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After a cholecystectomy, dropped stones can serve as a nidus for abscess formation. Intrabdominal abscesses tend to cause irritation and inflammation of the peritoneum and are thus rarely asymptomatic. This report discusses a 38-year-old female complaining of a recurrent right upper quadrant pain that led to multiple hospital admissions. Her surgical history was significant for cholecystectomy six years back complicated by a retroperitoneal abscess which was drained twice. A computed tomography (CT) scan was done, and she was diagnosed with a subdiaphragmatic collection as a result of a dropped stone.Objectives Chemosaturation with percutaneous hepatic perfusion (PHP) is a relatively new minimally-invasive liver-directed therapy, which aims to deliver high-dose chemotherapy into the liver with low systemic side effects. Initial studies showed promising results, especially in the treatment of metastatic uveal melanoma. But unfamiliarity of the interventional radiologists prevents its widespread implantation in clinical routine. This study aimed to outline how to initiate a PHP program and report initial results. Methods We retrospectively reviewed all patients who underwent chemosaturation with PHP in our institution between March 2016 and February 2017 and their follow-up results till October 2018. Patient demographics, procedural characteristics, clinical and imaging results, and complications were evaluated. Additionally, modifications regarding infrastructure and procedure techniques were described. Results A total of three patients (two females and one male) with a mean age of 59 underwent six PHP proies.Coronavirus disease 2019 (COVID-19) is an infectious respiratory disease caused by the novel coronavirus severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Initially, it was reported in December 2019 and became a global pandemic in March 2020, with many presentations and after-effects. We report the case of a 68-year-old female patient who presented to the emergency room with the chief complaint of a skin rash and itching all over her body, developing within a few minutes of insulin injection. The patient had tested positive for COVID-19 almost eight days ago and was self-quarantined. She was a known diabetic for the past 28 years. Her blood glucose levels were maintained within the normal range by a combination regimen of oral anti-diabetic drugs and subcutaneous humulin 70/30 (70% neutral protamine Hagedorn (NPH) insulin and 30% regular human insulin) injections. After careful examination and thorough history taking, a newly acquired insulin allergy was diagnosed in the patient, attributed to her disrupted immune system due to the recent COVID-19 infection.Candidal infection of the gastrointestinal tract (GIT) is rare but has recently increased due to the increased number of immunocompromised patients, injudicious use of antibacterial agents, and prolonged use of antacid drugs in immunocompetent patients. The most frequent organ involved in GIT candidiasis is the esophagus, followed by the stomach, small intestine, and large intestine. The clinical spectrum of gastric candidiasis ranges from asymptomatic to gastric perforation and even shock. This case report presents a 58-year-old immunocompetent male patient diagnosed with Candida tropicalis-induced gastric perforation peritonitis.Serum sickness or serum sickness-like reactions (SSLRs) constitute a rare complication that manifests in individuals after receiving vaccinations. In this case report, we present a patient with typical symptoms of SSLRs after pneumococcal vaccination. The time course of this disease and our diagnostic process are documented in detail. The literature related to serum sickness and SSLRs is also reviewed.Background Chiari type I malformation (CM1) is a herniation of the caudal cerebellum and/or medulla oblongata into the upper spinal canal, occurring in pediatric and adult populations. We aimed to analyze the surgical outcomes of adult patients with CM1 consecutively treated with a posterior fossa decompression and duraplasty (PFDD) in a tertiary institution. Patients and methods We retrospectively reviewed the medical charts of 45 adult patients with CM1 who underwent PFDD at the Neurosurgery Department of our institution between January 2012 and December 2017. Radiological evaluation was based on pre- and postoperative syrinx/cord ratio, syrinx length, and regression of the ectopic cerebellar tonsils on coronal and sagittal magnetic resonance imaging (MRI) images, and clinical assessment of the patients was performed with the Chicago Chiari Outcome Scale (CCOS). Results Of the 45 patients included in the study, 25 (four men, 21 women) were diagnosed with symptomatic CM1 with an age average of 36.6±11.4 (18-66) years. Headache was the most common symptom (72.0%), while pinprick losses were prevalent in 13 (52.0%) patients. The mean postoperative CCOS score was 14.7±2.0 (8-16). Symptoms improved in 20 patients (80.0%) at the last follow-up. The mean regression in ectopic tonsils on midsagittal and coronal images were 9.1±1.8 (range 0-16.5) mm and 8.3±1.2 (0-12.0) mm, respectively (p less then 0.05). The syrinxes had regressed completely or significantly in 7 (87.5%) of eight patients with syrinx. Conclusion Our findings showed that PFDD is sufficient to relieve most of the major symptoms and resolve the syrinx cavity without additional surgical interventions. The CCOS keeps its measurability of assessment of the clinical outcomes. A reliable radiological evaluation should be performed on midsagittal and coronal MRI images.Prolidase deficiency (PD) is a rare autosomal recessive disorder that has symptoms such as chronic skin ulcers, dysmorphic facies, cognitive retardation, hematological anomalies, splenomegaly, and chronic infections. Bone and joint