2-year History Research Articles

Anti-CD20-Triggered Crohn’s-Like Disease with Severe Perianal Involvement in a Patient with Multiple Sclerosis: Case Report, Review of the Literature, and Potential Therapeutic Approach

This case report describes a 38-year-old female patient with a 3-year history of multiple sclerosis who developed rituximab-induced pancolitis, possibly representing a new onset of inflammatory bowel disease. The patient presented with bloody diarrhea, epigastric pain, fever, and general malaise. Laboratory testing revealed elevated acute inflammation markers, and endoscopy showed deep ulcerations and severe perianal disease. The patient was treated effectively with corticosteroids. Monthly doses of ustekinumab have been administered during follow-up due to perianal disease that has remitted. Rituximab was discontinued and ozanimod was initiated with clinical and analytical stability to date.

P-53 Resistant macroprolactinoma

Abstract Introduction Dopamine agonists (DAs) are considered to be the mainstay treatment for prolactinomas. Primary DA-resistance has been reported in approximately 20–30% of the patients on bromocriptine, and in around 10% of those on cabergoline. The DA-resistance is usually defined as a failure to achieve normal prolactin levels on maximally tolerated doses of DAs for at least 3-6 months and failure to achieve 30-50% reduction in tumor size in case of macroprolactinoma. Most of resistant prolactinomas have shown to be large and/or invasive tumors. We present a clinical case of microprolactinoma, resistant to cabergoline. Clinical Case A 21-year old woman reported of a 2-year history of amenorrhea. Primary examination revealed hyperprolactinemia up to 361 ng/ml (bioactive prolactin 256 ng/ml). MR imaging with contrast enhancement showed the ovoid microadenoma in the right half of the adenohypophysis up to 10 mm without invasion to cavernous sinus (Figure 1). Hormone tests excluded the overproduction of ACTH, GH and TSH by the tumor (Table 1), and revealed no signs of hypopituitarism. The patient was prescribed cabergoline (0.5 mg per week), which was followed by the initial decrease of prolactin level to 116 ng/ml. However, subsequent increase of cabergoline dose up to 4,5 mg per week did not lead to further prolactin decrease and normoprolactinemia and there was no resumption of menstrual function. On the follow-up MR images (6 months after the first one) no dynamics was revealed: the tumor was up to 10 mm in size without invasive spreading to cavernous sinus or chiasm. Taking into account the resistance to cabergoline, young age and pregnancy planning, the patient underwent transnasal debulking of the tumor. A week after the operation, normalization of prolactin level was noted, and there were no any signs of hypopituitarism. Within a month after operation, the patient reported of resumption of regular menstrual cycle. r4 months later the woman got pregnant. The pregnancy proceeded without complications and ended in timely delivery.Figure 1.MR image of pituitary microadenoma (contrast enhanced) Table 1.Primary hormone examination

Arthroscopic resection of large synovial hemangioma in the posterior recess of the left knee via median and double posteromedial portals: A case report

Synovial hemangioma is a rare benign tumor. This case report describes a 27-year-old woman who was admitted to the hospital with a 1-year history of pain in the popliteal fossa of the left knee and mobility limitation. According to the medical history

Genetic analysis of a case with mosaicism complex structural aberration of chromosome 18

