The Association of Research Quantitative Measures With Faculty Ranks of Australian and New Zealand Dental Schools.

INTRODUCTION: The scholarly productivity of a faculty member can be measured through several indicators including annual appraisals, feedback, and the number of publications per year. The present study aims to assess the association of quantitative research measures and academic ranks in Australian and New Zealand dental schools. METHODS: It was an analytical observational cross-sectional study. Full-time faculty members working in Australia and New Zealand's dental schools were discovered on official websites. Various bibliometric parameters including h-index, total number of citations, total number of publications, and maximum number of sources of a single publication were analyzed. Spearman rank correlation was used to determine the correlation between bibliometric variables and academic ranks (lecturer, assistant professor, professor). The Mann-Whitney U test was used to compare bibliometric parameters among departments (Basic and Clinical) and gender (male and female). RESULTS: Through the present search strategy, 207 full-time faculty members were identified, of which 12 were from New Zealand, and 195 were from Australia. Among them, 130 (62.8%) were male and 70 (33.8%) were female faculty members. There was a positive correlation of all bibliometric parameters with academic ranks (p = 0.001). There was no statistical difference between the two countries for academic parameters (p > 0.05). Male faculty members showed significantly higher academic productivity than female members in Australian dental schools (p = 0.001). CONCLUSION: These bibliometric parameters and other educational parameters can be considered for determining faculty promotions. These bibliometric parameters appear to be suitable metrics for assessing research productivity, impact, and visibility.

Effect of Different Standard Geometry Shapes on the Tensile Properties of 3D-Printed Polymer.

This study presents a comparative analysis of the tensile properties of 3D-printed polymer specimens with different standard geometry shapes. The objective is to assess the influence of printing orientation and geometry on the mechanical performance. Rectangular-shaped ASTM D3039 specimens with angles of 0°, 15°, and 90° are compared to various tensile test specimens based on ASTM and ISO standards. All specimens are fabricated using polyethylene terephthalate glycol (PETG) material through fused deposition modeling (FDM). Two printing orientations, flat and on-edge, are investigated, and tensile strength, elastic modulus, strain, and elongation at break are measured. The study examines the weak spot commonly found at the neck of the specimens and evaluates the broken areas. Additionally, a numerical analysis using the finite element method (FEM) is performed to identify stress risers' locations in each specimen type. Experimental results show that the ASTM D3039-0° specimen printed in the on-edge orientation exhibits the highest tensile properties, while the flat orientation yields the best results in terms of the broken area. The ISO 527-2 specimens consistently display lower tensile properties, irrespective of the printing orientation. The study highlights the enhanced tensile properties achieved with the rectangular shape. Specifically, the tensile strength of ASTM D3039-0° was 17.87% and 21% higher than that of the ISO 527 geometry shape for the flat and on-edge orientations, respectively. The numerical analysis indicated that the ISO 527-2 specimen had either no or minimal stress raisers, and the higher stresses observed in the narrow section were isolated from the gripping location. The findings contribute to understanding the relationship between standard geometry shapes, printing orientation, and the resulting tensile properties of 3D-printed polymer specimens.

The Morning Report Practice and Its Contribution to Education of Internal Medicine Residents: A Multicenter Cross-Sectional Survey in the Eastern Province, Saudi Arabia.

