Case Review Research Articles

Primary Extra-axial Glioblastoma Mimicking Meningioma: Case Report and Review of Literature

Glioblastoma (GBM) is the most common malignant brain tumour in adults. On radiology, diagnostic dilemmas can arise with other brain pathologies like metastasis, brain abscess, and lymphoma. However, GBM mimicking a meningioma on radiology has been rarely reported. Here, we report a case of GBM with magnetic resonance imaging (MRI) features suggestive of meningioma. A 46-year-old female presented with a one-month history of headaches. The MRI brain suggested a broad-based extra-axial mass lesion in the left frontal convexity with cerebrospinal fluid (CSF) cleft sign with compression of underlying brain parenchyma. Overall, the MRI brain was suggestive of a cystic meningioma. The patient underwent gross total resection of the tumour under microscopy, and final histopathology confirmed GBM. Although GBM is usually an intra-axial tumour, it may present as an extra-axial mass lesion with radiological features mimicking meningioma. Therefore, it should be considered a differential diagnosis in patients with an extra-axial tumour displaying atypical malignant features.

PDSS1 mutations-associated steroid-resistant nephrotic syndrome: case report and review of literature.

PDSS1 mutations hamper Coenzyme Q10 biosynthesis and cause a rare multisystem mitochondrial disease characterized by diverse clinical features and limited treatment options. To date, renal involvement has been reported in only one patient. We report a new female patient with compound heterozygous PDSS1 mutations and the clinical outcome following a trial of Coenzyme Q10 therapy. Our patient presented with developmental delay and regression at age three, which progressed to steroid-resistant nephrotic syndrome at age six, leading to stage 5 chronic kidney disease. Whole exome sequencing identified two pathogenic variants in the PDSS1 gene. High doses of Coenzyme Q10 therapy had no effect at this advanced stage of disease. Coenzyme Q10 treatment did not appear to improve the clinical outcome in this patient. Further data is needed to better understand the phenotypic spectrum of PDSS1-associated disruption, and the potential benefit of early Coenzyme Q10 therapy.

Concomitant Nasopharyngeal and Otomastoid Tuberculosis: a Report of 3 Cases and a Review of Literature.

Objective: Concomitant nasopharyngeal and otomastoid tuberculosis (TB) is an extremely rare clinical condition. So far, there have only been 2 such cases reported in English literature, and another 2 such cases have been reported in Chinese literature. The objective of this work is to summarize our experience dealing with this condition and to review the literature. Methods: A retrospective review of cases with concomitant nasopharyngeal and otomastoid TB treated at 2 tertiary medical institutions between June 2022 and May 2024 was undertaken. Data were retrieved from case notes and analyzed. Results: In total, 3 cases were included (2 male patients were from the former institution, and 1 female patient was from the latter). One case was bilateral, and the other 2 cases were unilateral. Their age was between 23 years old and 49 years old (average and median age was 36.3 and 37 years old, respectively). Presenting symptoms included ear fullness, hearing loss, otorrhea, facial paralysis, and otalgia. Careful diagnostic work-up led to the discovery of both otomastoid and nasopharyngeal lesions in all patients. Surgical procedures were planned, and histopathological examination of lesions of both sites was suggestive of TB for all cases, while polymerase chain reaction (PCR) confirmed the presence of Mycobacterium tuberculosis. All patients were subjected to 6 months of anti-TB treatment. The median duration of follow-up was 10 months. No recurrence was documented. A summary of all 7 such cases was also presented. Conclusions: Concomitant nasopharyngeal and otomastoid tuberculosis is very rarely encountered. Surgery or surgical biopsy is important for both treatment and diagnosis. After confirmation of TB by histopathology and PCR, anti-TB treatment is very important for the prevention of recurrence. Symptoms could generally be improved, although not always optimistic.

Magnetic Seizure Therapy in Refractory Psychiatric Disorders: A Systematic Review and Meta-Analysis: La thérapie par convulsions magnétiques pour la prise en charge des troubles psychiatriques réfractaires : revue systématique et méta-analyse.

