Thoracic outlet surgery is performed to relieve both neurological and vascular problems associate with the first rib. An extremely rare complication of this surgical procedure is the iatrogenic removal of the second versus the first rib. This paper will describe an illustrative case and give recommendations to include pre-operative imaging modalities imaging to identify aberrancies that may contribute to this complication. Also pertinent experiential operative recommendations are discussed that may reduce the inadvertent resection of the second versus the first rib.
Marieke J. Kuiper, Salah A.M. Said*, Ali Agool
We report a case diagnosed with Postural Tachycardia Syndrome (PoTS), 8 years after onset of symptoms. The patient, a 47-year old female, presented with recurrent episodes of light-headedness, presyncope, palpitations and tremulousness. There were no abnormalities on clinical examination. On two earlier occasions, the patient was evaluated by cardiologist, neurologist, pulmonologist and the ear nose and throat physician for her symptoms. She underwent several diagnostic tests, which showed no abnormalities. No diagnosis was established and the symptoms spontaneously disappeared twice. On the current occasion of recurrence of symptoms, the diagnosis of PoTS was highly suspected and proved by a positive tilt table test. She was successfully managed accordingly.
Salah A.M. Said*, Marc Hartmann, Ali Agool
Aim: The aim of this review is to present a case report of Takotsubo cardiomyopathy and to review the current literature. The second aim is to describe the role of ivabradine in the management of Takotsubo cardiomyopathy when intolerance for beta blockers occurs.
Materials: Case report and literature review of Takotsubo cardiomyopathy.
Results: A 52-year-old Caucasian female presented with Takotsubo cardiomyopathy triggered by severe emotional stress. Dmission electrocardiogram mimicked acute ST-segment elevation myocardial infarction , coronary angiography excluded significant coronary stenosis and left ventriculogram showed a typical Takotsubo cardiomyopathy apical ballooning appearance. Due to beta blocker intolerance, “off-label” treatment with ivabradine was initiated because of symptomatic sinus tachycardia. Echocardiography revealed normalization of the ejection fraction at outpatient follow-up. In the recent literature, ivabradine has been used in the management of different entities such as stable angina pectoris, congestive heart failure, inappropriate sinus tachycardia syndrome, postural tachycardia syndrome and Takotsubo cardiomyopathy.
Conclusion: Takotsubo cardiomyopathy may be induced by witnessing a robbery. The patient was intolerant for beta blockers and had a favorable response to treatment with ivabradine. Ivabradine may be an alternative choice in cases where there is an intolerance of beta blockers. We present an exceedingly rare case of Takotsubo cardiomyopathy induced by uncommon severe emotional stress, catching her colleague stealing money from the cash register, which was associated with sinus tachycardia in a female patient with intolerance for beta blockers. The patient responded well to treatment with oral ivabradine. The literature is briefly reviewed.
Hazem B. Aljasem, Zaynab. Alourf*
Introduction: Endoscopic ultrasound (EUS) is a very important procedure to preoperatively localize insulinomas and plan the surgery. This end with less time and less invasive surgical approach. However, under optimal conditions, about 10-20% of insulinomas are missed even by experts. The purpose of this retrospective study was to recognize factors that could affect EUS results.
Methods: This study was carried out at Al-Assad University Hospital (AUH), Damascus, Syria. Eighteen patients fulfilled the inclusion criteria ( positive 72 hours fasting test and successful surgery with histopathology confirmation). All EUSs were performed by one experienced examiner.
Results: All 18 cases were benign insulinomas (16 were tumors and two were hyperplasias). Preoperative EUS did not detect six tumors (negative EUS). They were all isoechoic to surrounding normal pancreatic tissue. The ten detected cases (positive EUS = 62.5%) were hypoechoic, isoechoic or hyperechoic lesions. Positive EUS patients were younger than negative EUS patients (P =0.05). The mean tumor diameter in positive EUS was significantly larger than negative EUS (P =0.04).
Conclusion: Some Isoechoic Insulinomas were not detected by EUS imaging. Smaller tumor diameter and older age of the patient might be behind negative imaging.
Javed Altaf*, Muhammad Adeel Mahesar, Taimur Jatoi
Introduction: Bladder carcinoma is one of the common urological malignancies occurring worldwide in both sexes. The clinical presentation of bladder cancer is classically with painless haematuria and dysuria. The vast majority of bladder tumours are epithelial in origin; of these ≈ 90% are TCCs, the remainder being squamous cell carcinoma, adenocarcinoma and mixed tumours. The purpose of this study was to determine the frequency of clinical and pathological features of Bladder Tumors, so that appropriate screening and preventive strategies could be developed to minimize the morbidity.
Objective: To determine the frequency of clinicopathological features of bladder tumors in patients presenting at University Hospital.
Study Design: Descriptive Cross-sectional study.
Setting: Department of Urology, Liaquat University of Medical and Health Sciences Jamshoro.
Duration with dates: Six months from 7TH JANUARY 2013 TO 6TH JUNE 2013
Subjects and Methods: A total of 95 cases meeting inclusion criteria were enrolled in the study. The bladder specimens of all the patients were sent for histopathological examination to find out the nature and grade of the disease. Clinical factors like dysuria, urgency, hematuria, adenocarcinoma, TCC, SCC were noted in the proforma.
Results: Mean (±SD) age was 60.04 ±10.3 years with M: F = 5.7: 1. Mean ±SD duration of disease was 2.1 ±1.3 years. Hematuria was found in 60 (72.6%) cases followed by dysuria in 36 (37.9%) cases and urine urgency in 21 (22.1%) cases. Transitional-cell carcinoma (TCC) seen in 86 (90.5%) of the cases. Squamous-cell and adenocarcinoma were found in 6 (6.3%) and 3 (3.2%) cases respectively.
Conclusion: In this study painless macroscopic hematuria and histological sub-type transitional-cell carcinoma was dominant.
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