Casual Finding Research Articles

Casual finding of burkitt’s lymphoma in HIV pacient

Casual finding of burkitt’s lymphoma in HIV pacient

Anatomical variant of the azygos vein course in a cancer patient and review of the literature

The azygos vein is responsible for drainage through a staff of venous blood from the chest wall for the most part. Sometimes its course causes the independence of part of the lung parenchyma, which is known as the accessory lobe of the azygos. The present article presents the casual radiological finding of this anatomical variant in a 70-year-old patient undergoing a computed tomography scan for colon cancer. The azygos accessory lobe is a mostly asymptomatic anatomical variation, but it can be a problem in some thoracic surgeries.

Partial anomalous pulmonary venous return: a casual finding in many cases

Partial anomalous pulmonary venous return: a casual finding in many cases

Partial anomalous pulmonary venous return: a casual finding in many cases.

Partial anomalous pulmonary venous return: a casual finding in many cases.

Casual finding in colonoscopy: Diphyllobothrium latum.

Diphyllobothrium spp., also known as fish tapeworms, is the largest human tapeworm, reaching up to 25 meters of length. Human are considered the definitive host in the Diphyllobothrium lifecycle. Adult tapeworms attach to human intestinal mucosa with to bilateral grooves. There are at least 14 different species of Diphyllobothrium spp. Capable of causing Dyphyllobothriosis, being D. latum and D. nihonkaiense the most frequent etiologic agents in humans. We present the clinical picture and endoscopic images on a patient with incidental finding of Dyphyllobothriosis in a colonoscopy.

Laterality defect of the heart in non-teleost fish.

Dextrocardia is a rare congenital malformation in humans in which most of the heart mass is positioned in the right hemithorax rather than on the left. The heart itself may be normal and dextrocardia is sometimes diagnosed during non-related explorations. A few reports have documented atypical positions of the cardiac chambers in farmed teleost fish. Here, we report the casual finding of a left-right mirrored heart in an 85 cm long wild-caught spiny dogfish (Squalus acanthias) with several organ malformations. Macroscopic observations showed an outflow tract originating from the left side of the ventricular mass, rather than from the right. Internal inspection revealed the expected structures and a looped cavity. The inner curvature of the loop comprised a large trabeculation, the bulboventricular fold, as expected. The junction between the sinus venosus and the atrium appeared normal, only mirrored. MRI data acquired at 0.7 mm isotropic resolution and subsequent 3D-modeling revealed the atrioventricular canal was to the right of the bulboventricular fold, rather than on the left. Spurred by the finding of dextrocardia in the shark, we revisit our previously published material on farmed Adriatic sturgeon (Acipenser naccarii), a non-teleost bony fish. We found several alevins with inverted (left-loop) hearts, amounting to an approximate incidence of 1%-2%. Additionally, an adult sturgeon measuring 90 cm in length showed abnormal topology of the cardiac chambers, but normal position of the abdominal organs. In conclusion, left-right mirrored hearts, a setting that resembles human dextrocardia, can occur in both farmed and wild non-teleost fish.

Новые данные о технологии изготовления кузнечной продукции сельских поселений Золотой Орды по результатам металлографических анализов изделий с селищ Багаевское и Широкий Буерак

The article introduces into scientific circulation the results of metallographic studies of the technology of blacksmithing products originating from excavations and casual finds from Bagaevka and Shiroky Buerak, the Golden Horde settlements of the Lower Volga region. In historiography, there is a shortage of studies of iron processing technology of the Golden Horde population from the Lower and Middle Volga regions. This article is intended to partially fill the existing research gap based on the results of archaeo-metallographic studies conducted in the archaeological laboratory of the Ulyanovsk State Pedagogical University. In the study, the authors use the archaeo-metallography method, developed by B.A. Kolchin, and currently widely applied in Russian archaeological science. As a result, it was established that simple bloom iron, raw irregularly carburized steel and specially prepared high-carbon steel were the main raw materials for blacksmithing products of the Bagaevka and Shiroky Buerak settlements. In the arsenal of forging products of the Bagaevka settlement, 86.8% of technological operations belong to group I (simple technologies without the use of a structural joint by forging welding of bloom iron and high-carbon steel, without copper soldering) and 13.2% belong to group II (wares with a structural joint by forging welding of bloom iron and steel with copper soldering). 58% of the metallographically studied wares were made of bloom iron and raw irregularly carburized steel. 29% of the items were forged technologically in order to obtain high-quality products. 15.8% of the products were made of all-steel work pieces, 10.5% produced from package work pieces. Cementation technology was recorded in 2.6% of the items. End welding and forging from two-lane iron-steel work pieces, which amounted to 5.3% each, were identified in the technological schemes related to the technological group II. In general, the revealed technological features of the blacksmith products of the Bagaevka collection are characteristic of the iron processing in the Middle Volga region in the Golden Horde period.

