Articles

   A wandering spleen is a rare clinical occurrence with fewer than 500 cases reported and an incidence of less than 0.2% [1]. wandering spleen is caused by either extreme laxity or absence of the normal ligaments that anchor the spleen to the left upper quadrant. Gravity also plays a role by allowing the spleen to descend into the lower abdomen attached by its vascular pedicle [2].

   Mastopexy or reduction mammoplasty is a surgery performed to reduce the breasts are usually more invasive because it involves larger incisions, tissue, skin, fat and repositioning of the areolas. These patients have back and neck pain due to the weight of the breasts, in some cases, the clinical picture even presents curvature of the back, some patients seek this type of surgery because they are unhappy with their aesthetic appearance [1].

   A 50-year-old man without ATCD who suffers from dyspepsia and frequent vomiting, prompting him to seek medical help. There were no abnormalities found during the clinical evaluation. A CT scan of the abdomen was ordered to identify a duodenal polyp that was limiting the digestive light (Figure 1).

   Mesenteric cysts account for 1 in 100,000 adult admissions [1]. Symptoms range over a broad spectrum and include abdominal pain, distention, mass and obstruction [2, 3]. Diagnosis of this often requires an imaging study. The location of these cysts can vary. Complete excision of the cysts is typically performed to rule out malignancy [4].

    Zinner’s syndrome is one of the rarest congenital malformations present with cysts in the seminal vesicle, ejaculatory duct obstruction, and ipsilateral renal agenesis [1]. Its origins in the development abnormality of the Wolffian duct at embryogenesis. Some of the patients with Zinner’s syndrome may remain asymptomatic and discovered incidentally, while others present with clinical signs of bladder outlet obstruction, nonspecific pelvic pain, and symptoms related to ejaculatory dysfunction [2].

   Adipose tissue, omentum, small intestine, colon and sometimes different organs are most commonly obtainable in the hernia sac [1, 2]. Acute appendicitis is accepted as a common surgical emergency. Appendix vermiformis can be detected in abdominal wall hernias such as inguinal, obturator, umbilical and incisional hernias, with an incidence of 0.008-1% [3]. If the appendix is located in the inguinal hernia sac or in the femoral hernia sac, they are specially named as Amyand and Garengeot, respectively [1-3].

    A 57-year-old patient presented with dyspepsia. The abdominal ultrasound revealed a hyperechogenic lesion of 2cm on segment VIII of the liver. Liver MRI (Figure 1) showed a 22mm lesion of well-defined margins, hyperintense on T1 and T2, with significant restriction; in the dynamic study, the lesion had peripheral enhancement without central uptake on all phases.

   Cerebral aspergillosis occurs in the vast majority of cases during hematogenous spread of pulmonary invasive aspergillosis, usually affecting immunocompromised patients. Cerebral localization is not uncommon and represent a poor prognostic factor [1]. The prevalence of the various forms of aspergillosis varies worldwide, depending on the socioeconomic level and the prevalence of chronic diseases, but the figure of three million people suffering from chronic and allergic aspergillosis worldwide has been suggested [2].

   A 78-year-old man presented with a one-year history of skin lesions on his anterior neck, submandibular and retro-auricular region. His medical history was unremarkable except for respiratory allergies (prick test positivity: dermatophagoides pharinae +++, dermatophagoides pteronissinus +++). The lesions were recalcitrant to topical corticosteroids and ivermectin. Physical examination revealed multiple round, reddish papules up to 3-5 mm in diameter, uniformly distributed over severely photodamaged skin on the anterior neck, submandibular and retro-auricular region.

   66-year-old woman with no significant pathological history is admitted for etiologic assessment of anemia. It is an iron deficiency microcytic anemia with hemoglobin at 9.8g/dL. An upper digestive endoscopy showed multiple fundic polypoid lesions of variable size measuring more than 10mm, including a subcardial lesion measuring 20mm (Figure 1&2). With the presence of other antrals centimetrics polypoids lesions.

   Myocarditis is the dynamic aggravation of the center layer of the heart taken after by a myocardial damage without ischemic occasions [1, 2]. The irresistible and non-infectious causes of myocarditis decide its prognostic results. The (focal/ diffuse) degrees of myocardial aggravation decide the seriousness of side effects in patients with myocarditis.