Background: Morning Report (MR) is a ubiquitous traditional educational activity in internal medicine residency training. It is under-researched; hence, this study was conducted. It aimed to examine the practice of MR by internal medicine residents, their motivation to engage with it, and their perception of its contribution to education. Methods: This was a multi-center cross-sectional study. The data was collected using an online self-administered 12-item questionnaire that covered MR practice, respondents' motivation for participation, MR contribution to education, and its impact on the practice of evidence-based medicine and quality improvement and patient safety. Results: One hundred seventy residents returned the online questionnaire (54.7%). The respondents' gender and year of training were balanced (P > 0.05). The most common MR frequency and duration were five days per week (85.4%) and 45-60 minutes (47.1%), respectively. The most common format was handover combined with an emergency long case presentation (55.8%), and consultants were the most common facilitators (79.7%). The respondents' motivation to engage with MR was predominantly intermediate. The top reasons for attending and not attending MR were mandatory attendance and embarrassing questions, respectively. The perceived MR contribution to residents' different roles development was predominantly intermediate; however, it was predominantly very low/low (42%) for overall education. The perceived MR impact on the practice of EBM and QIPS were both predominantly intermediate. Conclusion: MR was found to be a commonly practiced educational activity in internal medicine residency training programs in the eastern province of Saudi Arabia. The case discussion was the core format for education. The respondents' motivation to participate in MR and their perception of its contribution to education was predominantly intermediate. To our best knowledge, this is the first study in Saudi Arabia that examined MR. We hope its findings will be taken for further MR studies and actions for improvement.

Giant cyst-like cortical tubers in an adult with tuberous sclerosis presenting as spastic tetraplegia.

Introduction and importance: Tuberous sclerosis complex (TSC) is an autosomal dominant disorder caused by inactivating mutations in TSC1 or TSC2 genes, resulting in benign lesions that involve multiple organs including the central nerves system. Case presentation: A 39-year-old male of known TSC presented with inability to walk for two months. On physical examination, he was consciously oriented and cooperative, but he had spastic tetraparesis in the muscle-motor examination. On brain imaging, cystic lesions of various sizes in the supra and infratentorial regions were observed, consistent with giant cyst-like tubers. However, they could not differentiate from TSC related brain tumors based on the imaging findings. He underwent surgical intervention to resect/evacuate the large cystic lesion, which had the mass effects on the brain stem. The pathologic examinations revealed no malignant changes. Clinical discussion: Although the cyst-like lesions in the cortex and white matter have been reported in several previous studies of TSC, they usually had a small size and similar intensity to CSF on T2- weighted MRI and low intensity on FLAIR images. Conclusion: Giant cyst-like cortical tubers are exceedingly rare and atypical findings of tuberous sclerosis complex, which are usually associated with epilepsy and neurological deficits. Though many authors recommend the brain MRI as a screening tool for patients with TSC once every 1-3 years until the age of 25, our report showed that the brain lesions may develop in patients with TSC even after the age of 25. Thus, the MRI should be used periodically in all patients with TSC to timely detect the brain lesions and prevent the patient's disability. Surgical resection is the mainstay of treatment for the symptomatic cystic-like cortical tuber; however, it may recur after resection.

Prevalence of hypertension in Type-2 diabetes mellitus.

Background: Cardiovascular disease is the most prevalent cause of morbidity and mortality in diabetic patients. Hypertension (HTN) has been confirmed as a major risk factor for cardiovascular disease, which is frequently associated with diabetes mellitus (DM). Therefore, the detection and management of elevated blood pressure (BP) is a critical component of the comprehensive clinical management of diabetics. Since the rates of hypertension in diabetics are lacking in Afghanistan, this study aimed to evaluate the prevalence of elevated blood pressure in type-2 diabetic patients. Materials and methods: This is a descriptive cross-sectional study, which included 321 type -2 diabetic patients (119 males, 202 females) with a mean age of 53.86 ± 11.54 years who were presented to the Noble OPD center from November 2019 to January 2020. Results: The elevated blood pressure was detected in 70.5% of the patients. It was more prevalent in women than men (76.8% and 59.7% respectively). The mean systolic blood pressure was 146.94 ± 23.19 mmHg and mean diastolic blood pressure was 89.61 ± 11.59 mmHg. The mean pulse pressure was 57.32 ± 15.58 mmHg and the mean arterial pressure was 48.98 ± 7.73 mmHg. The mean body weight was 73.09 ± 13.75 Kg. The mean duration of diabetes mellitus was 7.08 ± 5.95 years with the average HbA1c of 9.27 ± 2.41%. The mean body mass index (BMI) of the patients was noted 28.77 ± 5.58 kg/m2. Conclusion: This study showed high prevalence of hypertension in type-2 diabetes patients with a significant difference in the rate of elevated blood pressure between males and females (it was higher in females than males). The systolic blood pressure had a positive correlation with age. However, it was insignificant for diastolic blood pressure. Healthcare providers and other health sector should work in collaboration for designing appropriate preventive strategies targeting the modifiable risk factors associated with hypertension.