To qualitatively and quantitatively synthesize the literature on the efficacy and safety of magnetic seizure therapy (MST) in psychiatric disorders. A literature search was conducted of the OVID Medline, OVID EMBASE, PsychINFO, CINAHL, Web of Science and Cochrane databases from inception to 14 January 2024, using subject headings and key words for "magnetic seizure therapy." Randomized controlled trials (RCTs), post-hoc analyses of RCTs, open-label trials, or case series investigating MST in adults with a verified psychiatric diagnosis and reporting on two possible primary outcomes (1) psychiatric symptom reduction (as measured by validated rating scale) or (2) neurocognitive outcomes (as measured by standardized testing), were included. Abstracts, individual case reports, reviews and editorials were excluded. Extracted data included: (1) basic study details; (2) study design; (3) sample size; (4) baseline demographics; (5) outcome data (including secondary outcomes of suicidal ideation and adverse events); and (6) stimulation parameters. Cochrane's risk of bias tool was applied. A quantitative analysis was conducted for the depression studies, using Hedge's g effect sizes. A total of 24 studies (n = 377) were eligible for inclusion. Seventeen studies in depression (including three RCTs), four studies in schizophrenia (including one RCT), one study in bipolar disorder, one study in obsessive-compulsive disorder and one study in borderline personality disorder were summarized. We found no significant difference in depressive symptom reduction between MST and electroconvulsive therapy (ECT) in randomized, controlled trials (g = 0.207 towards ECT, 95% confidence interval (CI) -0.132 to 0.545, P = 0.232). We found a significant reduction in depressive symptoms overall with MST in the pooled RCT and open-label analysis (g = 1.749, CI 1.219 to 2.279, P < 0.005). It is suggested that MST has modest cognitive side effects. Large-scale RCTs are necessary to confirm early signals of MST as an effective intervention in psychiatric disorders with a cognitive profile that is potentially more favourable than ECT.

Metachronous metastasis of papillary thyroid carcinoma to the parotid gland: a case report and review of the literature.

We present a case of metachronous metastasis of papillary thyroid carcinoma to the parotid gland, this being an extremely rare metastasis, and a literature review. A 56-year-old female patient presented with a history of a slowly growing mass on the left side of the neck. The patient reported a medical history of thyroidectomy due to papillary thyroid carcinoma 23 years previously and neck dissection for lymph node metastases 10 years previously, with additional therapy using radioactive iodine in both cases. Computed tomography (CT) of the neck revealed a single nodular solid mass in the tail of the left parotid gland which showed heterogeneous intake of contrast agent. FNA biopsy of the left parotid gland revealed cells typical of papillary thyroid carcinoma with positive immunochemistry for TTF-1. Due to this new metastasis, a total parotidectomy with preservation of the facial nerve was performed and additional therapy with radioactive iodine was administered. Despite the fact that papillary thyroid carcinoma has a low incidence of regional and distant metastases, there are a few rare cases with distant metastases reported in the literature. Thus, awareness, especially among endocrinologists, and a multidisciplinary approach are crucial to ensure early detection and efficient treatment of these rare cases, distant metastases being the main cause of mortality and of reduction of overall survival rate among these patients.

Legal Analysis of Violence by the Gank Gaza Group in Bali: A Review of Cases and Law Enforcement

This research examines acts of violence by the "Gank Gaza" group in Bali, highlighting legal dynamics and challenges in effective law enforcement. The study analyzes a series of cases involving the group's violence, identifying the patterns and motivations behind their actions. Through a juridical-sociological approach, this research evaluates the response of law enforcement officials, highlighting structural and operational weaknesses that hinder optimal handling. The results of the analysis show the need to increase law enforcement capacity through special training, strengthening intelligence, and collaboration between institutions. The study also emphasizes the importance of preventive approaches, including youth empowerment programs and community awareness campaigns, to address the root causes of gang violence. Thus, this research provides strategic recommendations to strengthen the legal system and create a safer environment in Bali.

KESALAHAN PENJATUHAN HUKUMAN DALAM PROSES PENEGAKAN HUKUM (STUDI KASUS CRAIG COLEY DAN IMPLIKASI BAGI SISTEM PERADILAN)

This study discusses the problem of wrongful conviction or errors in sentencing, especially in the context of the death penalty. These errors often occur due to various factors, such as forced interrogation, errors in forensic evidence analysis, and institutional bias. The method used in this study is normative legal research that focuses on the study of literature and primary legal materials, such as laws and regulations and related legal theories. The results of the study indicate that to minimize errors in sentencing, especially in cases of the death penalty, there needs to be reform in interrogation methods, standards of proof, and access to adequate legal aid. The use of modern forensic technology, such as DNA testing, and broader review of death penalty cases have also proven to be effective steps in reducing the risk of wrongful convictions.

Operative caseload of general surgeons working in a rural hospital in Central Australia.

There is limited published data on the caseload of general surgeons in Central Australia. The region has a significant Indigenous population, who often face higher rates of chronic diseases and require more frequent surgical interventions compared to non-Indigenous individuals. This study aims to outline the workload of surgeons at Alice Springs Hospital to determine the necessary skill set and surgical education for future surgeons. A retrospective review of all general surgery operative cases performed in Central Australia, Alice Springs Hospital was conducted between January 2012 and December 2021. The RACS Morbidity Audit and Logbook Tool was used to classify surgical procedures along with Medicare Benefits Schedule item numbers. Tables were created to present the annual and specialty-specific data on the types and volumes of procedures. From January 2012 to December 2021, 35 318 cases were performed, with 92.5% being general surgery, 3% plastics and reconstructive surgery and 2.8% vascular procedures. Indigenous patients received a higher proportion of procedures (50-60%) compared to non-Indigenous patients (30-50%). Common procedures included incision and drainage of abscesses and debridement of wounds, while trends across specialties showed a decline in ENT and plastic surgeries, stable thoracic and vascular cases, and increased numbers of urology operations. General surgeons in rural centres must possess a wide range of skills and be capable of performing a variety of procedures. Trainees should be encouraged to consider practicing in rural areas, and those interested should account for the specific needs of the communities they plan to serve.

