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.