Cytotoxic and photocatalytic studies of hexagonal boron nitride nanotubes: a potential candidate for wastewater and air treatment.

Boron nitride (BN) nanomaterials are rapidly being investigated for potential applications in biomedical sciences due to their exceptional physico-chemical characteristics. However, their safe use demands a thorough understanding of their possible environmental and toxicological effects. The cytotoxicity of boron nitride nanotubes (BNNTs) was explored to see if they could be used in living cell imaging. It was observed that the cytotoxicity of BNNTs is higher in cancer cells (65 and 80%) than in normal cell lines (40 and 60%) for 24 h and 48 h respectively. The influence of multiple experimental parameters such as pH, time, amount of catalyst, and initial dye concentration on percentage degradation efficiency was also examined for both catalyst and dye. The degradation effectiveness decreases (92 to 25%) as the original concentration of dye increases (5-50 ppm) due to a decrease in the availability of adsorption sites. Similarly, the degradation efficiency improves up to 90% as the concentration of catalyst increases (0.01-0.05 g) due to an increase in the adsorption sites. The influence of pH was also investigated, the highest degradation efficiency for MO dye was observed at pH 4. Our results show that lower concentrations of BNNTs can be employed in biomedical applications. Dye degradation properties of BNNTs suggest that it can be a potential candidate as a wastewater and air treatment material.

Prevalence of cervical extension of the thymus in children.

Background: The cervical extension of the thymus is the most common variation. However, this may be mistaken for a soft tissue mass in the neck particularly by the radiologists who are not familiar with the pediatric population and not aware of this variation, leading to unnecessary surgery and increased medical costs. Since the rates of cervicaly extended thymus in children in clinical practice are lacking in Turkey, this study aimed to evaluate the prevalence of cervical extension of the normal thymus in the pediatric population. Materials and methods: This descriptive cross-sectional study included all pediatric patients who were referred to the radiology department for neck ultrasonography between August-October 2018. A high-frequency probe was implemented and 220 patients (152 male, 68 female) with a mean age of 8.7 ± 4.39 years (ranging from 1 month to 18 years of age) were examined. Results: Cervical extension of the thymus was detected in 103 patients (46.8%). The age of the patients was found to be significantly lower than the age of the patients whose thymus was not extended (7.87 ± 4.15 years and 9.59 ± 4.46 years, respectively. p = 0.006). The mean craniocaudal length of the thymus that cervically extended was 6.41 ± 2.31 mm. There was no significant difference in the length of the thymus between males, females (6.48 ± 2.12 mm and 6.37 ± 2.46 mm. p = 0.924), and different age groups (p = 0.442). Conclusions: Approximately half of the children have the cervical extension of the thymus. Thus, radiologists and clinicians should be aware of this entity to avoid unnecessary imaging studies and interventional procedures.

Choledochal cyst: A challenging diagnostic and therapeutic entity in low-resource settings.

