ABSTRACT
Spine metastases occur because of the spread of the primary tumour that causes back pain and neurological deficits in the sufferer and has a high risk for surgery. Case presentation: In this case series, all three patients had the same initial symptoms; back pain and lower limb weakness and had a history of previous primary tumours that metastasized to the spine. The MRI showed a tumour mass on T11 accompanied by a burst fracture in the first patient, L4 in the second patient, and T3 in the third case accompanied by a dislocated fracture. The three reported patients underwent a posterior decompression procedure, and a histopathological examination showed a metastatic adenocarcinoma. Outcomes: Postoperatively the patient underwent physiotherapy and showed a change in the Frankel grade condition. However, in the second case, the patient had complications such as a pathological fracture that made the patient undergo further surgery for this. Still, after the operation, the patient died due to hemodynamic instability due to heavy blood loss. In this report, the indication for surgery is because the three patients complained of pain and neurological deficits resulting in the patient having limited motor movement in the lower limbs. Conclusion: Surgery is one of the things that can improve spine metastatic patients' activities of daily living and quality of life even though it is a high-risk procedure; The surgeon must carefully assess the patient's condition in determining the classification, evaluation, and scoring system to provide the necessary therapy.
ABSTRACT
INTRODUCTION: Ulcerative colitis (UC) is a chronic inflammatory disease that affects colon while the incidence is increasing worldwide. The pathogenesis of the disease is complex and involves multi factors such genetic predisposition, defects in epithelial barrier and immune response as well as environmental factors. Combination UC with Hemophilia A, a hereditary hemorrhagic disorder, is very rare but can lead massive rectal bleeding that will be fatal for the patients. AIM: The case report present a case of a man with hemophilia A with rectal bleeding and recently diagnosed with ulcerative colitis. CASE REPORT: A 52 years old man presented with massive rectal bleeding since 3 days before admitted to hospital. The patient reported recurrent rectal bleeding for years but never continue for more than a week. He was previously diagnosed with hemophilia A since 34 years ago with factor VIII between 5 to 8 percent and receive recombinant human factor VIII routinely. Colonoscopy examination showed redness and ulcer along colon descendent and was confirmed for ulcerative colitis with histopathology analysis. The patient showed clinical improvement after administered with sulfasalazine and tranexamide acid. CONCLUSION: UC can cause fatal bleeding in patient with hemophilia A therefore early diagnosis of UC altogether with UC flare prevention, continuing FVII infusion and anti-hemorrhagic administration are the most important strategy in management UC in hemophilia A patient.
ABSTRACT
INTRODUCTION: Thoracic spinal psammomatous meningioma is a rare subtype of meningioma. Surgery is the definitive treatment for symptomatic spinal meningiomas and offers a substantial possibility for complete resection and cure. PRESENTATION OF CASE: A 42-year-old female complaining of back pain for one year and progressive weakness and numbness of both lower limbs with urinary incontinence and constipation for two months. Magnetic resonance imaging showed an intramedullary spinal mass at D3-D4 level. The patient underwent laminectomy at D3-D5 level, revealing dural bulge. A midline durotomy performed. Intraoperative findings showed firmed, greyish to white and moderately vascular mass. A clear margin was identifiable between cord and tumor. Simpson grade 3 resection was performed. Pedicle screw and rod was placed for posterior stabilization. Histopathological examination demonstrated a psammomatous spinal meningioma. Despite the pain and the sensory sensation was improved, the motoric and autonomic function still showed no significant improvement in the early postoperative period. DISCUSSION: The preferred approach or procedure must be tailored case by case based on preoperative surgical grading of the tumor and its associated factors. Meanwhile, the prognosis for recovery depends mainly on two factors: the severity of the neurological deficit and the duration of the deficit before decompression. CONCLUSION: Surgical resection of the tumor may relieve the spinal cord compression in a neglected case. Even though the neurologic function after surgery rarely returns to the functional stage due to chronic neural tissue damage.
