Serranobigum4517

Chemodectomas are rare neuroendocrine tumors that typically arise at the carotid bifurcation and progressively englobe the internal and external carotid artery. Surgical asportation of the capsulated mass is the elective treatment. Pre-procedural embolization of this high vascular tumors is highly recommended because it has shown to improve surgical outcome by reducing both, mean blood loss and total operation time. Many different embolization techniques have been described in literature. In the here presented case we opted for an endovascular approach using resorbable purified porcine skin gelatin cross-linked with glutaraldehyde microspheres (Optisphere - MEDTRONIC) as an embolic agent. These turned out to be very safe and effective in improving surgical outcome by reducing operative blood loss and thus reducing treatment-related morbidity.

Onychomatricoma is a rare subungual tumor composed of stroma and nail matrix-like epithelium. Only seven cases of the pigmented variant have been reported in the literature.

We present a 62-year-old male patient with a 2-years history of a single fingernail thickening, deformation, and hyperpigmentation. He had been treated for onychomycosis, without improvement. Due to the increasing hyperpigmentation, and to rule out tumoral entities, including melanoma, a color Doppler ultrasound examination of the nail was requested, which showed a hypoechoic tumor of the nail matrix and bed, with hyperechogenic linear images inside, suggesting the diagnosis of onychomatricoma. Onychectomy and partial matricectomy were performed. Histological evaluation confirmed the diagnosis of onychomatricoma. Discusion and conclusion Histological evaluation is the gold standard for the diagnosis of onychomatricoma. However, ultrasonography represents an easily accessible, non-invasive diagnostic tool for the initial evaluation of these tumors, especially in unsuspected atypical clinical presentations.

We present a 62-year-old male patient with a 2-years history of a single fingernail thickening, deformation, and hyperpigmentation. He had been treated for onychomycosis, without improvement. Due to the increasing hyperpigmentation, and to rule out tumoral entities, including melanoma, a color Doppler ultrasound examination of the nail was requested, which showed a hypoechoic tumor of the nail matrix and bed, with hyperechogenic linear images inside, suggesting the diagnosis of onychomatricoma. Onychectomy and partial matricectomy were performed. Histological evaluation confirmed the diagnosis of onychomatricoma. Discusion and conclusion Histological evaluation is the gold standard for the diagnosis of onychomatricoma. read more However, ultrasonography represents an easily accessible, non-invasive diagnostic tool for the initial evaluation of these tumors, especially in unsuspected atypical clinical presentations.

We describe the first case to our knowledge of Hypervascularised placental polyp (HPP) presenting with acute pelvic pain and hemoperitoneum.

A 33 years-old woman with a history of medical abortion three months earlier came to our attention complaining acute pelvic pain and vaginal bleeding. Transvaginal (TV) and transabdominal (TA) ultrasound (US) demonstrated a highly vascular intrauterine lesion and intra-abdominal free fluid consistent with a diagnosis of haemoperitoneum. Emergency laparoscopy yielded no intra-abdominal bleeding and was followed by bilateral selective embolization of the uterine arteries due to persistent vaginal bleeding. Hysteroscopy and pathology findings were consistent with a final diagnosis of HPP.

HPP may occur months or years after pregnancy or abortion and the clinical picture of abnormal vaginal bleeding associated with acute abdominal pain and haemoperitoneum should warrant to consider HPP among the differential diagnosis. Clinical and imaging findings need to be considered when planning the conservative management of HPP. Our experience suggests that uterine artery embolization is a safe and effective for the conservative treatment of highly vascularized HPP.

HPP may occur months or years after pregnancy or abortion and the clinical picture of abnormal vaginal bleeding associated with acute abdominal pain and haemoperitoneum should warrant to consider HPP among the differential diagnosis. Clinical and imaging findings need to be considered when planning the conservative management of HPP. Our experience suggests that uterine artery embolization is a safe and effective for the conservative treatment of highly vascularized HPP.

We present a case of a woman affected by nonconvulsive status epilepticus (NCSE) caused by cerebral hyperperfusion syndrome (CHS) after carotid endarterectomy (CEA) who was successfully treated with Brivaracetam (BRV) administered via nasogastric tube (NGT).

An 82-years old woman was referred for increasing blood pressure, severe headache and two focal motor seizures on postoperative day four after right CEA. CT scan showed edema of the right hemisphere with a midline shift of 5 mm. The patient underwent daily Electroencephalography (EEG) monitoring which showed continuous epileptiform discharges over the right hemisphere, compatible with a diagnosis of status epilepticus. She was treated with standard antiepileptic drugs (Phenytoin, Lacosamide and Levetiracetam iv) without clinical response. A therapeutic trial with BRV 200mg administered via nasogastric tube (NGT) was tried which resulted in substantial clinical benefit.