BACKGROUND: Choledochal cyst is an uncommon congenital biliary tract abnormality of unknown etiology. Its classical symptoms are jaundice, abdominal pain, and right upper quadrant mass. However, the disease may present with a vague and non-specific chronic abdominal discomfort. Delay in diagnosis and management may increase the risk of complications particularly the malignancy, which can directly affect the prognosis and outcome. Complete excision of the extra-hepatic duct, cholecystectomy, and Roux-en-Y hepaticojejeunostomy through the open surgical intervention or laparoscopic procedure is the mainstay of treatment. CASE PRESENTATION: A 14-year-old male was presented to our hospital complaining of vague abdominal pain for 5 years. The radiologic imaging showed the features of a type IVa choledochal cyst. He underwent complete excision of the extra-hepatic duct, cholecystectomy, and Roux-en-Y hepaticojejeunostomy. Although the bile leakage occurred as a complication of the procedure, our team best managed the patient in the post-operative period until full recovery. DISCUSSION: The Choledochal cyst was first described by Vater, which is a congenital anomaly that sometimes may remain asymptomatic till adulthood. Surgical intervention is the mainstay of treatment. However, postoperative complications including bile leakage need a close follow-up of the patient. CONCLUSION: Diagnostic delay (antenatal and postnatal) and non-specific symptoms will mask the real feature of the disease, especially in low-resource settings. Technical facilities and professional care of the patient may preclude complications.

Lupus Mastitis in a Young Female Mimicking a Breast Carcinoma; a Rare Entity Through a Case Report and Review of the Literature.

Lupus mastitis (LM) is a rare presentation of lupus panniculitis (LP) that usually affects women of childbearing age and may mimic malignancy. The condition is recurrent and progresses along with the underlying disease. Breast pathology that may be associated with LM includes fat necrosis, calcification, fibrosis, scarring, and breast atrophy. Therefore, LM should be considered in the differential diagnosis of a suspicious breast mass on mammography or ultrasound, particularly if the patient has a background of systemic lupus erythematosus (SLE) or discoid lupus erythematosus (DLE). Traumatic procedures such as surgery or biopsy may worsen the condition and it is advisable to avoid biopsy if the diagnosis can be established through accurate patient history, with identification of typical clinical and radiological features. Thus, awareness of the radiologic and clinical features of LM is essential to avoid unnecessary interventional procedures that carry the potential for disease exacerbation. The authors present here the imaging findings of LM in a 37-year old female with SLE, which presented as bilateral palpable breast lumps.

Fibroepithelial Breast Tumors in a Teenager with Beckwith-Wiedemann Syndrome: A Case Report and Review of Literature.

Beckwith-Wiedemann syndrome (BWS) is a human genomic imprinting disorder that presents with a wide spectrum of clinical features, including overgrowth, abdominal wall defects, macroglossia, neonatal hypoglycemia, and predisposition to embryonal tumors. Its diagnosis is based on molecular tests or clinical signs. However, in children with features of BWS who do not fulfill the clinical diagnostic criteria, the molecular tests may play an important role in the diagnosis. There is an increased risk of embryonal tumors in patients with BWS, but few case reports have been reported on benign breast tumors in female adolescents with this syndrome. To our knowledge, this is the first case report in the literature that describes the imaging findings of fibroepithelial breast tumors (phyllodes tumor and fibroadenomas) in a 13-year-old female with BWS, highlighting the need for lifelong tumor surveillance in this patient population.

Pulmonary arteriovenous malformations presenting with upper back pain in an adult: A case report and literature review.

Pulmonary arteriovenous malformations (PAVMs) are the abnormal connections between the pulmonary artery and pulmonary veins branches without intervening in the pulmonary vascular bed. Although the most common cause of PAVMs is hereditary hemorrhagic telangiectasia, the etiology of single PAVMs appears to be idiopathic. Dyspnea, cyanosis, cerebrovascular events, and brain abscess are the common clinical manifestations of these lesions, though they may present with a nonspecific symptom as upper back pain. Computed tomography is the gold standard investigation for diagnosing pulmonary arteriovenous malformations, and demonstrating their size and extent before therapy. Transcatheter embolization is the first-choice treatment for patients without severe complications. Surgical intervention is reserved for the lesions not amenable to embolotherapy.

Superior mesenteric artery syndrome caused by acute weight loss in a 16-year-old polytrauma patient: A rare case report and review of the literature.

