11^th International Congress on Clinical and Medical Case Reports September 14-15, 2020 Vienna, Austria

Biography:

Abstract:

A 19-year-old man came to the hospital presenting with fever, sweating, cough and myalgia that had persisted for five days at outbreak phase of influenza in IRAN.  On physical examination, the patient was febrile (38.5°C axillary), other vital sign was normal and had no respiratory, gastro-intestinal, or circulatory abnormalities and no clinical evidence of any organomegaly. In The first day of admission, blood test results showed pancytopenia, anemia (Hb: 9.6g/dL), leukopenia (3.900/mm3), thrombocytopenia (45,000/mm3), high ESR (65 mm/hr), high CRP (60.4 mg/l), mildly elevated liver enzymes. Peripheral blood smear confirmed pancytopenia without other abnormality.  Chest X-ray was normal. On the basis of high prevalence of influenza, he suspected for influenza and undergo for management of this diagnosis.  Blood cultures and other laboratory tests were normal. Swabs of throat secretions was negative .Two days after admission while we were waiting for PCR influenza results, pancytopenia intensified (WBC=1600/mm3, plt=52000 and Hb=8 gr/dl). Peripheral blood smear reevaluated.  Microscopic slides of thick and thin Giemsa-stained blood smears showed the presence of schizonts of P. vivax . Rapid diagnostic tests (RDTs) also confirmed the presence of P. vivax in the blood sample. In 2009, Iran started a malaria elimination program with a goal to achieve this target by 2025. Total number recorded cases has dropped to less than 200, 90, 89, 0 cases in 2015, 2016, and 2017, 2018 respectively. In the context of the head of the health ministry’s malaria control and prevention bureau, there have been no cases of malaria reported in Iran since March 2018 until the July 2019, this case report is of particular interest, as it is a parable for the success and risks for countries nearing and maintaining malaria elimination status and malaria should be suspected in patients with any febrile illness. 

Biography:

Shokoufeh Bonakdaran is an Associate Professor at Department of Endocrinology, Endocrine Research Center from Mashhad University of Medical Sciences, Mashhad, Iran

Abstract:

A 31 year-old man was admitted with low back pain (LBP).He had LBP since 4 months ago .He also suffered from severe weakness since 1 year ago. He had anorexia and about  8 kilogram weight loss  during last year. He also complained of polydipsia and polyuria. Physical examination revealed tenderness on L2 vertebrae and loss of dorsiflexion in left foot and positive left SLR. Physical exam was normal otherwise. Vital signs were normal and blood pressure was 110/70. Hypokalemia ranged from 1.4-3 mg/dl was detected. 24 hour urinary volume was 3850cc  and urine specific gravity was 1006. 24 hour urinary potassium concentration was 54 meq/L (normal range=25-125). Lateral lumbosacral radiography showed decreased bone density , intervertebral space  and vertebral height. These findings did not signify the low back pain. CT scan of lumbosacral vertebras showed lithic destructive lesion at body of L2 accompanied with L1-L2 intervertebral disc involvement and paravertebral abscess (figure 1).Metastatic bone lesion was the radiologic diagnosis.  In order to confirm the nature of the lesion open biopsy was done. Metastatic adenocarcinoma  was the anatomical diagnosis. Abdominal ultrasonography showed a70x150 millimeter lobulated mass with irregular border   in retroperitoneal space next to spine with left kidney invasion .Abdominal and pelvic ct scan showed left adrenal mass with several calcification focuses and pesoas muscle involvement .other organs were normal.                                       

Hypokalemia had induced nephrogenic diabetes insipidus and polyuria and polydipsia . For evaluation of hypokalemia several laboratory tests were conducted. Aldosterone was low and plasma rennin activity was low .other hormonal evaluations were normal .According to laboratory data’s mineralocorticoid excess other than aldosterone  was considered and deoxycorticosterone level was measured  which was high( 4.3ng/ml ).

After correction of hypokalemia, surgery proceeded and adrenal mass removed. The pathologic exam revealed  a 11x7x5 centimeter  mass with  large  necrotic  and hemorrhagic focuses  and cells with vesiculated , nucleolated  nucleous accompanied with  numerous mitotic  and  also atypical mitosis in some foci and   granular eosinophilic  cytoplasm,  indicating adrenal  carcinoma. According to Weiss system, pathologic staging was  IV.                        

Hypokalemia resolved after surgery. The patient was referred for radiation treatment of vertebrae after he was discharged.  After radiation, adjuvant treatment with Mitotan  2 g /day was  instituted  and no recurrence was observed up to 24 months follow up.

Biography:

Jie Zhao completed her MD degree from the University of New South Wales and Master's from the University of Edinburgh. She is currently working as a Research Fellow/surgical reigstrar with John Hunter University.          