To determine the karyotype of a patient with mosaicism complex structural aberration of chromosome 18. A male patient with a 2-year history of infertility presented at the Center of Reproductive Medicine of the Third Hospital of Peking University in October 2019 was selected as the study subject. Clinical data of the patient was collected. Peripheral blood sample was taken for chromosomal karyotyping, copy number variation (CNV) analysis and fluorescence in situ hybridization (FISH) assay. Semen sample was taken for single sperm CNV analysis. The patient was found to have a karyotype of mos 47,XY,del(18)(q21q23),+r(18)(q21q23)[84]/46,XY,del(18)(q21q23)[9]/48,XY,del(18)(q21q23),+r(18)(q21q23)×2[6]/47,XY,del(18)(q21q23),+r(18)(q21q23×2)[1].ish 47,XY,del(18)(q21q23),+r(18)(q21q23)[84]/46,XY,del(18)(q21q23)[9]/48,XY,del(18)(q21q23),+r(18)(q21q23)×2[6]/47,XY,del(18)(q21q23),+r(18)(q21q23×2)[1]del(18)(q21q23)(D18Z1+,18p+,18q+,WCP18+),r(18)(q21q23)(WCP18+),r(18)(q21q23×2)(WCP18+). No pathogenic CNV was identified. Sequencing of 20 single sperms showed that 1 sperm was normal, 1 had yielded no result, 9 had harbored del(18q), 7 had harbored dup(18q)×2, and 2 had harbored dup(18q)×3. The dup/del fragments had both spanned approximately 33 Mb. It is rare for carriers of complex structural and numerical abnormalities of chromosome 18 to have a normal phenotype. Based on the accurate cytogenetic and molecular analyses and the single sperm CNV analysis, the influence of the aberrant karyotype on the gametogenesis may be evaluated.

A combined EMDR/CBT-based approach for the successful management of cyclical vomiting syndrome: a case study

Abstract Cyclical vomiting syndrome (CVS) is an extremely debilitating condition that can have an adverse impact on physical health and can significantly disrupt social and occupational functioning. It is a poorly understood illness in terms of aetiology, and most research has focused on the pharmacological management of the condition. This article describes a case study of a combined cognitive behavioural therapy (CBT) and eye movement desensitisation and reprocessing (EMDR)-based intervention with an adult with past trauma who had a 20-year history of CVS accompanied by high cannabis use. Therapy led to improvements in physical health and social functioning, reduced use of cannabis, and a significant reduction in the frequency and severity of vomiting episodes and associated hospital admission. Implications for future research and management of the illness are discussed. Key learning aims (1) To understand how the presence of co-morbid untreated trauma in individuals with CVS may result in unhelpful coping strategies that can worsen the course of the illness. (2) To explore how the addition of psychological therapy to routine care of gastrointestinal disorders such as CVS can improve treatment outcome. (3) To consider how offering an individualised and flexible approach to appointments may benefit individuals who find it more difficult to engage in psychological therapy.

Successful treatment of nail psoriasis with topical roflumilast: A case report

Nail psoriasis occurs in approximately half of all cases of plaque psoriasis and manifests with onychodystrophy, which includes morphological features of onycholysis, subungual hyperkeratosis, oil drop sign, pitting, splinter hemorrhages, leukonychia, and crumbling of the nails. Nail psoriasis can have a significant adverse impact on quality of life. However, nail psoriasis is often refractory to both local and systemic therapies, making it challenging to treat. Topical and oral phosphodiesterase-4 inhibitors have been successfully used to treat multiple different subtypes of psoriasis. Topical roflumilast, a phosphodiesterase-4 inhibitor cream, has recently received United States Food and Drug Administration and Health Canada approval for the treatment of plaque psoriasis. In this case report, a 25-year-old female with a 20-year history of nail psoriasis achieved complete resolution of her onychodystrophy after 5 months of daily application of topical roflumilast, without experiencing any side effects. This case report suggests that topical roflumilast may be a useful and well-tolerated therapy for psoriatic nails.

Long-term follow up of a patient with Camurati–Engelmann disease: Case report and literature review

Camurati-Engelmann disease is an exceedingly rare genetic disorder characterized by distinct radiological features that differentiate it from other osteo-dysplastic diseases. A 52-year-old woman presented with a 20-year history of right hip pain with recent exacerbation over 18 months. Diagnostic evaluation included bone scintigraphy, radiography, and blood tests. Bone scintigraphy revealed symmetrically increased uptake throughout the diaphysis of long bones and skull, while radiography showed cortical thickening and coarse trabeculation with bilateral enlargement of multiple bones. These findings indicated diffuse diaphyseal sclerosis, consistent with Camurati–Engelmann disease. She was managed with analgesics, anti-inflammatory agents, and intermittent intralesional steroid injections for over 7 years, during which no additional radiographic changes were noted. Therefore, we aim to report this case and conduct a literature review.