Integrating Blockchains with the IoT: A Review of Architectures and Marine Use Cases

This review examines the integration of blockchain technology with the IoT in the Marine Internet of Things (MIoT) and Internet of Underwater Things (IoUT), with applications in areas such as oceanographic monitoring and naval defense. These environments present distinct challenges, including a limited communication bandwidth, energy constraints, and secure data handling needs. Enhancing BIoT systems requires a strategic selection of computing paradigms, such as edge and fog computing, and lightweight nodes to reduce latency and improve data processing in resource-limited settings. While a blockchain can improve data integrity and security, it can also introduce complexities, including interoperability issues, high energy consumption, standardization challenges, and costly transitions from legacy systems. The solutions reviewed here include lightweight consensus mechanisms to reduce computational demands. They also utilize established platforms, such as Ethereum and Hyperledger, or custom blockchains designed to meet marine-specific requirements. Additional approaches incorporate technologies such as fog and edge layers, software-defined networking (SDN), the InterPlanetary File System (IPFS) for decentralized storage, and AI-enhanced security measures, all adapted to each application’s needs. Future research will need to prioritize scalability, energy efficiency, and interoperability for effective BIoT deployment.

Management of Post-Traumatic Pseudomeningocele as Consequence of Root Nerve Avulsion: Case Report and Review of the Literature

Management of Post-Traumatic Pseudomeningocele as Consequence of Root Nerve Avulsion: Case Report and Review of the Literature

Clear Cell Sarcoma of the Parotid Gland: Case Report and Review of the Literature.

Clear cell sarcoma (CCS) of the parotid gland is a rare and aggressive cancer, predominantly affecting the deep soft tissues of the lower extremities, and is more frequently observed in the elderly. Its occurrence in the head and neck area, particularly in the parotid gland, is exceedingly rare. This study presents a 75-year-old male who exhibited a substantial, swiftly-enlarging mass on the left side of the mandible, which was diagnosed as CCS of the parotid gland. Morphologically and immunohistochemically, CCS shares characteristics with melanomas, and Ewing sarcoma, complicating differential diagnosis. The primary treatment for localized CCS typically involves surgical excision with clear margins. However, due to its resistance to conventional chemotherapy, there is ongoing research regarding the efficacy of adjuvant therapies such as chemoradiation, lymphadenectomy as well as immunotherapies such as immune checkpoint inhibitors. Further research is imperative to enhance our understanding of CCS and to develop more effective treatment strategies.

Overcoming Challenges in Retrieving an Encapsulated Rear Tip Extensor During Conversion From Malleable to Inflatable Penile Prosthesis Surgery: A Case Report and Review of Literature

Overcoming Challenges in Retrieving an Encapsulated Rear Tip Extensor During Conversion From Malleable to Inflatable Penile Prosthesis Surgery: A Case Report and Review of Literature

Awake resection of a right motor cortex arteriovenous malformation in a pediatric patient: A case report and review of the literature

Background: Intracranial arteriovenous malformations (AVMs) are extremely rare in the pediatric population, with an estimated prevalence of 0.014–0.028%. About 75–80% of pediatric AVMs present with intracranial hemorrhage, a source of significant morbidity and mortality. Awake craniotomy (AC) has become the standard approach for resecting eloquent area intracranial lesions in the adult population. Its use, however remains limited in the pediatric population and has very rarely been reported for an AVM of the motor cortex in this age group. Case Description: We report the case of a 17-year-old, right-handed boy who presented to our setup with a 2-month history of left-sided hemiparesis and left facial hypoesthesia following an episode of acute loss of consciousness (ALOC) while playing football. A computed tomography scan done after ALOC revealed an AVM in the right frontoparietal cortex with associated acute hemorrhage. Digital subtraction angiography (DSA) was done which revealed a right-sided grade II AVM with arterial supply from the right middle cerebral artery and venous drainage into the superior sagittal and cavernous sinuses. The patient underwent elective neuronavigation-guided right frontoparietal AC and resection of AVM. Postoperative DSA revealed no residual disease. The patient’s neurologic deficits showed improvement in the first few days following surgery. He was discharged with advice to follow up in a neurosurgery clinic to monitor his postoperative recovery and ensure compliance with physiotherapy. Conclusion: This case represents only the second pediatric patient in the available medical literature to have ever undergone AC for intracranial AVM resection. Pediatric AVMs are a rare entity and pose the risk of significant morbidity and mortality. Awake surgery has the potential to reduce iatrogenic neurological deficits in the pediatric population significantly. More work must be done to increase pediatric patient compliance with awake surgery.