   F-18 fluorodeoxyglucose-positron emission tomography-computed tomography (F-18 FDG PET/CT) is frequently used in oncology patients. F-18 FDG PET/CT plays an important role in the detection and management of gynecological cancers, as in many different organ cancers. In addition, PET/CT helps the differentiation of benign and malignant gynecological lesions [1].

   Occluding tear drainage system is known as a mechanical blocking procedure of punctum to preserve natural tear for a longer time [1]. Punctal occlusion is an underutilized therapy for treating dry eye disease (DED) [2] that can be an option when the prescribed medications are no longer ameliorating the complaints and symptoms in patients [3]. Dry eye can occur due to immoderate tear evaporation or tear deficiency [4- 6] and have a deleterious consequent on the visual function and life quality in DED patients [7].

   Advanced tubal EP is uncommon and it can never lead to alive fetus. Diagnosis can be missed easily in the absence of classic symptoms of spotting, abdominal pain and amenorrhea. A woman aged 41, referred complaining of spotting. She had amenorrhea for 2 months.Her medical history was hypertension without any history of pelvic inflammatory disease.

   Acute heart failure is a term used to describe the sudden onset or change in the signs and symptoms of heart failure [1]. The prevalence of this syndrome is increasing due to the increased incidence of coronary heart disease, particularly in older people. In addition, acute heart failure has a high mortality and morbidity [2]. Therefore, early and timely diagnosis and identification of patients at high risk is critical. Each year 5,000,000 people in the United States suffer from heart failure, and the prevalence of this disease worldwide is increasing, especially in developed countries [3].

   In this paper we present a real case, a 10-year-old female with back pain, on CT images, a well-defined lytic lesion surrounded by dense reactive sclerosis is seen in the right lamina and posterior aspect of the 11th vertebral body, on MRI high T2 signal nidus with thick low T2 rim due to surrounding sclerosis and extensive bone marrow edema is present, which are characteristic features of osteoid osteoma.

   Mucoceles are slowly expanding mucus-containing benign cystic lesions lined with pseudo-stratified respiratory epithelial lining, which usually develops after chronic obstruction of the ostia of paranasal sinuses. Mucoceles usually occur in the fronto-etmoidal region, possibly because of the complexity of this region’s anatomy and drainage.

   Ankle fracture is one of the common injuries in orthopedic department. The Maisonneuve fracture was first reported by the French doctor Maisonneuve in 1840 [5, 11, 12, 20]. It’s a specific type of ankle injury. It includes injury of the medial structure (medial malleolus fracture or deltoid ligament tear), inferior tibiofibular syndesmosis injury and proximal 1/3 fracture of the fibula. Associated with the posterior tibiofibular ligament or fractures of the posterior malleolus injures sometimes.

   Diabetes is a disease condition resulting to the body’s ability to produce or respond to the hormone insulin is impaired, resulting in abnormal metabolism of carbohydrates and elevated levels of glucose in the blood. Diabetes is considered a metabolic disease characterized by a disorder in the regulation of carbohydrate metabolism. It results to a high blood glucose level or hyperglycemia.

   One of the critical concerns in pediatric surgery is the ingestion of foreign bodies (FBI), especially if they are magnetic or consist of metal with conductive or (ferro)magnetic properties. FBI is most common in older babies and toddlers between 6 months and three years [1] but has a second peak in children up to 12 years in age, with a median age of 7.9 years [2].

   The patient is a 33-year-old male with no past ocular or medical history who presented to the office with several days of left retroorbital pain and headache but no vision changes or vision loss. Ocular examination revealed visual acuity in both eyes without correction of 20/20. Pupils were equal, and no afferent pupillary defect was noted.

   Oral ulcerations (OU) are a common condition in childhood representing a frequent reason for seeking medical attention. The discomfort of OU can impact negatively on the quality of life of a child, interfering with eating and speaking [1]. The causes of OU are numerous from minor irritating triggers to systemic diseases, recurrent apthous stomatitis (RAS) is the most common and it is a diagnosis of exclusion.

   Fetus-in-fetu (FIF) is a rare condition in which an abnormal parasitic twin grows inside the body of its co-twin. Fetal Medicine specialists should be suspicious of dealing with FIF when ultrasound imaging shows a heterogenous mass inside the fetal abdomen. We present a case of a 21-year-old pregnant woman who presented an abnormal ultrasound at 31 weeks gestation that revealed a fetus with an intra-abdominal mass. The fetal ultrasound evaluation was suggestive of FIF. The patient had a vaginal delivery after spontaneous onset of labour at the end of pregnancy.