An Innovative Combination of Natural Therapies for the Treatment of Female Orgasmic Disorder

ABSTRACT This case report presents an innovative approach to treating female orgasmic disorder (FOD) in a 28-year-old Asian-Australian female. The patient, undergoing significant academic stress and exhibiting no prior medical or psychological conditions, presented with a 2-year history of inability to achieve orgasm despite normal sexual desire and arousal. Following a comprehensive clinical evaluation, including a physical examination and psychiatric assessment, she was diagnosed with FOD, primarily of a situational type. The treatment implemented was a unique blend of natural therapies: aromatherapy, tantric yoga, mindfulness-based therapies, Yoni massage, and cognitive-behavioral therapy. This integrative approach was conducted over 17 weeks, with each treatment of 2 weeks being followed by a 1-week break to prevent tolerance. The patient initially hesitated but consented to this bold treatment regimen. Remarkable progress was observed, with the patient achieving a strong sexual climax by the 7th week and consistent improvement thereafter. As the conclusion of the treatment and a year of follow-up, the patient reported sustained relief from her symptoms. This case illustrates the potential of combining various natural therapies in treating FOD, emphasizing the importance of patient consent and the efficacy of a holistic, intermittent treatment approach.

The Value of 3D SPACE MRI in Differentiating between Sequestrated Lumbar Disc Herniation and Tumors: Two Cases and Literature.

Intervertebral disc herniation, defined as the protrusion or extrusion of the disc mass outside the disc space, is common and easy to diagnose on conventional Magnetic Resonance imaging (MRI) or Computed Tomography (CT) scans. However, the sequestrated disc fragments are challenging to detect, and intervertebral disc mass displacement into the dural sac, which can lead to serious neurological problems such as Cauda equina syndrome (CES). The sequestrated disc fragments do not have specific clinical or radiological characteristics that can differentiate an atypical disc mass from a tumor, making the diagnosis difficult preoperatively. Herein, we describe the use of Sampling Perfection with Application Optimized Contrast using different flip angle Evolution in Magnetic Resonance Imaging (3D SPACE MRI) in the diagnosis of the intervertebral disc fragment that mimicked a tumor. In this study, we report two cases of sequestered lumbar disc herniation. The first case was a 37-year-old patient with a 2-year history of intermittent left lower limb pain that aggravates with exercise and is relieved at rest, while the second case was a 42-year-old patient with a history of 40 days of numbness and pain in the left lower limb. 3D SPACE MRI is a beneficial diagnostic imaging tool for discriminating between disc mass that mimics a tumor and a tumor before surgery. If the disc fragment mimicking a tumor can be identified before the operation, open surgical treatment won't be necessary for all patients.