INTRODUCTION: Superior mesenteric artery syndrome is a rare entity, caused by compression of the duodenum between the superior mesenteric artery and the aorta. CASE PRESENTATION: A 16-year-old male in the inpatient service of our hospital complained of vomiting for two weeks. The patient had a long hospital stay in our center for the management of trauma-related complications, which resulted in significant weight loss despite the parenteral nutrition as he was unable for taking the enteral nutrition due to severe facial traumatic injury. In oral contrast study, the proximal duodenal segments were dilated. The contrast media could not reach the duodenojejunal junction in the supine position, though a small amount of the contras passed the distal duodenal part on repositioning the patient to prone. On abdominal CT images, the angle and distance between the superior mesenteric artery and the abdominal aorta were decreased to 20. 80, and 7.3 mm respectively. The findings were consistent with the superior mesenteric artery compression syndrome. He underwent a mini-laparotomy for the placement of a jejunostomy feeding tube aiming to promote weight gain and mesenteric fat restoration for preventing the SMA compression effects on the duodenum. DISCUSSION: The decrease in retroperitoneal fat owing to weight loss may result in aortomesenteric angle reduction and duodenal compression. Prompt nutritional support and timely diagnosis may preclude the need for more invasive surgical intervention. CONCLUSION: Superior mesenteric artery syndrome is a rare condition, often resulting in small bowel obstruction. The clinical symptoms of this syndrome are nonspecific, which may underestimate the diagnosis. However, clinical suspicion supported by imaging study may help the accurate diagnosis. Superior mesenteric artery syndrome should be considered in all polytrauma and longstanding immobile patients present with rapid weight loss and vomiting.

Heterotaxy polysplenia syndrome in an adult female with complete endocardial cushion defect.

Heterotaxy syndrome is a rare condition characterized by the abnormal arrangement of thoracoabdominal organs across the left-right axis of the body. It is generally classified as right and left atrial isomerism or asplenia and polysplenia syndrome, even though there are overlaps and uncertainties. The diagnosis of isomerism is typically made by echocardiography. However, multidetector computed tomography and MRI can help in obtaining detailed data on the morphology of the heart, great vessels, the anatomy of the internal organs, and their mutual arrangement that make an accurate diagnosis of heterotaxy syndrome. The authors present here the imaging findings of the heterotaxy polysplenia syndrome in a 21-year-old female with a complete endocardia cushion defect and a duplicated right renal vein.

Endovascular management of aortocaval fistula complicating abdominal aortic aneurysm presenting as an acute renal failure.

INTRODUCTION: Aortocaval fistulas (ACFs) are a rare complication of abdominal aortic aneurysm (AAA), associated with high morbidity and mortality. It is thought that increased tension in the walls of large aneurysms can cause an inflammatory reaction resulting in adhesion to the adjacent vein and culminating in necrosis of the adherent layers and fistula formation. PRESENTATION OF CASE: A 70-year-old male was referred from a local state center to the emergency department of our hospital, complaining of weakness and oliguria for two days. The laboratory analysis yielded high urea and creatinine levels, indicating an acute renal failure. Computed tomography images showed an aortocaval fistula complicating infrarenal abdominal aortic aneurysm. The patient was successfully managed with endovascular intervention. DISCUSSION: Aortocaval fistulas generally affect elderly men with an average age of 65 years. The diagnosis is often delayed because of the variable clinical manifestations, which increases the difficulties in treatment. Conventional surgical intervention has high mortality rates. However, endoleaks and paradoxical pulmonary embolism are the main concerning complications of endovascular treatment. CONCLUSION: Spontaneous aortocaval fistulas are a rare, but potentially life-threatening complication of abdominal aortic aneurysm with myriad clinical manifestations. Early diagnosis and management can directly affect the prognosis and outcome. Modern non-invasive diagnostic imaging can help timely diagnosis and provide a road map for the treatment plan. Endovascular repair is the first choice of treatment. However, a high incidence and persistence of endoleak with the endovascular approach requires caution and a close long time follow up.

Giant renal pseudoaneurysm complicating angiomyolipoma in a patient with tuberous sclerosis complex: An unusual case report and review of the literature.

