Open Access Case Report

Low Residue Diet & Codeine May Substitute Faecal Diversion in Conservative Management of Patient with Rectourethral Fistula - A Case Report

Sharfuddeen A. Mashi

International Journal of Medical and Pharmaceutical Case Reports, Page 1-4
DOI: 10.9734/IJMPCR/2017/32963

Aims: We present a patient that developed rectourethral fistula following prostatectomy for a misdiagnosed prostate cancer. He was managed conservatively without faecal diversion.

Case Presentation: A 65 year old man presented to our hospital with a year history of lower urinary tract symptoms. He was evaluated and diagnosed to have BPH. Serum PSA was wrongly reported to be 0.9 ng/ml. He had open prostatectomy. On the 6th post-operative day, he developed faecaluria. Rectal examination revealed a fistula, admitting tip of the index finger. Histology revealed adenocarcinoma. He had bilateral total orchidectomy a week later, but refused surgical repair of the fistula and urinary or faecal diversion. He was maintained on urethral catheterization, low-residue diet and codeine.

Discussion: The codeine and low residue diet made him constipated. Faecaluria stopped, fistula closed within 3 months. He however developed bladder neck contracture after a year.

Conclusions: In some selected cases, low residue diet and the use of codeine can replace faecal diversion in managing rectourethral fistula; this can save the patient from the agony of having colostomy, only for the fistula to recur later.

Open Access Case Study

Subcutaneous Emphysema of the Axilla, Chest Wall, Mediastinum, Retroperitoneum and Spinal Canal in a Patient with Cannabis Hyperemesis Syndrome

Samuel M. Miller, Michael Yacovelli, Earl Stewart, Alfredo C. Cordova

International Journal of Medical and Pharmaceutical Case Reports, Page 1-6
DOI: 10.9734/IJMPCR/2017/32481

Aim: We describe the clinical history of a young adult male who presented with repeated episodes of emesis and subcutaneous emphysema in the context of frequent cannabis use.

Case Presentation: A 20-year-old male presented with a ten-day history of vomiting of up to forty times per day. He had experienced frequent episodes in the past but had never sought medical care. His vomiting was accompanied by subjective fever, chills, and severe nausea limiting his ability to take in food and liquids. Several days prior to presentation, he noticed “rice crispy” crackling under the skin of his neck and chest. His social history was notable for daily marijuana use.

Laboratory tests were remarkable for low levels of sodium (129 meq/L; normal 135-145), potassium (2.5 meq/L; normal 3.5-5.0), and chloride (77 meq/L; normal 96-106) as well as elevated bicarbonate (CO2) (40 meq/L; normal 20-24). Computed tomography (CT) with intravenous (IV) contrast of the neck, chest, abdomen and pelvis revealed extensive subcutaneous emphysema throughout the supraclavicular, axillary, and bilateral anterior/posterior chest walls which track down into the mediastinum, retroperitoneum, abdomen, lower back, and upper thoracic spinal canal (Figs. 1-4). No significant pneumothorax was present. A barium swallow study yielded no evidence of an esophageal perforation.

Conclusion: We present a case of extensive subcutaneous emphysema secondary to rupture of a peripheral airway from forceful vomiting secondary to cannabis hyperemesis syndrome.

Open Access Case Study

Large Mesenteric Cyst (Cystic Lymphangioma) in Young Male Patient - Case Report

Jurij Janež

International Journal of Medical and Pharmaceutical Case Reports, Page 1-4
DOI: 10.9734/IJMPCR/2017/32956

Cavernous lymphangioma (cystic hygroma) is a rare form of mesenteric cystic tumor, which can be located anywhere along the intestinal mesenterium or elsewhere in the body.  Mesenteric cystic tumors are rare malformations. They are more common in pediatric population with estimated incidence to be 1 in 20.000 patients, rarely they occur in adults with estimated incidence to be 1 in 100.000 patients. Usually they are benign growths with malignant transformation reported in 3% of cases and they usually present in the first decade of life. Mesenteric cysts are often incidental findings on physical examination or imaging in about 40% of cases, but they can cause unspecific abdomainal symptoms. In this article is presented a case of a 26-year-old male patient with a large cystic  mesenteric tumor, a cavernous lymphangioma.