Abstract:

Introduction: A hernia is defined as the protrusion of an organ through a muscle or tissue holding it in place. Littre’s hernia is a rare surgical entity, containing Meckel’ diverticulum. A Richeter’s hernia is when bowel wall partially herniated. We present a case of an elderly lady with the rare surgical presentation of having both hernias simultaneously.

Case study: An 84 year-old lady presented with signs and symptoms consistent with a small bowel obstruction. This is on the background of obesity, type 2 diabetes, ischaemic heart disease, and asthma. On examination she was hemodynamically stable, alert and orientated. Her abdomen was soft and non-tender with an easily reducible ventral hernia.  She subsequently had a CT abdomen which showed a left sided inguinal hernia which was not detected by the emergency or surgical staff due to the patients body habitus. She underwent open inguinal hernia exploration, and on opening the sac, a Littre as well as Richter’s hernia was revealed. The neck of the small bowel was deemed viable, so only a diverticulectomy of the Meckel’s diverticulum was performed. The hernia was subsequently repaired with a Lichtenstein technique. There was no significant post-operative complications, and patient was discharged on Day 7 post operation.

Discussion: There is no published literature reported on combined Littre’s and Richter’s inguinal hernia. Given the potential high morbidity and mortality associated with Richter’s hernia, this condition should be included in the list of differential diagnosis.

Biography:

Hong Shujuan is working at Department of Surgery from Binnan Clinic, Xiamen, Fujian, China

Abstract:

Background:  A case of extensive nasal polyposis with rarely aggressive recurrent nature and its management is presented.

Case:  A 64-year-old female patient complained of recurrence of nasal polyps. The patient presented with multiple large polypoid lesion protruding from the both nostril, which had been treated with thermal ablations for more than four times. Biopsy under local anaesthesia was performed, showing findings consistent with nonspecific inflammation.  Minimally procedure with microinjection of Triamcinolone Acetonide through nasoscope under local anaesthesia was performed at the comprehensive clinic layer by layer in a sequential time-point fashion, and the polypoid masses were medically ablated one after the other in the next three weeks. Postoperative follow-up has shown no evidence of recurrence after 3 months.

Conclusion: Nasal polyps manifests typically in an aggressive recurrence manner. Since thermal ablation has been intolerant after multiple times, we managed it under local medical ablation with Triamcinolone Acetonide at the clinic, suggesting minimally invasive management on complex nasal polyps is feasible in the clinical setting. 

Biography:

Batsuuri Bayanduuren is currently working at Grand Med Hospital, Ulaanbaatar, Mongolia.

Abstract:

Introduction: The occurrence of an ectopic spleen is relatively common and observed in 10-30% of autopsy patient. Ectopic spleen is found in 10-15% of the population, and even more prevalent in patient with hematological disorders. Usually, ectopic spleen is asymptomatic; torsion and infarction rupture with bleeding, and infections with abscess are a very rare complication. Rupture of an ectopic spleen is extremely rare, and requires prompt medical attention.

Case Presentation: We report the case of 49 years, old female. Presenting with an upper recurrent abdominal pain and nausea, vomiting, and, dizziness. Pain is sudden onset presenting 5 days ago. Previously no pain and no history of family.

Blood Examination: HGB=9 g/dl, RBC=3.10*10^3 U/l.

Abdominal Computed Tomography: 8cm×5cm×4cm well defined homogenous lesion in middle abdomen adjacent in the stomach wall. Free blood in peritoneal cavity. Exploratory laparotomy, ectopic splenectomy. Large ectopic spleen next to stomach wall to vascular pedicle. Cracked ectopic spleen with hemoperitoneum.

Biography:

Rahul Hajare was fortunate enough to be recognized for hard work with scholarships from India Council of Medical Research Ministry of Health Research New Delhi scholarship including a centenary post doc National AIDS Research Institute Pune that is presented by Respected Dr. R.S.Paranjape, Immunologist and World Renowned Scientist., Retired Director & Scientist ‘G’ National AIDS Research Institute Pune. His initial journey was a quest to heal with a different kind of highly education and did a sponsorship at the Ana Laboratory in Mumbai. After completing his training, he was privileged to practice in KLE College of Pharmacy Bangalore as a board certified Secretary KLE society Belgavi, .he was work to formerly reputed Pune University and services to be recognized by special Investigation team (SIT) for work in education. 

Abstract:

A female mind reacts much more and is more stimulated than a male one when aroused. Turns out, a woman's mind is much more complex than a male's when it comes to intimacy. According to a recent Pune University study, a female mind reacts much more and is more stimulated than a male one when transition of morphine to functional morphine. In the study conducted on 20 men and 20 women, each of the individuals was shown erotic film clips while their brain vitals were scanned by two scanners. One of the scanners was an MRI machine that tracked stimulation in their brains. The other was a heat-seeking camera that measured levels of arousal through participant's genitals. While not massive, the recorded difference between stimulation levels between male and female brains highlighted the consistent disparity between the two counterparts. There were no brain regions in men with stronger brain-genital correlations than in women", the study stated, according to the Independent. While interesting, the sample size for the study was too small, according to researcher Pune University. He further added that more detailed research would be required to draw such certain conclusions. However, he did not deny the complexity of female arousal.

