Challenging Recurrence and Management of Squamous Cell Carcinoma in the Calcaneal Region: A Case Report.

Squamous cell carcinoma (SCC) is the second most common type of skin cancer. As ultraviolet exposure represents an important risk factor, SCC commonly occurs on the face, lips, scalp, hands, and heels. The foot is an unusual location to manifest SCC. In this report, we present a case of a 44-year-old woman with severe local recurrence of SCC in the right heel, four years after an initial excision of a primary, small lesion. For various reasons, the patient did not visit the clinic for follow-up assessment during this period. Considering the extent of the lesion and infection risk, the affected leg was amputated at one-third of the lower leg. This case report underlines the importance of educating patients about the risk of SCC and assisting them in attending follow-up visits. In addition, adequate attention should be given to foot lesions with suspicious appearance. Early detection would minimize systemic risks, including metastasis and infection, and maximize preserved function after surgical intervention.

The Combined Middle and Inferior Antrostomy for Fungal Maxillary Sinusitis Treatment.

Aims: The objective of this study is to assess the effectiveness of the combined middle and inferior meatal antrostomy (MIMA) in management of patients with maxillary fungal sinusitis. Material and Methods: Design: retrospective cross sectional study. Setting and subjects: From September 2018 to March 2021, fifty-five patients with non-invasive maxillary fungal sinusitis, who underwent transnasal endoscopic combined MIMA. Methods: The study compared patients' pre- and post-operative subjective symptoms, including nasal obstruction, discharge, facial pain or pressure, halitosis, anosmia, and other non-specific symptoms. Endoscopic characteristics of recurrent fungal maxillary sinusitis and postoperative complications were also observed. Closure of the IMA site was evaluated at three and six months post-surgery and patients were categorized into three groups based on closure degree. Results: All clinical symptoms, including nasal discharge, nasal obstruction, nasal pruritus, anosmia, halitosis, sneezing, facial pain, ophthalmic and otologic symptoms, were resolved over six months after combined MIMA in majority of cases (94 - 100%). After three and six months, the postoperative endoscopic evaluation revealed recurrent fungal maxillary sinusitis in 1.8% and 5.4% of cases, respectively. Partial stenosis of the inferior antrostomy was observed in 7.2% and 16% of cases, while complete stenosis was noted in 3.6% and 7.2% of cases after three months and six months. Conclusions: The combined MIMA is effective and has better outcomes than the medial meatal antrostomy approach alone without additional operative time. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-03863-6.

Liver abscess caused by the ingested foreign body without sign of gastrointestinal perforation: A case report.

The ingested foreign body is a very unusual etiology of liver abscess. This clinical scenario is infrequently reported in the literature. A 66-year-old male patient presented to the hospital because of abdominal pain along with 7 days of right upper quadrant pain and intermittent low-grade fever. He was living in an epidemiological area of Fasciola infection. Physical examination showed right hypochondria tenderness without guarding or rebounding. Laboratory results were significant for leukocytosis, predominant neutrophils, and increased inflammatory markers. The liver function tests were within normal limits. Abdominal ultrasonography and CT scan were consistent with a hepatic abscess spread from segment 4B to segment 3. The patient was preliminarily diagnosed with a parasitic hepatic abscess. After management with fluid infusion and antibiotics, the patient was discharged in stable condition. Two weeks later, on the follow-up visit, the patient reported intermittent low-grade fever had persisted. After consulting the CT scan, an abnormal high-attenuation linear structure was identified inside the liver lesion, which is suspected of being a foreign body. Laparoscopic surgery was performed, and a fishbone was removed from the abscess cavity. Perforation was not found in the stomach, duodenum, or in the bowel. One week later, their condition was fully resolved. Liver abscess due to a foreign body should be suspected when a patient has radiology findings suggestive of an abscess, but the clinical presentation does not indicate the common etiologies. Meticulous observation on abdominal CT scans or ultrasonography can help with diagnosis and guide treatment.

Assessment of embolic cardiomyopathy from atrial myxoma on magnetic resonance imaging: A case report.

Atrial myxoma is the most common benign cardiac tumor, which can present with diverse symptoms. Systemic embolism is a frequent complication, affecting up to one-third of cases and frequently involving cerebral arteries. However, cardiac myxoma-induced myocardial infarction (MI) is rare. We report a case of a 56-year-old man presenting with predominant neurological symptoms and an unexplained elevation of hs-Trop T without clinical signs of acute MI. Computerized tomography of the head showed no acute lesions, but subsequent magnetic resonance imaging (MRI) revealed multiple small ischemic lesions and old microhemorrhage foci. A comprehensive cardiovascular investigation was performed. Ultrasonography revealed a left atrial mass. Cardiac MRI confirmed the mass was an atrial myxoma, and showed many old infarctions and scarring lesions in the cardiac muscle. The patient underwent tumor resection, but residual motor-neurological deficits were observed. This case emphasizes the importance of cardiac MRI in the diagnosis of multiple focal infarctions attributed to coronary embolism.

Spontaneous Hepatic Rupture in a Pregnant Woman with Preeclampsia and HELLP Syndrome.

Spontaneous hepatic rupture is a rare complication associated with preeclampsia and is characterized by hemolysis, elevated liver enzymes, and a low platelet count (HELLP syndrome), with a nonspecific clinical presentation and high mortality rate. We present the case of a 34-year-old primigravida woman in whom spontaneous hepatic rupture associated with HELLP syndrome was accidentally detected during cesarean delivery. The patient was successfully managed with liver packing and transcatheter arterial embolization, followed by plasmapheresis. Spontaneous hepatic rupture should be considered in any HELLP syndrome patient presenting with epigastric or right upper quadrant pain and early signs of hemodynamic instability. A multimodal approach can help achieve good clinical outcomes in patients with this rare presentation.

A Rare Case of Acute Pancreatitis as Dengue Complication.

A 31-year-old male was admitted to the hospital because of fever for 2 days. He also had chills, headaches, muscle aches, fatigue, and diarrhea. His vital signs were stable. Dengue virus nonstructural protein 1 (NS1) antigen was positive. Laboratory tests were significant for thrombocytopenia of 67.000/mm3 and high hematocrit of 45%. On the fifth day of the onset of fever, he experienced sudden epigastric pain. Laboratory results showed elevated serum amylase and lipase. Noncontrast abdominal CT findings were consistent with acute pancreatitis, Balthazar grade D. The patient was managed with supportive care and bowel rest. Two days later, his condition became stable, and he was discharged without complications.