abnormalities were referred occasionally and included the signs and symptoms of prolidase deficiency, but were not deeply investigated in PD patients. We report a case of two PD Moroccan sisters with osteoarticular deformities, some of them were never described before toes deformities and equinovalgus with fusion and dislocation of a tarsal bone in radiography x-rays.Introduction The Throckmorton sign, or John Thomas sign, is a well-established orthopedic eponym, anecdotally used in orthopedic surgery to correlate the direction of male genitalia, observed on a pelvic radiograph, with the laterality of an associated orthopedic pathology. In earlier studies, the direction of pelvic shadowing on X-ray has been neither a credible nor a reliable predictor of fracture laterality. Given this small body of evidence, we sought to further investigate the relationship between peri-trochanteric hip fracture laterality and male genitalia lie. Method A single-center retrospective chart review was conducted of 397 consecutive male patients who received pelvic radiographs performed upon entry to an urban level 1 trauma center. Exclusion criteria included age less than 18 years or a prior history of pelvic or urological surgery. Of this cohort, 360 patients met the inclusion criteria and underwent investigation. Results The study population had an average age of 42 years (range 18-91 years). Statistical analysis yielded a 4.24 relative risk with pelvic shadowing laterality and respective peri-trochanteric hip fracture sidedness. Additionally, there was a 4.63 and 9.88 relative risk of tibial shaft fractures and distal radius fractures having a concomitant positive Throckmorton Sign, respectively. Conclusion Pelvic shadowing can be used as an additional diagnostic tool in predicting peri-trochanteric hip fracture sidedness in a trauma bay setting.Purpose The accuracy of the diagnosis of hypertension increases by obtaining repeated blood pressure values. This can be achieved by obtaining multiple office blood pressure measurements (OBPM) or by home blood pressure measurements (HBPM) or using ambulatory blood pressure measurement (ABPM). A 24-hour ABPM is recommended as the preferred modality to diagnose hypertension by the latest guidelines. In this study, we evaluated the diagnostic accuracy achieved by four short-duration-ABPM (sABPM) protocols, i.e., two-hour, four-hour, six-hour, eight-hour compared to standard 24-hour ABPM. Materials and methods We performed a prospective diagnostic accuracy study in individuals attending the medicine outpatient department. Participants were >18 years, had systolic BP between 130 and 150 mmHg, and were not previously diagnosed as hypertensive. Initially, two OBPM values were taken, and then the ABPM apparatus was applied for 24 hours, which recorded BP at every 30 minutes while awake and at every 60 minutes while asleep. We used four sABPM values (2-hour, 4-hour, 6-hour, and 8-hour sABPM) and OBPM values as index tests, with awake ABPM cut-off of greater than or equal to 135/85 as the definition of hypertension. Analyses were conducted using the R Statistical language (version 4.0.3; R Core Team, 2020) on macOS Catalina 10.15.6. Result Based on the 24-hour ABPM based reference standard definition, 76 (48.7%) individuals out of 156 were classified as hypertensive. The positive predictive value (PPV) of sABPM at two-hour, four-hour, six-hour, and eight-hour above the cut-off of 135/85 was 80.0%, 83.8%, 93.4%, and 94.8%, respectively. PPV increased from 83.8% to 93.4%, and the positive likelihood ratio (LR+) increased from 5.4 to 15.0 with an increase in the sABPM duration from four to six hours. selleck chemicals Conclusion We conclude that short-duration ABPM for six hours has a good diagnostic accuracy amongst hospital attendees. It can act as an intermediary approach between multiple OBPM and standard 24-hour ABPM in this population.Penetrating injuries due to fragments energized by an explosive event are life/limb-threatening and are associated with poor clinical and functional outcomes. Penetrating injuries are commonly inflicted in attacks with explosive devices. The extremities, especially the leg, are the most commonly affected body areas, presenting a high risk of infection, slow recovery, and the threat of amputation. This report presents a case of a young factory worker who sustained an injury to the leg with a foreign body lodged near the neuro-vascular bundle. A 44-year-old gentleman sustained a projectile injury while working in a stainless steel factory from the rula (steel rolling) machine with a foreign body getting lodged in the leg in March 2019. He was initially managed with wound care and didn't report any functional impairment. Gradually patient developed numbness and claudication symptoms of the foot over the next couple of years. He was subsequently operated on in 2021 for removal of the stainless steel foreign body encased in dystrophic calcification close to the tibial nerve and posterior tibial vessels. Interestingly the entry point of the foreign body was on the anterolateral aspect of the leg. The foreign body was removed using the postero-lateral approach to the tibia with careful dissection close to the neurovascular bundle. At a follow-up of 3 months, the patient is symptom-free with significant improvement of limb function. The authors propose that the foreign body crossed the interosseous membrane to get lodged close to the posterior tibial neurovascular bundle. In such a scenario, the patient was extremely lucky to have survived an amputation or significant functional injury of the limb. Proper protective equipment is needed not only for the torso but also for extremities to protect industrial workers from such limb-threatening injuries. Moreover, primary care physicians should be sensitised for the proper management of such injuries.