic-assisted exploration of the abdomen was offered, and a hard obstructing charcoal mass was found in the small bowel. Clinicians should be aware of the rare occurrence of gastrointestinal complication or obstruction following the administration of multiple-dose activated charcoal, especially in patients who ingested a drug that is potentially antiperistaltic.

http://bit.ly/2I1DzJZ

When breast cancer gets complicated. A case report of synchronous bilateral breast cancers with discordant tumor markers from the primary to nodes with findings of a sentinel internal mammary subpectoral lymph node

Abstract

This case reviews synchronous bilateral breast cancer with left infiltrating ductal carcinoma ER+/PR−, Her2− and right invasive lobular carcinoma ER+/PR−, Her2−. Independent primary bilateral breast tumors are present in 0.2–3.2% of breast cancer. Biopsy also showed differing ER status on the left breast versus the node which was triple negative. The final sentinel node was a left internal mammary node. Recent studies have found that the ER, PR and HER2 status of the primary tumor do not always correlate to the ER, PR and HER2 status of the metastatic sites. This can have deleterious effects on survival. There are no clear guidelines on course of treatment for these complex cases. A review of the current literature is supportive of treating the highest-risk breast malignancy. Despite the unusual pathology and severity of disease, our patient is doing well with treatment.

http://bit.ly/2Ghfxt2

Primary midgut volvulus in a patient with Marfan syndrome

Abstract

Marfan syndrome is a mutation in the fibrillin-1 gene resulting in a connective tissue disorder primarily affecting musculoskeletal, cardiovascular and ocular systems. However, patients with Marfan's rarely manifest gastrointestinal symptoms. Midgut volvulus is abnormal twisting of small bowel around its mesentery that can result in compromising blood flow to the bowel causing intestinal ischemia and obstruction. Primary midgut volvulus is a term used when there is no underlying cause for the volvulus. This case describes an 80-year-old female with Marfan syndrome presenting with primary midgut volvulus, which preoperatively was suspected based on imaging, and later confirmed upon operative exploration. The small bowel mesentery was long with a narrow base twisted around its mesentery 360°. The long narrow base and floppy mesentery likely contributed to hypermobility leading to volvulus and small bowel obstruction. To our knowledge, this is the first reported case of primary midgut volvulus associated with Marfan's syndrome.

http://bit.ly/2I9p47g

Extra-gastrointestinal stromal tumor with a large cyst

Abstract

Gastrointestinal stromal tumors (GISTs) arising at sites other than the alimentary tract are rare, and they are called extra-GISTs (EGISTs). We report a case of a large EGIST forming a cyst, probably arising in the mesentery of the transverse colon. A 64-year-old Japanese man presented to a hospital with an abdominal tumor forming a large cyst. Intraoperatively, the tumor was neither present in nor in contact with the alimentary tract. It was present in the mesentery of the transverse colon and was attached to the greater omentum and peritoneum, immediately anterior to the body of the pancreas. The tumor was resected with the spleen and a part of the pancreas. Histological examination of the tumor revealed that it belonged to the high-risk category of cystic EGISTs.

http://bit.ly/2Gi8z6N

Paraneoplastic opsoclonus–myoclonus syndrome as a rare presentation of breast cancer

Abstract

Opsoclonus–myoclonus paraneoplastic syndrome is a medical condition that includes opsoclonus along with diffuse or focal body myoclonus and truncal titubation with or without ataxia and other cerebellar signs. This rare neurological syndrome is poorly understood and can result in long-term cognitive, behavioral and motor sequelae. We report a case of a 49-year-old woman with anti-Ri antibody opsoclonus–myoclonus syndrome and an invasive ductal carcinoma with axillary nodes involvement. Following the diagnosis of opsoclonus–myoclonus syndrome, a multimodal immunotherapy treatment, with partial remission of the neurological symptoms. The patient underwent lumpectomy and axillary node dissection and the surgical pathology confirmed the diagnosis of breast cancer stage IIA. This was followed by chemotherapy, radiotherapy and hormone therapy with tamoxifen. At the 6 months follow-up there was a partial improvement, anti-Ri antibody was subsequently reported as negative and there was no evidence of disease recurrence.

http://bit.ly/2I9p0o2