Pilomatrix carcinoma of the lower extremity: A rare case report and literature review.

INTRODUCTION: Pilomatrix carcinoma (PC) is a rare skin malignancy of the hair follicles matrix that tends to be locally aggressive with 10-16 % risk of metastasis mostly to the pulmonary and lymphatic system. There are no clear protocols for the management of PCs, however surgical intervention with clear margins has been highly considered in PC management to decrease risk of recurrence. CASE PRESENTATION: A 40 year-old male patient presented to our clinic to evaluate an asymptomatic, slow-growing nodule localized on his left thigh. A CT scan revealed a well-defined, enhanced lesion with microcalcification. "En bloc" surgical resection of the lesion was performed and histopathology confirmed the diagnosis of pilomatrix carcinoma. CLINICAL DISCUSSION: Given its rarity, there are no definitive guidelines regarding PC treatment. However, surgical intervention with clear margins including wide local excision or Mohs micrographic surgery has been highly considered. In our case, wide excision of the lesion with clear margins was performed with no evidence of recurrence one year later. CONCLUSION: Given the local aggressive nature of PC, appropriate surgical intervention is essential in decreasing the risk of recurrence. Wide excision with clear margins has been proposed to decrease the risk of recurrence. Additionally, total-body skin examination should be done 2-3 times annually to evaluate for recurrence or metastasis.

The first reported case of clicking larynx syndrome complicating thyroidectomy due to papillary thyroid cancer.

INTRODUCTION AND IMPORTANCE: When the superior cornu or the top edge of the thyroid cartilage rubs against the hyoid, or when these structures come to rub against the cervical spine, Clicking Larynx Syndrome (CLS) occurs. Which is a very rare disorder in that only less than 20 cases are reported in the literature. Patients seldom ever mention past laryngeal injuries. The cause of the accompanying pain when present is yet unknown. Gold standard management appears to be thyroplastic surgery in which the structures responsible for the clicking sounds are removed or reduction of the size of the large horn of the hyoid bone. CASE PRESENTATION: Herein, we present a 42-year-old male patient with a history of papillary thyroid microcarcinoma treated with left thyroidectomy presented with a spontaneous continuous painless clicking noise and abnormal clicking movement of the larynx. CLINICAL DISCUSSION: CLS is a very rare condition with a very limited number of cases reported worldwide, most reported cases revealed abnormal laryngeal structural anatomy. However, our patient had normal laryngeal structures where multiple diagnostic tools (i.e.: Computed tomography, laryngoscopy) failed to disclose causative abnormality to explain his symptoms, nor literature could reveal any previously reported similar causes or explain the causative relationship between our patient's history of thyroid malignancy or thyroidectomy with his condition. CONCLUSION: It is crucial to explain to patients with mild CLS that these clicking noises are safe and to provide them with information on the best possible case-dependent treatments to avoid the usually associated anxiety and psychological stress. Further observations and research are needed to analyze the association between thyroid malignancy, thyroidectomy and CLS.

Hijama (wet cupping therapy) enhances oral and dental health by improving salivary secretion volume and pH in adult patients at King Abdul Aziz University Hospital (KAUH), Jeddah, KSA: A controlled trial study.

Objective: The aim of this study was to explore the potential effect of Hijama in promoting oral health by analyzing its effects in modulating saliva flow and pH. Method: An open-label, non-randomized controlled trial design was conducted at the Hijama clinic of Y.A. Jameel Scientific Chair of Prophetic Medical Applications at King Abdul Aziz University Hospital (KAUH), Jeddah, KSA. Forty-one healthy volunteers were divided into two groups: Hijama (intervention, N = 21) and control (N = 20). Saliva volume and pH were measured in salivary samples collected in a standardized fashion, 1 h before admission to the Hijama room (pre-Hijama) and 30 min after the procedure (post-Hijama) in both groups. The Hijama group underwent an additional salivary collection 7 days after Hijama. Result: Early post-Hijama assessment showed an increase in saliva volume by an average of 1 mL in the Hijama group, whereas that in the control group decreased by 0.6 mL (p < 0.001; large effect size, Cohen's d = 1.24). Saliva pH also increased in the Hijama group by an average 0.22 but decreased by 0.08 in controls (p < 0.001; large effect size, Cohen's d = 1.22). The multivariate model demonstrated that Hijama explained 48.8% of the variability of both pH and volume together (group × time effect, eta squared = 0.488, p < 0.001), whereas time and sex had no effect. At 7 days post-Hijama, both the volume and pH of saliva had increased in the Hijama group with respect to the early post-Hijama time point; however, only the volume increase was statistically significant. Conclusion: Hijama enhanced salivary function and induced a significant increase in saliva volume and pH, which was maintained 7 days after the intervention. Further studies are warranted to identify other effects of Hijama on salivary glands and explore its long-term efficacy and clinical applications.

The effect of wet-cupping therapy (hijama) in modulating autoimmune activity of Hashimoto's thyroiditis: A pilot controlled study.

OBJECTIVES: To investigate the possible effects of wet-cupping therapy (hijama) on autoimmune activity and thyroid hormonal profiles of Hashimoto's disease (HD) patients. METHODS: A prospective pilot controlled trial was carried out among adult females following HD at the Endocrinology Clinic of King Abdulaziz University Hospital, Jeddah, Saudi Arabia, from February 2014 until March 2017. A total of 13 patients (intervention group) underwent 3 hijama sessions at 3-week interval with a 6-month follow-up. Blood tests were carried out for both pre- and post-hijama, including: thyroid peroxidase antibody (TPO), thyroglobulin antibody (TG), thyroid stimulating hormone (TSH), thyroxine-4 (T4), and prolactin. Control group included 13 randomly selected HD patients following usual care with 2 consecutive measurements of TPO and TG at 2-3 months interval. RESULTS: Changes in anti-TPO and anti-TG showed a decrease in hijama group versus an increase in control group, and intervention group comparison was statistically significant. On a fixed thyroxine supplement for each patient, significant decrease in levels of anti-TPO, anti-TG, TSH, prolactin, and erythrocyte sedi-mentation rate (ESR) occurred. CONCLUSION: These findings are presumptive to the efficacy of hijama on the pathogenesis of HD in modulating the immune inflammatory process demonstrated by the reduction in ESR, TPO, and TSH levels on a fixed thyroxin supplementation dose, along with patient-reported clinical improvement and positive changes in ultrasound including regaining of gland physiological size, echogenicity, and vascularity.