Epileptic Seizures As the Sole Presentation of a Radiologically Isolated Syndrome: A Case Report and Review of the Literature

Epileptic Seizures As the Sole Presentation of a Radiologically Isolated Syndrome: A Case Report and Review of the Literature

Biliary sphincterotomy resets pancreaticobiliary pain refractory to intrasphincteric Botox injections in functional biliary pain.

The management of Type III sphincter of Oddi dysfunction or functional biliary pain (FBP) is challenging. A strategy of intermittent intrasphincteric botulinum toxin (Botox) injections into the sphincter of Oddi can alleviate pancreaticobiliary pain. In patients who lose response to intermittent Botox injections, endoscopic biliary sphincterotomy (ES) could potentially reset pain facilitating ongoing management of symptoms. A retrospective review of case notes over a seven-year period (2014-2021) was performed. All patients underwent blood tests, gastroscopy, trans-abdominal ultrasonography, cross-sectional imaging withmagnetic resonance cholangiopancreatography (MRCP)/computed tomography (CT) and endoscopic ultrasound (EUS)to rule out alternative causes for their symptoms of pancreaticobiliary pain. A diagnosis of FBP was made in patients with typical post-cholecystectomy pain and normal liver function tests and bile duct size on imaging. Patients with symptomatic FBP underwent intermittent endoscopic Botox injections to the sphincter of Oddi. Patients who lost response to Botox injections underwent ES and were followed up in an outpatient setting to assess response. One hundred and thirty (128 female, 2 male) patients with FBP underwent a mean of four (2-8) Botox injections over the study period. Of 130 (90%) patients, 117 reported a significant improvement in pain on post procedure review with 81% of patients managing to discontinue opioid medication post procedure. Fifty-one out of 130 (39%) lost response to Botox injections after a median of six (range 5-11) sessions (median eightmonths between sessions [range 6-18months]) and continued to have ongoing pancreaticobiliary pain and subsequently underwent biliary ES. Forty-one out of 50 (82%) reported a clinical improvement in their symptoms of pancreaticobiliary pain following ES, with response persisting at follow-up for up to mean of eight (5-15) months and no further hospital attendances due to severe pancreaticobiliary pain. ES can reset pancreaticobiliary pain in FBP once Botox injection therapy to the sphincter of Oddi becomes ineffective and may provide ongoing relief of symptoms.

Hypothyroidism Management through Individualized Homoeopathic Medicine: A Case Review

Hypothyroidism Management through Individualized Homoeopathic Medicine: A Case Review

Malignant Peripheral Nerve Sheath Tumor of the Small Bowel: A Case Report and Review of the Literature

Malignant Peripheral Nerve Sheath Tumor of the Small Bowel: A Case Report and Review of the Literature

Rare giant epithelioid inflammatory myofibroblastic sarcoma of the abdominal cavity in a child: a case report and review of the literature

Epithelioid inflammatory myofibroblastic sarcoma (EIMS) is a distinct subtype of inflammatory myofibroblastoma tumor (IMT) that is recognized as a rare malignant tumor characterized by anaplastic lymphoma kinase (ALK) positivity, significant aggressiveness, treatment challenges, and a poor prognosis. We report on the case of an 8-year-old boy presenting with abdominal pain and vomiting. Computed tomography (CT) of the abdomen revealed a large tumor, and the pathology results following a biopsy confirmed the diagnosis of EIMS. The patient underwent radical tumor resection, and genetic testing identified the presence of the RANBP2–ALK fusion. To our knowledge, this represents the largest pediatric case of abdominal EIMS documented in the literature. Currently, there is no standard therapy for EIMS; however, existing studies advocate for the use of ALK tyrosine kinase inhibitors (TKIs) in its treatment. This case was reported to be in remission following treatment with crizotinib, thereby contributing to the understanding of the specific pathology of EIMS and facilitating accurate diagnosis and targeted therapy.

Spontaneous Resolution of an Aggressive Direct Carotid Cavernous Fistula Following Partial Transvenous Embolization Treatment: A Case Report and Review of Literatures

Spontaneous Resolution of an Aggressive Direct Carotid Cavernous Fistula Following Partial Transvenous Embolization Treatment: A Case Report and Review of Literatures

Posttransplant Erythrocytosis after Allogenic Stem Cell Transplant for Acute Myeloid Leukemia: A Case Report and Review of Literature

Posttransplant Erythrocytosis after Allogenic Stem Cell Transplant for Acute Myeloid Leukemia: A Case Report and Review of Literature