Bulbar Onset Amyotrophic Lateral Sclerosis: A Case Report.

Amyotrophic lateral sclerosis is a rare, progressive, incurable neurodegenerative disorder that affects motor neurons leading to progressive muscle weakness, disability, and eventually death. A 45-year-old male, initially presented with hoarseness, flickering of tongue, and intermittent aspirations. In course of three years, patient developed motor aphasia, frequent aspirations and an inability to hold his neck. Patient was diagnosed with a bulbar onset type of amyotrophic lateral sclerosis on the basis of neurodegenerative features with normal radiographic imaging. For the prevention of recurrent aspiration pneumonia, he was managed with a percutaneous endoscopic gastrostomy tube. As he started developing respiratory failure tracheostomy was performed and kept on a continuous bi-level positive airway pressure ventilator, in the meantime, two courses of injection Edaravone were given. Early evaluation, diagnosis and management of the condition is a cornerstone for better prognosis of disease and survival. Keywords: amyotrophic lateral sclerosis; aspiration pneumonia; case reports; edaravone.

A case of giant primary splenic hydatid cyst: Case report.

Introduction: Primary splenic hydatidosis is a rare zoonotic disease, common in grazing regions of the world. Primary splenic hydatid cyst is rare and accounts for <2% of patients. Splenectomy is advocated in case of giant hydatid cyst locating in central and hilum area; however, spleen salvaging operations are done in superficial cyst, cysts localized to one pole of the spleen or cysts that are unresectable due to extensive adhesions and in children. Presentation of case: We present a case of 29-year male patient from rural areas presented with the complain of left hypochondriac pain and tenderness along with the history of farming and cattle raising. There was no other significant history. Clinical findings and investigations: Physical examination showed mildly distended abdomen, mild tenderness over left hypochondrium. Routine laboratory investigations were sent. Ultrasound and CT scan of the abdomen showed giant splenic cyst measuring approx. 15 × 14 × 11 cm along with daughter cysts. Postoperatively, cyst was sent for histopathological examination. Intervention and outcome: Preoperatively, vaccinations against Pneumococcus, Hemophilus influenzae and Meningococcus along with Albendazole (15 mg/kg/day) was given 2 weeks before the planned operation. Total splenectomy was performed and diagnosis was confirmed by histopathological examination. Albendazole was continued for 2 more weeks. Patient remains asymptomatic thereafter and regularly followed up in OPD basis. Relevance and impact: Presence of isolated splenic cyst should raise suspicion for primary splenic hydatid cyst in endemic areas. Splenectomy versus spleen salvaging options should be analyzed and performed as per the indications. Splenic hydatid cyst is one of the rare clinical findings and there is very much high chance that it goes undiagnosed during the clinical practice. So, the main motive behind writing this article is to shed knowledge on basic approach to this splenic finding.

Bilateral complete duplication of ureter with ectopic ureter presenting as persistent urinary dribbling with normal voiding pattern in 17-year-old female: Case report.

Introduction: and importance: Bilateral complete ureteral duplication is a rare urinary tract abnormality and presence of unilateral ectopic ureter makes it a rarest entity. Continuous urinary dribbling with normal voiding pattern and recurrent UTI are frequent presenting complains in case of ectopic ureter. Long term childhood problem of urinary incontinence with delayed diagnosis in adult in this case makes it a perfect case to report. Presentation of case: We present a case of 17-year-old girl with continuous urinary dribbling and constant wetting with normal voiding pattern since childhood. She also had recurrent history of urinary tract infections. Clinical findings and investigations: Local external examination of genitourinary system was found to be normal. There were skin lesions on buttocks and thighs suggestive of urine dermatitis. There were no examination findings of other congenital anomalies. Complete blood count, Renal function test, Serology, Urine R/ME, Urine culture and sensitivity, Ultrasound abdomen and pelvis, Computed Tomography scan, intraoperative cystoscopy were done. Intervention and outcome: Right upper pole hemi nephroureterectomy was performed. She was post operatively managed with IV Fluids, antibiotics, analgesics, antipyretics and antiemetics. She is asymptomatic now and regularly followed up on OPD basis. Relevance and impact: Congenital abnormalities of the genitourinary system like ectopic ureter should be clinically suspected in case of persistent urinary problems like urinary dribbling with normal voiding pattern and recurrent urinary tract infections. Upper pole heminephrectomy is an ideal choice of treatment in case of nonfunctional upper moiety. This case emphasizes the early detection of genitourinary abnormalities and provide the perspective on late diagnosis and management in such cases.