International Journal of Medical and Pharmaceutical Case Reports

Aim: To highlight the potential for misdiagnosis of ovarian fibromas and need for careful evaluation especially when fertility altering decisions need to be taken in the young adolescent.

Presentation of Case: The authors here review literature and present the case of a 15 year old pre-menarchal patient with bilateral, solid hard ovarian tumors with marked ascites, who had bilateral salpingo-oophorectomy, in whom the tumors turned out to be bilateral calcific ovarian fibromas.

Discussion: Ovarian neoplasia are often misdiagnosed because of their non-specific symptoms and similarities to other pathologies on radiological imaging. The management of adolescents with ovarian tumors poses peculiar challenges as there is need for a balance between the risk of malignancy and the need to preserve fertility. About 1/3 of pelvic masses in pre-pubertal girls are malignant. This fact in addition to the non-specific features of malignancy in this patient such as weight loss, ascites, necessitated further evaluation which included laparotomy.

Conclusion: Ovarian fibromas occur in adolescents and can pose a diagnostic dilemma; a high index of suspicion is required to plan fertility-sparing and cancer-limiting management.

The management of high-grade renal trauma remains debatable in various education and research centers, especially the cases of patients with stable hemodynamics. This paper reports the case of a 24-year-old man with high-grade renal trauma due to blunt injury in the left flank. The patient had stable hemodynamics and was managed conservatively, followed by three months of post-trauma follow up. In this case, the conservative management has resulted in a satisfactory outcome, confirming that conservative management is an appropriate alternative treatment for patients with similar cases.

Occupying only 0.01% of all adult cancer patients, the rare entity urachal adenocarcinoma constitutes 22-35% of adenocarcinomas originating from urinary bladder. Though with the gradual descend of the bladder in the course of development urachus should turn into median umbilical ligament, exceptional persistence of it can give rise to urachal cyst or urachal adenocarcinoma in adulthood. With only 43% of survival rate for 5 years and mean survival between 12 and 24 months urachal carcinoma is a devastating disease. Diagnosis of it is based on the MD Anderson Cancer Centre (MDACC) criteria. Computed Tomography (CT) Scan and/or Magnetic Resonance Imaging (MRI) Scan of abdomen and pelvis are the major imaging modalities to proceed towards diagnosis and staging. Not only histopathological examination but also immune-histochemical expression of both CK7 and CK20 suffice to clinch the diagnosis. Though surgical intervention forms the mainstay of treatment, several regimens of chemotherapy have also been tried to fight against unresectable, residual, extensive urachal carcinomas.

This case took place in a 52 years old male patient who was presented with a gradually enhancing infra-umbilical swelling with slow growing urinary symptoms. By dint of Ultrasonography (USG) and Contrast Enhanced CT (CECT) scan of whole abdomen the tumour was detected involving the bladder wall and the anterior abdominal wall. Cystoscopy was followed by upfront cytoreductive surgery. Histopathological examination revealed the diagnosis of an adenocarcinoma which was further confirmed to be an urachal remnant carcinoma with the help of immunohistochemistry. Post-operative CT scan showed residual disease involving bladder wall and was treated with an adjuvant platin based chemotherapy regimen.

Background: Hydroxyurea (HU) has redefined the quality of life of children with sickle cell anaemia and their care givers. Despite the acclaimed benefits of HU, the drug could be associated with variable side effects affecting different systems in the human body, including the skin and integuments. The aim of this report is to raise the awareness about the less common side effects of HU.

Case Report: A 5-year 8 months old homozygous sickle cell anaemia child presented with pruritic hyperpigmented lesions on the trunk, arms and the legs, four weeks after commencement of HU. HU was initially discontinued for two weeks and thereafter recommenced with a different brand but there was worsening skin lesions despite at a daily low dose of 10 mg/kg. The rashes eventually resolved with low dose once in 3 days HU therapy.  She had recurrent episodes of acute painful crisis; average of three [3] episodes per year warranted hospital admission prior to commencement, but with HU therapy, there has been significant improvement in the crisis.

Discussion: Cutaneous lesions are uncommon side effect of hydroxyurea. This side effect is dependent on genetic predisposition and photosensitivity. However, with the established benefit of HU in the management sickle cell anaemia, it is important for the sickle cell experts to continue to monitor closely the children for both the common and rare side effects and to individualize therapy to ensure maximal benefit with minimal or no side effects.

Background: Myofascial pain syndrome is a common pain condition characterized by a key symptoms and signs, determined by multiple etiologies, comorbid with a variety of systemic diseases and regional pain syndromes and managed by diverse therapies with variable outcomes.

Objective: This study aimed to concisely report 11 cases of myofascial pain syndrome managed by myofascial trigger point therapy.

Methods: The relevant information about 11 cases was collected prospectively using a semistructured proforma. All patients were diagnosed mainly by detailed history and gold standard palpation method that helps identify taut muscles, tender myofascial trigger points, local twitch response and autonomic manifestations.

Results: Most of the patients with variable age and profession presented in emergency room with acute pain, limited motion, weakness, referred pain of specific pattern and associated autonomic signs and symptoms. Myofascial trigger point therapy alone with a timeline of about 30-60 minutes of 1-3sessions brought about good results in all 11 patients (100%) who remained stable at two to three months followup.

Conclusion: Myofascial pain syndrome linked with latent or active myofascial trigger points developed due to repeated strains and injuries needs to be diagnosed by history and palpation method, systemic evaluation and laboratory investigations. Though several interventions are used in myofascial pain syndrome, myofascial trigger point massage therapy alone is found to be reasonably effective with excellent results. This clinical case series is calling for double-blind randomized controlled trials among patients with myofascial pain syndrome not only in Saudi Arabia but also in other Middle East countries in future.