The administration of new antiepileptic drugs (AEDs) such as BRV may result in significant clinical improvement in refractory cases of status epilepticus. The enteral administration of AEDs via NGT should always be considered for refractory cases of status epilepticus when standard iv treatment has failed or is not possible.

The administration of new antiepileptic drugs (AEDs) such as BRV may result in significant clinical improvement in refractory cases of status epilepticus. The enteral administration of AEDs via NGT should always be considered for refractory cases of status epilepticus when standard iv treatment has failed or is not possible.We present the clinical case of a patient who developed acute hypercalcemia diagnosed after presenting acute pancreatitis.Male patient, age 67, arrived at the Emergency Department of the University Hospital of Parma for upper abdominal pain, radiated to the back, and associated with nausea. Laboratory tests showed elevation of lipase, serum calcium levels, PTH levels and serum creatinine. Due to the persistence on hypercalcemia an ultrasound scan of the cervical region was performed and showed a hyperechoic nodule of about 25x26x30 mm at the level of the lower pole of the left thyroid lobe, compatible with hyperplastic parathyroid. In the light of clinical-radiological examinations, acute edematous pancreatitis due to hypercalcemia was diagnosed. Hypercalcemia was attributable to primary hyperparathyroidism, so surgical indication to parathyroidectomy was gave.After medical treatment there was a progressive improvement of the clinical conditions and a few days later the patient underwent surgical operation of lower left parathyroidectomy with progressive normalization of the serum calcium levels. If hypercalcemia persists after the beginning of a specific therapy there is an indication to perform an emergency parathyroidectomy; in our case the surgical procedure was performed some days after the diagnosis because the calcium serum levels had returned to normal values with significant improvement of the clinical conditions, despite persistence of high PTH values.We report a peculiar case of jejunal diverticulitis in 54-year-old female. Since hospital admission, a colonic diverticulitis was suspected. CT scan of the abdomen showed multiple fluid collections with free intraperitoneal extraluminal air, suggesting bowel perforation. A complicated acute diverticulitis of the colon was suspected but intraoperatively, a perforated acute diverticulitis of jejunum was detected. The aim of this work is to evidence the key role of CT scan of the abdomen in differential diagnosis of unfrequently pathological entities, such as jejunal diverticulitis, to prevent diagnostic mistakes.Cribiform-morular thyroid carcinoma is a rare variant of papillary thyroid carcinoma. It is usually related to Familial Adenomatous Polyposis (FAP) but rarely it may be sporadic. This variant of PTC occurs in young females and it is rare in the elderly. We report a case of a 20 years old female presenting thyroid carcinoma and personal history of FAP.

The authors discuss challenges in extensor function restoration at the finger level following distal posterior interosseous or tendon complex injuries, according to the typologies of lesions or the specific patient requirements.

The authors report on two cases describing challenging resolutions. One patient with EDC lag from zone 6B to 8 requiring FCU prolonged with cadaveric grafts. One young patient with distal posterior interosseous lesion requiring selective tendon transfers to EPL and EIP to restore selective and autonomous index extension.

In both cases the main goals were obtained, achieving high index of patient satisfaction and excellent outcomes with the restoration of the extension of the fingers. Conclusions In distal posterior interosseous nerve lesion, high demanding patients may require selective function to restore fine motor skills, such as autonomous index extension. In extensor tendons loss of substance from zone 6 to 8, involving musculotendinous junction proximally and short remnants distally, by-pass tendon transfer prolonged with cadaveric grafts is required. The authors highlight the techniques available as escape plan according to the necessary solutions.

In both cases the main goals were obtained, achieving high index of patient satisfaction and excellent outcomes with the restoration of the extension of the fingers. Conclusions In distal posterior interosseous nerve lesion, high demanding patients may require selective function to restore fine motor skills, such as autonomous index extension. In extensor tendons loss of substance from zone 6 to 8, involving musculotendinous junction proximally and short remnants distally, by-pass tendon transfer prolonged with cadaveric grafts is required. The authors highlight the techniques available as escape plan according to the necessary solutions.Hemoperitoneum often occurs due to abdominal trauma, abdominal tumors, gastro-intestinal perforation and more rarely it's spontaneous due to coagulopathies. Superior epigastric artery (SEA) iatrogenic damage is rarer than the Inferior epigastric artery injury, it may occur during laparotomy and, in most cases, it causes a rectus muscle hematoma. We present the case of a caucasian 44 years-old-woman with hemoperitoneum after cytoreductive surgery for ovarian cancer. Active bleeding from the distal branch of the SEA was diagnosed at computed tomography and coil embolization followed by surgical laparotomic drainage of the hemoperitoneum was performed. After initial resolution, active bleeding from the same vessel was observed. Further embolization of the same vessel was necessary to stop bleeding. Ultrasound follow-up showed a complete resolution of the hemoperitoneum.