INTRODUCTION: Angiomyolipomas (AMLs) are uncommon benign lesions, which are composed of dysmorphic blood vessels, adipose tissue, and smooth muscle components. They tend to bleed because of the hypervascularity and the presence of small aneurysms, leading to life-threatening complications. PRESENTATION OF CASE: A 31-year-old female was presented to the emergency service of our hospital, complaining of left flank pain for 1 week followed by hematuria for one day. Radiologic imaging showed the features of a giant renal pseudoaneurysm. Superselective embolization was applied and she had an uneventful recovery. DISCUSSION: The blood vessels in AML are tortuous and thick-walled with the absence of supportive elastic tissue, which tend to the formation of the intralesional pseudoaneurysm. The risk of bleeding is higher with tumors larger than 4 cm, rapid tumor growth, and aneurysms larger than 0.5 cm. Early detection and treatment are essential for the prevention of bleeding and improving patient outcomes. CONCLUSION: Giant pseudoaneurysm in a renal angiomyolipoma associated with tuberous sclerosis complex is a rare entity, often leading to potentially life-threatening bleeding. Selective angioembolization is recommended as firstline therapy for bleeding AML and is increasingly used as a preventive treatment for AML at risk of bleeding. However, a high incidence of the recurrence requires caution and a close longtime follow-up. Surgical intervention is indicated if the hemorrhage is not responsive to embolization or if there is suspicion of malignancy.

Corpus callosal lipoma in a young adult with extracranial extension, presenting as a frontal scalp swelling: A rare case report.

Intracranial lipomas are rare congenital lesions of the pediatric age group and incidental findings in neuroimaging studies, but some are associated with other congenital malformations. They are usually located in the interhemispheric fissure, often in the vicinity of the corpus callosum. Most of the intracranial lipomas are asymptomatic and require no therapy. The diagnosis is usually made based on the imaging findings and doesn't need histologic conformation. The author presents here the imaging findings of a corpus callosal lipoma with unusual extracranial extension in a 30-year-old male, highlighting the need for a complete evaluation of each patient presenting with a scalp lesion before any intervention, irrespective of the age group.

Pseudoacromegaly Associated with Non-Functioning Pituitary Adenoma.

Acromegaly is characterized by excess skin and soft tissue growth due to increased growth hormone (GH) levels. Patients with similar physical findings but without somatotroph axis abnormalities are considered to have pseudoacromegaly. The list of pseudoacromegaly differential diagnoses is long. It may be caused by several congenital and acquired conditions and diagnosis can be challenging due to its rarity and occasional overlapping of some of these conditions. The presence of a pituitary tumour in such cases may lead to a misdiagnosis of acromegaly, and thus, biochemical evaluation is key. Here, we present a case of pseudoacromegaly with an acromegaloid phenotype, normal IGF levels, a supressed GH response to an oral glucose tolerance test, moderate insulin resistance and non-functioning pituitary microadenoma. LEARNING POINTS: There are several conditions that present with clinical aspects of acromegaly or gigantism but without growth hormone (GH) excess. Such cases are described as "pseudoacromegaly" or "acromegaloidism".In cases of excessive soft tissue growth with normal GH levels, other growth promotors (for example, thyroid hormone, sex hormones, insulin and others) should be taken into consideration.Biochemical confirmation of GH excess in patients presenting with clinical features of acromegaly and pituitary adenoma should always be considered to avoid unnecessary surgeries.

Female form of persistent Müllerian duct syndrome: A rare case report and review of literature.

