ABSTRACT
Periaortic graft infections are a dangerous and extremely rare subtype of aortic graft infections (AGI). We hereby report a unique case of periaortic graft abscess in a 46-year-old male four months following a supracoronary ascending aorta replacement for DeBakey Type 2 dissection, resulting in the successful preservation of the original graft.
ABSTRACT
Extra-cardiac stimulation after cardiac pacemaker implantation is seldom seen in the cardiac field. However, this case report demonstrates an unusual symptom of persistent abdominal twitching in a 42-year-old male patient who underwent pacemaker replacement, lasting for 15 years. Initially, it was attributed to diaphragmatic pacing by the new pacemaker. Despite several attempts to replace the endocardial leads, the patient's symptoms did not improve. Finally, he was referred to our hospital, where our team conducted further investigations and discovered that the old pacemaker lead was exposed, leading to excitation of the rectus muscle.
ABSTRACT
Background: Iatrogenic diversion of inferior vena cava (IVC) to the left atrium (LA) after atrial septal defect repair (ASD) is an unusual complication. It rarely occurred nowadays due to trans-oesophageal echocardiography (TEE) check during surgery, but there are still few numbers of patients who survived from an old operation during childhood and reached adulthood undiagnosed. Case summary: We present a 27-year-old female post ASD repair in childhood with a unique presentation of recurrent abortion in adulthood besides exertional dyspnoea. A full workup of investigations was normal except for haemoglobin of 21 and oxygen saturation of 70%. TEE revealed abnormal drainage of IVC to the LA. Surgical correction was done to release the IVC opening to drain in the right atrium and the oxygen saturation reached 99% after weaning from the bypass machine. The postoperative course was uneventful, and the patient was discharged 5 days later. Two years later, she got pregnant twice and completed her pregnancies to term with well-developed infants. Discussion: The diversion of the IVC may be either complete or partial. Such complications may result in intraoperative death on the table or may present as early desaturation, shortness of breath, cyanosis, and clubbing, or it may present with such symptoms in adulthood. Rarely, it may present with cerebral stroke. Our case presented with the unexpected presentation of recurrent abortion. So, even if it is rare, echocardiography should be considered as a workup for recurrent abortion in a patient with a history of congenital heart surgery.
ABSTRACT
BACKGROUND: Cystic echinococcosis (CE) is classified by the WHO as a neglected disease inflicting economic losses on the health systems of many countries worldwide. The aim of this case-series study was to investigate the burden of human CE in Palestine during the period between 2010 and 2015. METHODOLOGY/PRINCIPAL FINDINGS: Records of surgically confirmed CE patients from 13 public and private hospitals in the West Bank and Gaza Strip were reviewed. Patients' cysts were collected from surgical wards and formalin-fixed paraffin-embedded (FFPE) blocks were collected from histopathology departments. Molecular identification of CE species /genotypes was conducted by targeting a repeat DNA sequence (EgG1 Hae III) within Echinococcus nuclear genome and a fragment within the mitochondrial cytochrome c oxidase subunit 1, (CO1). Confirmation of CE species/genotypes was carried out using sequencing followed by BLAST analysis and the construction of maximum likelihood consensus dendrogram. CE cases were map-spotted and statistically significant foci identified by spatial analysis. A total of 353 CE patients were identified in 108 localities from the West Bank and Gaza Strip. The average surgical incidence in the West Bank was 2.1 per 100,000. Spot-mapping and purely spatial analysis showed 13 out of 16 Palestinian districts had cases of CE, of which 9 were in the West Bank and 4 in Gaza Strip. Al-Khalil and Bethlehem were statistically significant foci of CE in Palestine with a six-year average incidence of 4.2 and 3.7 per 100,000, respectively. CONCLUSIONS/SIGNIFICANCE: To the best of our knowledge, this is the first confirmation of human CE causative agent in Palestine. This study revealed that E. granulosus sensu stricto (s.s.) was the predominating species responsible for CE in humans with 11 samples identified as G1 genotype and 2 as G3 genotype. This study emphasizes the need for a stringent surveillance system and risk assessment studies in the rural areas of high incidence as a prerequisite for control measures.