Biography:

Benjamin Schapira graduated from UCL in 2020 with an MBBS and BSc in medical sciences. He is a young researcher working with a team of surgeons at the Whittington Hospital lead by Mr Hassan Mukhtar. Hasan Mukhtar completed his MBBS in 1989 at Punjab University, Pakistan followed by advanced surgical training at Oxford Deanery and West from where he was appointed as consultant colorectal and general surgeon at the Whittington Hospital in 2001. He is an Honorary Clinical Associate Professor of Surgery at UCL and has presented and published over 100 publications in national and international meetings and peer-reviewed journals.

Abstract:

Necrotizing enterocolitis (NEC) carries one of the highest mortality rates of all gastrointestinal disorders. Both its pathogenesis and aetiology remain enigmatic in adult patients. We report on the first known case of NEC following Roux-en-Y Gastric Bypass (RYGB) long-term. A 42-year-old female patient (BMI 51.2) underwent RYGB. At 12 months follow-up she presented with diarrhoea, vomiting, tachypnoea and hypotension. She was severely acidotic (pH 6.9), white cell count (24x10⁹/L) and lactate (7.3U/L). CT presented dilated bowel most prominently at the upper jejunum and she subsequently underwent laparotomy for small-bowel resection, subtotal colectomy and end ileostomy. Intraoperatively, patchy necrotic segments of colon were noted. Postoperatively, her lactate increased to 10U/L, necessitating relook laparotomy for further bowel resection. Caecal and ascending colon samples showed ischaemic and necrotic areas with transmural inflammation and marked bacterial overgrowth with no evidence of vascular compromise. These features resembled acute NEC. Clostridium, Campylobacter, Salmonella, Shigella and vasculitis screening were negative. She had a slow recovery, requiring total parenteral nutrition and at 36 months follow-up she is making good progress. We believe an episode of binge eating led to gastrointestinal dilatation as seen in anorexia nervosa following rapid diet change. Such dilatation would diminish blood flow and damage mucosal integrity through ischaemia, permitting invasion of pathogenic gas-forming bacteria. With no specific diagnostic criteria; delayed diagnosis, time to surgery and failure to resect all necrotic tissue exemplify the challenges in management. We believe it’s important to highlight this case to raise awareness of similar presentations in post-bariatric surgery patients.

Biography:

Mohammed Basamh completed his medical school degree at the University of Warmia and Mazury in Olsztyn,Poland with a final score of 4.5/5. He has received much recognition in his achievements including but not limited to a certificate of distinction in physiology. He has also gone on to study a post graduate certificate in Translational Cardiovascular Medicine and the University of Bristol, England. He is currently working as a Junior Doctor with the University Hospitals of Leicester working in the department of General Surgery at the Leicester General Hospital.  He has so far published 1 publication in the British Journal of Surgery.

Abstract:

Abstract: Colorectal cancer is one of the of most common cancers in the western world and cause of mortality. In the UK, it is the 3^rd most commonly diagnosed cancer with incidence rates highest amongst those between the ages of 85-89 and a tendency to involve the rectum Primary colonic liposarcoma is quite rare with less than 10 cases reported so far. We are presenting a case of de-differentiated liposarcoma of the colon with a concurrent lesion in the right kidney.

Our patient, a 64 year old male was referred from his GP to the colorectal clinic on a 2 week wait pathway for symptoms of rectal bleeding. His Past medical history includes hypertension, atrial fibrillation multiple cardioversions and ablation, Obstructive Sleep Apnea on home CPAP and a BMI of 36. Routine blood tests were unremarkable. With the COVID protocols, the patient’s symptoms were investigated with CT rather than a flexible sigmoidoscopy which has shown a large polypoid tumour lesion in the distal ascending colon with several enlarged adjacent lymph nodes and suspicion of liver infiltration. The preoperative staging was T3/4, possible N1 due to the suspected liver involvement and M 0. Further MRI scan of the liver showed that the liver lesions were in keeping with simple hepatic cysts. The patient underwent a right hemicolectomy which was an R 0 resection. The patient had an initial histopathological diagnosis of Inflammatory Myofibroblastic Tumour however on further MDT discussions and further staining, the diagnosis was changed to de-differentiated liposarcoma. A right kidney nodule was also further identified.

Conclusion:  There is no standardised protocol for treatment of primary colonic liposarcoma as only a few cases have been reported. Previous studies have treated this with complete wide excision. A surgical resection was the treatment of choice. Although primary bowel liposarcoma is rare in itself, it would be wise to consider this as one of the differentials while working up a colorectal malignancy as it may have an impact on the outcome and mode of surgery.