Open Access Case Study

Bisphosphonate-Associated Bilateral Atraumatic Ulna Fractures

W. Banks Hinshaw, Jennifer P. Schneider

International Journal of Medical and Pharmaceutical Case Reports, Page 1-6
DOI: 10.9734/IJMPCR/2017/33170

Aims: From 2003, low-impact fractures have been reported in association with bisphosphonate (BP) therapy. Most have involved the proximal femur, but over 100 cases involving other anatomic locations have been published. The 2010 American Society for Bone and Mineral Research case definition for subtrochanteric or femoral shaft “atypical” fractures (AFF) included non-comminution, transverse orientation, cortical thickening, beaking, and minimal trauma. Because other anatomic locations were excluded, there has been an unstated assumption since then that these atypical fractures are limited to the femur.  We present a case of bilateral fractures of the proximal shaft of ulna after bisphosphonate therapy. The similarity to the AFFs suggests that the anatomic location of atypical fractures is not limited to the femur.

Methodology: Case report.

Results and Discussion: After 15 years of BP use and several months of pain, the patient was diagnosed with a non-displaced transverse fracture of the left proximal ulnar diaphysis. Subsequently she developed a similar insufficiency fracture in her right ulna, and 2 months later the left fracture broke spontaneously. It was non-comminuted, transverse, with cortical thickening, and beaking. It was preceded by prodromal pain. This similarity to the AFFs suggests that the anatomic location of atypical fractures is not limited to the femur.

Conclusions: Non-femoral atypical-type fractures have been associated with BP therapy.  These atypical fractures suggest a systemic rather than local BP effect, and their exclusion has thus understated the incidence of BP-associated atypical fractures.

Open Access Case Study

Thyroid Hyalinizing Trabecular Tumor: A Case Series

Andreas Kiriakopoulos, Efthimios Poulios, Georgios Giannopoulos, Dimitrios Linos

International Journal of Medical and Pharmaceutical Case Reports, Page 1-4
DOI: 10.9734/IJMPCR/2017/33912

Aim: Hyalinizing Trabecular Tumor (HTT) of the thyroid gland is an unusual and rare follicular derived neoplasm, which was first described from Carney and colleagues in 1987. We aim to present two cases of HTT diagnosed as papillary thyroid carcinomas in preoperative FNA cytological findings, although the postoperative histological examinations revealed the presence of  Hyalinizing Trabecular tumors. Moreover, a short review regarding the diagnostic and clinical aspects of this rare thyroid tumor is also presented.

Cases Presentation: A 30 year old and a 33 year old females were referred as having papillary thyroid carcinomas on preoperative FNA. Total thyroidectomy was offered in both. Histologic sections revealed the presence of HTT with the characteristic trabecular arrangement of polygonal/spindle cells and positive staining for MIB-1. Both patients remain disease free at a  follow up of 5 years.

Discussion: Although HTT diagnosis and differentiation from other thyroid tumors remains a topic of controversy, immunochemistry and molecular analysis may provide adequate information for HTT distinction from papillary thyroid carcinoma (PTC), medullary thyroid cancer (MTC) and paragaglioma. Therefore, suspicious cases based on preoperative FNA, require careful evaluation and cooperation of pathologists, endocrinologists and endocrine surgeons for optimal diagnosis and treatment.

Conclusions: HTT is a rare, mostly benign neoplasm with favorable prognosis Preoperative identification of HTT is significant since its extremely low malignant potential and its favorable prognosis may lead to less extended operations and avoidance of postoperative radioiodine administration.