Long-term survival of a cat with a metastatic gastrointestinal stromal tumor

Case summary An 8-year-old spayed female mixed-breed cat presented with a 2-year history of recurrent vomiting and hyporexia. Physical examination revealed a palpable mass in the mesogastric abdominal region without discomfort upon touch. Abdominal ultrasonography revealed an intramural mass in the small intestine (duodenum) that caused a decrease in the segment lumen. A complete blood count revealed leukocytosis with marked neutrophilia, eosinophilia and mild hypoalbuminemia. Enterectomy was performed with 3 cm margins and end-to-end anastomosis at the duodenal site of the mass. Histology revealed neoplastic elongated spindle cells that were poorly confined, originating within the muscle layers and that had a mitotic index of 2/10 high-power field (hpf) (at 400×), human epidermal growth factor receptor-type 2 (HER-2) supporting the diagnosis of low-grade sarcoma. Immunohistochemical analysis was positive for KIT, confirming a gastrointestinal stromal tumor (GIST) with a Ki67 level of 15%. Furthermore, multikinase profile biomarkers revealed that the neoplastic cells expressed HER-2 (65%), epidermal growth factor receptor-1 (50%), vascular endothelial growth factor receptor 2 (35%), platelet-derived growth factor receptor beta (15%) and c-KIT (15%). Six months after the original surgery, CT revealed presumptive hepatic, splenic and peritoneal metastases. Toceranib phosphate was prescribed at a dose of 2.75 mg/kg and progressive disease was observed at 8 weeks of follow-up. Relevance and novel information To the best of our knowledge, this is the first case report to characterize the proliferation biomarker profile of a feline GIST in veterinary oncology. However, despite KIT expression in this tumor, the target drug did not inhibit tumor proliferation, providing new insights into this rare tumor in the feline species.

Exoscopic extradural anterior clinoidectomy.

Extradural anterior clinoidectomy is a resourceful technique to decompress the optic nerve as well as increase exposure of the parasellar region during extensive approaches. Despite requiring adjunctive epidural bone work, this technique allows safe optic nerve mobilization and early devascularization for anterior clinoidal meningioma resection. This 2D operative video describes right optic nerve decompression by extradural anterior clinoidectomy and subsequent resection of a right Al-Mefty type III clinoid meningioma under exoscope magnification. The patient was a 50-year-old woman with a 1-year history of right visual acuity impairment and papillary atrophy. The exoscope allows a 360° view around the anterior clinoid, improving maneuverability. The video can be found here: https://stream.cadmore.media/r10.3171/2023.10.FOCVID23118.

Plaque-like cutaneous mucinosis associated with pain: A case report

Plaque-like cutaneous mucinosis (PCM) is a rare atypical subtype of Lichen myxedematosus, characterized by hyperpigmented plaques typically found on the midline trunk. We report the case of a 26-year-old woman with a 1-year history of painful, pruritic, hyperpigmented plaques over her spine. Physical examination revealed soft plaques in the midline of the back, and histopathology showed dermal mucin deposition, consistent with PCM. The presented case is notable as the first reported instance of PCM presenting with lesional pain. We propose that mechanical stress, likely due to repeated friction at the site of spinous processes, contributed to the development of pain. The fact that pain lessened after the use of a lumbar support pillow and gaining weight supports our hypothesis. Our case demonstrates the importance of considering PCM in the differential diagnosis of hyperpigmented plaques and highlights the need for further research to elucidate its underlying pathogenesis and optimize treatment strategies.

Unusual refractive anomaly in Alport syndrome with lenticonus: A challenging case

Herein, we report a 15-year-old male with Alport syndrome, exhibiting hemorrhagic nephritis, hearing loss, and a 1-year history of poor distance visual acuity. Slit-lamp examination revealed bilateral anterior lenticonus, with unremarkable findings in other ocular structures. Unusual reflex movements were observed during retinoscopy, characterized by distinct central and annular reflexes yielding objectively an intraeye discrepancy of 12 D. Similar to the objective findings, a pair of subjective findings for each eye was obtained and each pair resulted almost equal visual acuity. However, small pupil size veiled plus error and final prescription was myopic.

Hereditary Gingival Fibromatosis: A Case Report and Review of Literature

Hereditary gingival fibromatosis (HGF) has been defined as a rare disorder characterized by a benign, nonhemorrhagic, fibrous gingival overgrowth that can appear in isolation or as part of a syndrome. Because it has no specific cause, it is also known as idiopathic gingival fibromatosis. HGF starts in its mildest form and progresses very slowly to reach a severe form that can cover the teeth, causing severe functional and cosmetic problems. Clinically, it appears as diffuse or localized gingival overgrowth, pinkish, and firm in consistency that could be seen in both the buccal and lingual gingiva of both the mandible and maxilla. There could be ulceration and bleeding secondary to traumatic biting on the lesion. We report a case of a 12-year-old boy who presented with 5-year history of multiple gingival lesions clinically diagnosed with HGF. The relevant literature and important aspect in the management of this condition has also been discussed.