INTRODUCTION: Persistent Müllerian duct syndrome (PMDS) is a rare form of internal male pseudohermaphroditism characterized by the presence of rudimentary Müllerian structures in a virilized male often presenting as undescended testes. Thus, each patient diagnosed with undescended testes should promptly be investigated for PMDS because the early diagnosis has direct effects on outcome and prognosis. CASE REPORT: A 26-year-old-male complained of long-standing abdominal pain two years ago and was diagnosed having bilateral undescended testes in the pelvic region. He underwent the orchidopexy about one year ago but, after 5 months of orchidopexy, he first complained of discomfort in the left and then right inguinal region due to an incisional hernia that presumed to have the ovotesticular disorder of sexual development. On the pelvic MRI exam, the Müllerian duct structures were observed and he was diagnosed as having PMDS. DISCUSSION: In this case the patient had bilateral cryptorchidism with testes fixed in the para iliac region with respect to the uterus, indicating the female type of PMDS which is a rare type of PMDS. The case is proven genetically and Müllerian duct remnants have been resected to avoid malignant transformation. CONCLUSION: Persistent Mullerian duct syndrome (PMDS) is a rare finding and may present as long-standing abdominal pain. Each patient diagnosed with undescended testes should promptly be investigated for PMDS. Diagnosis and management aim to preserve fertility and prevent malignant changes. Therefore, familiarity with this rare condition will lead to adequate management and prevention of complications.

Suprasellar epidermoid cyst in an adult female, presenting as amnesia and somnolence: A rare case report.

INTRODUCTION: Intracranial epidermoid cysts (ECs) are rare benign congenital lesions and account for approximately 0.3 to 1.8% of all intracranial brain tumors. They frequently occur at the cerebellopontine angles and parasellar regions, insinuating between brain structures. The author reports here a case of pathologically proven suprasellar epidermoid cyst in an adult female, presented with amnesia and somnolence to increase awareness about this unusual presentation. CASE REPORT: A 58-year-old female was presented to our hospital complaining of amnesia for one year, followed by weakness and somnolence for 2 months. Radiological imaging showed the features of the suprasellar epidermoid cyst which resected through the transsphenoidal endoscopic approach. DISCUSSION: Epidermoid cysts are slow-growing, benign lesions however, they may rarely undergo malignant transformation into a squamous cell carcinoma. The mean age at presentation of these lesions is 40 years. Suprasellar/sellar lesions usually present with non-specific headaches and visual disturbances. However, our case presented with amnesia and somnolence. CONCLUSION: Surasellare epidermoid cysts (ECs) are rare benign congenital lesions. They often manifest with headache and visual field defects but, they may present with atypical symptoms as amnesia and somnolence. Endoscopic transnasal and trans-sphenoidal approaches can help to remove the lesion in most cases. Attention needs to the possible postoperative complications and longtime imaging follow-up because this lesion may recur after a few years.

Sigmoid volvulus in a teenager, successfully managed with endoscopic detorsion: An unusual case report and review of the literature.

INTRODUCTION: Sigmoid volvulus (SV) occurs due to torsion of a dilated sigmoid colon around its mesenteric axis. This causes venous and arterial blood flow obstruction with progressive bowel ischemia, necrosis, and perforation if left untreated. In pediatric surgical practice volvulus of the sigmoid colon remains a rare occurrence and only a few isolated case reports and case series have been reported. The author presents herein a case of SV in a 19-year-old male. CASE REPORT: A 19-year-old male was presented to the emergency service of our hospital complaining of abdominal pain, constipation, nausea, and vomiting for 4 days. Radiologic imaging showed the features of the sigmoid volvulus. Endoscopic detorsion was applied and the patient underwent elective surgery for anterior sigmoid resection to prevent the recurrence. DISCUSSION: Sigmoid volvulus, first described by von Rokitansky in 1836 and remains a major cause of colonic intestinal obstruction in adults, which results from twisting of the sigmoid colon on its mesentery. The median age in children at presentation is 7 years, ranging from 4 h to 18 years. CONCLUSION: Sigmoid volvulus is an uncommon cause of bowel obstruction in teenagers and should be included in the differential diagnosis of young patients present with abdominal pain and absolute constipation. Early diagnosis and timely definitive treatment can prevent complications. Endoscopic detorsion is the initial treatment of choice in the absence of complications. However, elective surgery with sigmoid resection and primary anastomosis is mandatory to prevent a recurrence.