   In general, a majority of diseases disrupting the normal system of human are essentially caused by bacteria or viruses. They somehow enter the human body and slowly erodes the functioning of the overall system. It is no surprise that sometimes our own cells may become enemies for us. They may cause severe disruptions in the normal function of the body. This particular aspect is categorised as autoimmune disorder.

   Malignant tumors of the testis are in 98% of cases germ cell tumors (GCTs), divided into pure seminomatous GCTs (PSGTs) and non-seminomatous GCTs (NSGTs) in 55 and 45% of cases [1]. Since 2016, the WHO classification takes into account their histogeneses and molecular characteristics.

   The lockdowns and restriction of movements from 2019, the first-pandemic-outbreaks in Wuhan, China, COVID-19, caused by SARS-CoV-2, has spread worldwide quickly, badly affected our lives, physical activity, and sedentary behavior, food habits, etc., that intricately-linking-chronic-diseases, and the recent-pandemic-wave also starts from China again and may cause a high-transmission-rate with pathogenicity of mutant-coronavirus.

   We report the case of a 56 year-old patient, with a history of leukemia under treatment, who presented to the emergency room with respiratory distress associated to hemoptysis, chest pain and dyspnea NYHA stage IV with a decreased oxygen level to 85% on room air, a CBC revealed a bicytopenia. Plain radiograph showed a bilateral, peri hilar and basal alveolar syndrome, comparable to that observed in pulmonary oedema and thoracic CT scan showed bilateral and symmetrical hilifugal central ground glass areas.

   Bipolar disorder is a mental pathology that has been known since ancient times and has its origin in the concept of “mania,” a term that comes from the Greek “µανια,” meaning “madness” or “frenzy” [1-2]. Bipolar disorder, largely due to its chronic and recurrent course, poses an important burden for the patient, the family and the society and its treatment is essential to avoid the main complications of the disease.

   Splenic siderotic nodules, also known as Gamna Gandi’s bodies are nodules containing hemosiderin, fibrous tissue and calcium and result of small necrotic haemorrhagic focis in the spleen with a fibroblastic reaction leading to microarchitectural distorsion.

   Congenital nasal pyriform aperture stenosis (CNPAS) is a rare and unusual cause of neonatal nasal obstruction clinically mimicking bilateral choanal atresia [1, 3, 6]. The first clinical case was reported by Brown, et al in 1989 [9]. CNPAS is a result of abnormal development of the primary palate and bony overgrown of nasal process of maxilla that produces symptoms and signs of nasal obstruction in neonates and infants.

   A 65-year-old woman, who underwent a gastric cancer gastrectomy 4/5 20 years ago, was admitted to the emergency department for confusion syndrome with speech disorder without any other associated signs. Brain MRI (Figure 1, 2) was performed showing hyperintensity on Flair and diffusion on both sides of the third ventricle that extends to the thalamis, periaqueductal, and mammillary bodies.

   A 41-year-old woman, without pathological history, presented right flank nephritic pain and microscopic hematuria. She was referred to our hospital for an uro-computerized tomography (CT) scan without urinary tract and intra-abdominal abnormalities.

   Malaria is a mosquito borne illness that can infect human. Malaria infection ranges from febrile illness that can be easily treated to a life-threating condition that can be deadly. According to the WHO Malaria is endemic in Sudan and there is over 1.8 Million cases has been reported in 2019.

   Only a few reviews indicate that different procedures exist that can screen the motor development status of kindergarten children. Their quality and underlying constructs of motor development are pointed out. The tests studied are mostly based on motor skills, abilities or competencies.

   Hemorrhoidal disease is one of the most prevalent medical disorders, its incidence ranging between 4 and 35% [1] in patients between 40-60 years of both sexes, being rare under 20 years [2]. Hemorrhoids are composed of a submucosal connective tissue associated with smooth muscle (Treizt muscle) and an arteriovenous network, forming pads located at the left, anterolateral and right posterolateral level in the anal canal, and there may be accessory plexuses between them.