Decolonial Practices around “Portrait of a Man in a Red Suit” (formerly “Portrait of an African”), in the Royal Albert Memorial Museum (RAMM), Exeter

Recently renamed, the Portrait of a Man in a Red Suit, in the RAMM (Exeter) collection, is a rare example from the 18th century of an autonomous portrait of a Black sitter. This essay charts a 5-year history of debates between 2018-2023, before, during and after an exhibition: In Plain Sight: Transatlantic Slavery and Devon (2022) where the portrait played a central role. RAMM, which connected with other institutions through a series of loans of the portrait, is one of many European and American museums and galleries who are engaging with the legacy of transatlantic slavery. The case of the RAMM portrait allows reflection on decolonizing practices and methodologies, and on the challenges and opportunities for scholars and curators to reframe old paradigms: rethinking evidence, the function of identities in portraiture and the way exhibitions are conceived and staged. The lack of a known sitter enhances the portrait’s symbolic function to link with the past, to mediate for the voiceless and shape ongoing present debates, but also runs the risk of tokenism.

An Unusual Case of Mixed Superficial and Adenoid Basal Cell Carcinoma in a 57-year-old Filipino Female

Introduction: Basal cell carcinoma (BCC) is the most common cutaneous malignancy worldwide often occurring in sun-exposed areas. While the nodular variant accounts for the majority of cases, the adenoid type is extremely rare, comprising about 1.3% of all BCCs. Contrary to the typical presentation of BCC, adenoid BCC features a large sized lesion and a tendency to involve non-sun exposed areas such as the trunk. This case study presents a unique form of mixed superficial and adenoid BCC in a 57-year-old Filipino female. Case Report: A 57-year-old female presented with a 2-year history of a slowly enlarging bluish-black plaque with rolled borders on the left flank with noted bleeding, pain, and pruritus. Dermoscopy revealed arborizing vessels, leaf-like structures, blue gray globules, and white streaks, consistent with BCC. Histopathology showed a diagnosis of a superficial and adenoid type of BCC. Conclusion: Encounters with unusual forms of cutaneous carcinoma may arise in dermatologic practice. Dermoscopy serves as a powerful tool in identifying suspicious lesions and a pre-operative biopsy is done to correlate with the clinical diagnosis. Hence, the dermatologist will be able to decide the appropriate treatment option based on the clinical presentation and histopathologic type.

Pildikesi sügiskoolist / Pictures from the autumn school

This newsreel text opens the 10-year history of the autumn schools of the Heritage Technologies (since 2020 the Creative Applications of Cultural Heritage) of the University of Tartu Viljandi Culture Academy. Each year, a semi-academic event dedicated to some fascinating professional theme has been organised by second-year master’s students in different Estonian tourist farms. For example, the most colourful themes have been ‘The Creative Hand Heals the Soul’ (2015), ‘Life Before and After Oil’ (2016), ‘Born of Fire’ (2017). The two-day gatherings, which have been open to all interested parties with pre-registration, have included thematic lectures and presentations, discussions and brainstorming, and practical workshops. Always on the evening of the first day, baptised freshers, that is, master’s students who have started their studies, have been treated to the sauna and songs and tunes have sounded. At times, there has been a night hike, which the participants reminisce in detail afterwards. The tradition of the autumn school has not died out and school continues to the present day. In recent years, the autumn school’s presentations have been recorded on video on the University of Tartu’s online TV channel uttv.ee.

