The Utility of Smartphone 3D Scanning, Open-Sourced Computer-aided Design, and Desktop 3D Printing in the Surgical Planning of Microtia Reconstruction: a Step by Step Guide and Concept Assessment.

INTRODUCTION: Microtia, a congenital anomaly of the auricle with a wide spectrum of presentation with challenging reconstruction. Management depends on its severity with variable reconstructive options. Preoperative planning is crucial to achieve better results and decrease operative time. In this article, we aim to show the utility of an affordable technology with the use of a smartphone, an open-source computer-aided design (CAD) software, and a desktop 3D printer in planning future ear location for unilateral microtia reconstruction in step-by-step fashion. METHODOLOGY: Facial 3D scanning was done using a smartphone that has a three-dimensional capture system. The scan was then used in an open-sourced CAD software. A mirror image mask was created by reflecting normal side anatomic features to the abnormal side. The mask constitutes the desired area for reconstruction given the ear anthropometrics. Finally, the model was 3D printed and fitted to the patient in which incision marking and framework location was planned. DISCUSSION: Ear reconstruction requires careful assessment and specific technicality in its anthropometric measures. One important aspect in surgical planning resides in future ear location that varies between person to person. This variability makes the reconstructive option more customized based on the patient's needs. The utility of CAD software in the measurement and planning can help predict and optimize postoperative results as possible; however, it has major technical demands and added surgical fees. CONCLUSION: Herein, we demonstrate the efficacy of an easy-to-use system beneficial for preoperative planning that is affordable, time-saving, and cost effective.

Alemtuzumab-induced simultaneous onset of autoimmune haemolytic anaemia, alveolar haemorrhage, nephropathy, and stroke: A case report.

BACKGROUND: Alemtuzumab is a humanized anti-CD 52 monoclonal antibody approved as a disease-modifying therapy for active relapsing-remitting Multiple Sclerosis (MS). Alemtuzumab has been associated with several adverse effects, including infusion-associated reactions, infections, acquired autoimmune diseases, and malignancies. CASE PRESENTATION: We report a case of Alemtuzumab-induced simultaneous onset of autoimmune haemolytic anaemia, alveolar haemorrhage, nephropathy and stroke in a 52-year-old man that occurred 8 months after initiation of alemtuzumab. The laboratory testing was consistent with autoimmune haemolytic anaemia. Computed tomography of the chest and bronchoscopy revealed an alveolar haemorrhage. Stroke workup revealed acute infarcts in bilateral occipital territories. CONCLUSION: This is the first case report of a simultaneous onset of autoimmune haemolytic anaemia, alveolar haemorrhage, nephropathy, and ischaemic stroke after the first alemtuzumab course in relapsing-remitting MS patient. This case highlights the potential for the co-occurrence of unexpected and potentially life-threatening complications of alemtuzumab therapy necessitating rigorous monitoring once prescribed.

Brain metastasis from large cell neuroendocrine carcinoma of the prostate: A case report and literature review.

INTRODUCTION: Large-cell neuroendocrine carcinoma (LCNEC) of the prostate is a rare type of prostate cancer. Only eighteen case reports have been published in the literature to date. The present case report is the first case in the literature to describe brain metastasis of LCNEC of the prostate with neuroimaging, gross, and microscopic evaluation with immunohistochemistry CASE PRESENTATION: A 79-year old male with a history of high-grade prostatic adenocarcinoma treated with androgen deprivation therapy (ADT) who presented after remission with a severe headache and limbs weakness. Neuroimaging showed large right frontal lesion that caused a mass effect. Tumor resection was done, and the biopsy showed LCNEC of prostatic origin. The patient survived for 40 days after the diagnosis and tumor removal. DISCUSSION: We discuss the spectrum of neuroendocrine differentiation in prostate carcinomas and the possible pathological pathways leading to the development of LCNEC of the prostate, and how it affects the presentation and the pattern of metastasis. CONCLUSION: This case report describes a brain metastasis of a rare aggressive type of prostate cancer with poor prognosis. With metastatic lesions of prostatic adenocarcinoma, the probability of NE transdifferentiation increases. LCNEC has a poor prognosis attributed to its nature and late diagnosis. Thus, reporting and investigating such tumor will positively contribute to better management for future patients.