   Coronaviruses are RNA viruses classified as Alpha coronavirus, Beta coronavirus, Gamma coronavirus and Delta coronavirus. Their name comes from their conformation with the presence of spicules forming a kind of crown. Alphacoronaviruses and Betacoronaviruses (genus where zoonoses are observed) seem to originate from bats, while Gamma coronaviruses and Delta coronaviruses would originate from birds.

   HCC is a major global health problem, with 854,000 new cases and 810,000 deaths per year, one of the most frequent causes of cancer-related death globally [1, 2]. HBV infection remains the leading aetiology worldwide, along with alcohol and HCV, with increasing incidence metabolic risk factor.

   Breast cancer (BC) is well known to metastasize to the entire organs by hematological spread to such as the bone, lung, liver, and the brain. It also tends to invade through the lymphatic chains mainly to the axillary nodes or occasionally to the internal mammary nodes.

   38 year old staff nurse with no prior co-morbidities presented with transient loss of consciousness lasted for 1-2 minutes for the last 2 years associated with blurring of vision. No report of seizure activity or post ictal state. She was relatively asymptomatic till the last 2 months.During the last episode she was driving and fell down from the vehicle and sustained injury to the back of head.

   Anti-NMDA receptor encephalitis is an autoimmune encephalitis precipitated by antibodies generated against NMDA receptors, resulting in abnormalities in behavior, cognition, memory, and movement. Anti-NMDA receptor encephalitis is believed to affect one out of 1.5 million people per year and most commonly occurs as a paraneoplastic disorder associated with an ovarian teratoma.

   Hydatid cyst disease is an endemic parasitosis in Mediterranean region caused by Echinococcus granulosus, it is a public health problem, liver and lungs are most often affected but muscle localization is uncommon [1]. In this paper, we report a rare case of gluteal hydatic cyst, diagnosis and therapeutic modalities.

   Central Nervous System (CNS) Atypical Teratoid Rhabdoid Tumor (ATRT) is a rare but highly aggressive form of embryonal brain tumor of infancy and early childhood and often presents with metastasis at diagnosis. Historically, therapies have led to a 2-year event free survival of mere 11% [1].

   Dermatomyositis (DM) is an autoimmune disease included in the inflammatory myopathies whose symptoms can be cutaneous, muscular, or systemic, and it can affect adults and children [1]. Scalp involvement is common in patients with DM, however it is an understudied manifestation that has been poorly described.

   Heterotopic pregnancy is the coexistence of a living or dead intrauterine pregnancy, single or multiple and extra uterine pregnancy located in the oviduct, ovary, uterine corner, cervix or peritoneal cavity. The first case was described in 1708 – at that time the diagnosis was established during autopsy [1]. It is associated with significant morbidity and mortality for both mother and fetus including hypovolemic shock, fetal loss and maternal mortality, and early diagnosis is critical [2].

   The immune checkpoint inhibitors (ICIs) are now standard of care for several cancers treatment, including non-small-cell lung cancer (NSCLC). Due to their mechanism of action blocking specific targets like Cytotoxic T-Lymphocyte Antigen-4 (CTLA-4) and Programmed cell death protein 1 (PD-1)/ Programmed Death-ligand 1 (Pd-L1) these drugs are associated with a specific toxicity profile

   Colorectal cancer (CRC) is the third most common cancer of all cancers with metastasis being the major cause of death in the majority of patients [1]. Metastatic rectal cancer often spreads to lungs, peritoneum, bones or the liver where it takes mostly the form of parenchymal mass and rarely the form of intraductal lesions making the diagnosis with intraductal cholangiocarcinoma (ICC) difficult.

   Intestinal malrotation is an uncommon anomaly complicating approximately 0.2% of births. It is usually diagnosed during the first weeks of life. In adult it is extremely uncommon and rare cause of intestinal obstruction, it is incidence in adults can estimated between0.0001% to .19%.

   Hepatocellular carcinoma is the 4th most common malignancy in worldwide and it is leading cause of cancer like disease in liver, and it exceed more than 1 million deaths per year by 2030 [1]. Acute hepatitis and acute liver failure are the most serious medical condition that require early diagnosis by release of IL6, TNF-α and elevated alanine amino transferases, aspartate aminotransferases, alkaline phosphatase and α -Fetoprotein that progress healthy liver.