Surgical management of an elderly patient with strangulated inguinal hernia and cryptorchidism: A case report

Cryptorchidism, the condition of undescended testicles, and inguinal hernia share a common embryological origin, often presenting together. This case report describes the surgical intervention for a 73-year-old diabetic male with a 20-year history of left inguinal hernia and a single right testicle. The patient presented to the emergency department due to obstructed inguinal hernia, reporting pain, bowel obstruction, abdominal distension, and vomiting. Physical examination revealed a left inguinal hernia measuring 10 cm, which was incarcerated, non-expansile, and irreducible. Intraoperative exploration unveiled a strangulated oblique external left inguinal hernia with a 10 cm sac and a narrow neck containing an ischemic, yet non-necrotic, small bowel. Orchidectomy was performed due to testicular atrophy. The hernia repair utilized the Lichtenstein technique with a polypropylene mesh. Postoperatively, the patient recovered well without complications. Follow-up at 5 months showed no hernia recurrence or mesh infection. This case highlights the importance of timely surgical intervention in managing complex cases of hernia and cryptorchidism, particularly in elderly patients, and underscores the significance of careful intraoperative decision-making for optimal patient outcomes.

A Difficult Case to Diagnose: Machado-Joseph Disease/Spinocerebellar Ataxia Type III

Machado-Joseph Disease, also known as Spinocerebellar Ataxia Type III, was initially described in patients of Azorean heritage as a neurodegenerative disease but is now known to occur globally. The main clinical involvement is cerebellar and brainstem dysfunction causing progressive ataxia and usually disease onset is in young-adult to mid-adult years. A 20-year old female presented with a 3-year history of gradual onset, progressively worsening gait abnormality and tremor of the right hand. On examination, she had gargoyle-like facial features and pes cavus. On neurologic examination, she had dystonic tremor of right hand, cerebellar ataxia, dysdiadokokinesia, abnormal heel-shin coordination, hyperreflexia with downgoing plantar reflex bilaterally. Her MRI scan brain revealed communicating hydrocephalus with cerebellar atrophy. She was diagnosed with Machado-Joseph Disease/Spinocerebellar Ataxia type III.

PET OWNERSHIP AND LONGITUDINAL CHANGE IN PSYCHOLOGICAL ADAPTATION – EVIDENCE FROM THE BLSA

Abstract Successful aging depends in part on maintaining psychological adaptation. Research examining the relationship of pet ownership (PO) or human-animal interaction (HAI) to human health supports contributions to psychological status, mostly in populations with diseases or disabilities. We examine the contributions of PO to maintaining psychological adaptation among generally healthy community-dwelling older participants in the Baltimore Longitudinal Study of Aging (BLSA). Participants (N=637, age M=68.3, SD=9.6 years, pet owners N=149) completed assessments of anxiety (Perceived Stress Scale-10), depression (Center for Epidemiological Studies Depression), happiness (1-10 rating) and psychological wellbeing (SF-12 Mental Component Score) every 1-4 years and a 10-year PO history. Linear mixed models with random intercepts were used to examine changes in psychological adaptation outcomes over up to 13 years (M=7.5, SD=3.6) according to time-varying PO. Overall anxiety decreased (b=-0.0360,se=0.0104,p=0.001) and depression increased (b=.099141, se=0.015837, p< 0.001) with aging. Psychological wellbeing (b=0.00055, se=0.00119, p=0.644) and happiness (b=-.00405,se=0.0206,p=0.844) did not change. PO moderated changes in anxiety (b=0.058452,se=0.024376,p=0.017), happiness (b=-0.101373,se=0.04779,p=0.034), and psychological wellbeing (b=-0.005541,se=0.002764,p=0.045), but not depression (b=-0.01134, se=.037065,p=0.769). Anxiety and happiness improved in pet owners and deteriorated in non-owners. Psychological wellbeing deteriorated faster for pet owners than non-owners. This study provides important longitudinal evidence that PO may promote some aspects of psychological adaptation among generally healthy community-dwelling older adults by moderating age-related declines in psychological adaptation later in life. It also highlights differences in psychological responses to animal assisted interventions in residents of care facilities from changes during the life-courses of generally healthy community-residing older adults.