Crowleylyons7282

Introduction Phyllodes tumors are rare fibroepithelial breast tumors, accounting for less than 1% of all breast tumors. Most Phyllodes tumors are benign. However, about 10% are malignant. The Mean age of presentation for the Malignant Phyllodes tumors is 40 years. This case report describes an unusual presentation of Phyllodes tumor in a young female with an unusual site and presentation of the tumor. Presentation of case A 23-year-old female presented with multiple left breast rapidly growing masses. Imaging showed two intra-parenchymal left breast masses and one mass lying posterior to the left pectoralis major muscle, anterior to the chest wall. Diagnosed as phyllodes tumor. Nipple areola sparing mastectomy was performed with excision of the tumor and immediate reconstruction using a silicone implant, followed by radiotherapy. Conclusion Phyllodes tumor usually presents in patients between 35-55 years old as a single breast mass. Yet, in rare cases, multifocal disease can happen, and disease can present in younger ages. The sub-pectoral presentation of phyllodes tumor is not mentioned in the literature before this case.Introduction Zenker's diverticulum is an acquired mucosal pulsion of the upper esophagus. The aim of this paper is to report a case of Zenker's diverticulum with a complicated postoperative course including infection by Acinetobacter baumannii causing diagnostic as well as management dilemma. Case report A 43-year-old male complained from dysphagia for three months. Barium swallow revealed Zenker's diverticulum. Under general anesthesia, the small Zenker's diverticulum was ligated and myotomy was done. He developed erythematous swelling at the site of the operation. The patient was taken to the operation theater. The esophagus was tested, no trace of leak was found. The patient developed cardiac arrest. He was admitted to the intensive care unit and remained there for twenty eight days. Bronchial wash culture showed Acinetobacter baumannii. The patient was on antibiotic, supportive treatment and enteral feeding through nasogastric tube. After recovery he was extubated and barium swallow was done which was normal and showed no signs of leak. Three months after the operation, the patient was completely normal. Discussion This case had a positive culture for Acinetobacter baumannii. It is commonly accounted for nosocomial infections. It has been documented as a serious threat worldwide because of the emerging prevalence of multidrug resistant. However, an inadequate understanding of A. baumannii pathophysiology and ecosystem confines the progress of alternative therapeutic policies. In the current case, it was not clear either leak or Acinetobacter baumannii was the cause of deterioration. Conclusion Both esophageal leak and infection with Acinetobacter baumannii are fulminant debilitating conditions that could be managed with conservative strategies.Introduction Splenic rupture is often seen in the context of significant trauma. Atraumatic ruptures are described in the context of malignancy, inflammation or infection directly affecting the spleen. Splenic ruptures occurring in patients taking apixaban, a factor Xa inhibitor, are challenging due to the scarcity of a direct reversal agent. Presentation of case A 66 year old male presented with syncope and back pain and was found to be haemodynamically unstable and tender in the left upper quadrant. There was no preceding trauma. He has a background of extensive major arterial reconstruction and was taking apixaban for atrial fibrillation. A diagnosis of splenic rupture was confirmed on cross sectional imaging. A laparotomy and splenectomy was necessitated as salvage therapy following splenic artery embolisation. He recovered well and was discharged home 6 days after laparotomy. Conclusion Definitive intervention is required for the management of splenic ruptures. A high level of clinical suspicion should be maintained in patients taking direct oral anticoagulants presenting with haemodynamic instability. Open splenectomy remains the most definitive option for treatment of atraumatic rupture in anticoagulated patients.Introduction Spinoglenoid cysts are a rare cause of suprascapular neuropathy of compressive etiology in which the patient may present with shoulder pain and muscle hypotrophy. MRIs are the imaging modality of choice showing location, size, and extent of the lesion for preoperative assessment. Currently, surgical intervention is the preferred approach for the management of a spinoglenoid cyst with arthroscopy being favored over the open technique. Case presentation A 25-year-old male patient presenting with right posterior shoulder pain and decreased range of motion associated with the development of progressive weakness of the supraspinatus and infraspinatus muscles. Right shoulder MRI showed a posterior tear of the glenoid labrum and a spinoglenoid ganglion cyst. Preoperative electroneuromyography was suggestive of a suprascapular nerve impairment. Follow-up Six months postoperatively, the patient has regained full range of motion of his right shoulder with no residue signs of muscle hypotrophy. Conclusion Spinoglenoid cysts can cause compressive neuropathy with associated pain and muscle hypotrophy. MRI and EMG can help in establishing the diagnosis and in the pre-operative assessment. Surgical intervention with arthroscopy is currently the technique preferred by most surgeons.Introduction Impalement injuries are well defined. Transfixion injuries involve impalement and are defined in terms of fixation usually to a large object. Case report We report a spectacular case of sledge hammer impalement in the neck where the patient was transfixed, albeit to a small object, requiring movement of the patient and the transfixing object as a single unit. Discussion The patient was fixed to the head of the sledge hammer because he was unable to move with the heavy pendant. Envonalkib Conclusion We argue that transfixion injuries should be defined in terms of weight of the object in relation to the patient's weight and the ability of the patient to move (with) the impaling object.