Cystectomy of An Apical Root Cyst: Clinical Case and Literature Review

The root cyst is a cyst of odontogenic epithelial origin and inflammatory cause. It represents one of the most frequent cyst found on the oral cavity and has greater frequency at the maxillary level. The diagnosis is usually a casual finding on a routine X-ray. They are associated to tooth with negative vitality and the size is very variable. The treatment is a combined endodontic (root canal treatment) and surgical treatment (excision of the lesion). The diagnosis of certainty is obtained by a histopathological analysis. In this clinical case, a common situation of this type of lesions is shown, although in this case the patient comes to the clinic with symptoms. The root canal treatment of the affected tooth was performed. The periapical lesion did not disappear, so cystectomy was performed. The sample was sent for histopathological analysis that confirmed the diagnosis of radicular cyst. After 6 months follow-up, a periapical x-ray revealed how the lesion was ossifying.

Spontaneous subcapsular hepatic hematoma in pregnant patients.

Spontaneous subcapsular hepatic hematoma (SSHH) with or without previous history of preeclampsia and/or HELLP syndrome represents a very rare pathological condition in pregnancy and postpartum, (1/45,000-1/225,000 pregnancies). Its importance for the anesthesiologist lays in its association with high morbidity and mortality for the mother (60-86%, 39%) and newborn (42%). After a high clinical suspicion, the certainty clinical diagnosis is settled by different imaging techniques. However, in most cases the diagnosis of SSHH is a casual intraoperative finding associated to a maternal or foetal compromise. Nowadays the obstetric and anaesthetic management of a SSHH is not standardized and depends on its integrity, hemodynamic stability and the gestational period when diagnosed. The possibility of an acute critic haemorrhage with necessity of massive transfusion, makes advisable to provide updated protocols for the treatment of obstetric hemorrhage, adapting them to the clinical peculiarities of these patients. After the acute phase, close attention should be kept on thromboembolic complications.

Germline heterozygous exons 8–11 pathogenic BARD1 gene deletion reported for the first time in a family with suspicion of a hereditary colorectal cancer syndrome: more than an incidental finding?

BackgroundColorectal cancer (CRC) is a highly prevalent disease in developed countries. Inherited Mendelian causes account for approximately 5% of CRC cases, with Lynch syndrome and familial adenomatous polyposis being the most prevalent forms. Scientific efforts are focused on the discovery of new candidate genes associated with CRC and new associations of phenotypes with well-established cancer-related genes. BRCA1-associated ring domain (BARD1) gene deleterious germline variants are associated with a moderate increase in the relative risk of breast cancer, but their association with other neoplasms, such as CRC, remains unclear.Case presentationWe present the case of a 49-year-old male diagnosed with rectal adenocarcinoma whose maternal family fulfilled Amsterdam clinical criteria for Lynch syndrome. Genetic test confirmed the presence in heterozygosis of a germline pathogenic deletion of exons 8–11 in BARD1 gene. The predictive genetic study of the family revealed the presence of this pathogenic variant in his deceased cancer affected relatives, confirming co-segregation of the deletion with the disease.ConclusionsTo the best of our knowledge, this is the first published work in which this BARD1 deletion is detected in a family with familial colorectal cancer type X (FCCTX) syndrome, in which the clinical criteria for Lynch syndrome without alteration of the DNA mismatch repair (MMR) system are fulfilled. Whether this incidental germline finding is the cause of familial colorectal aggregation remains to be elucidated in scientific forums. Patients should be carefully assessed in specific cancer genetic counseling units to account for hypothetical casual findings in other genes, in principle unrelated to the initial clinical suspicion, but with potential impact on their health.

Asymptomatic endometrial thickening in postmenopausal women: predictor of malignant pathology?

It is not standardised what is the endometrial thickness that discriminates between normal and potentially malignant. The objective of this study was to determine the endometrial thickness cut-off point from which the risk of endometrial cancer (EC) increases in asymptomatic postmenopausal women; and to evaluate the risk factors linked to malignant endometrial pathology as well as other associated ultrasound findings. This was a retrospective observational study that included hysteroscopies performed at the Hospital Materno-Infantil on 267 asymptomatic menopausal women with an increase in endometrial thickness (AET) >5 mm, from 2015 to 2019. The results shows that the prevalence of malignant pathology in asymptomatic postmenopausal women with a casual finding of endometrial thickening was 3.7%. This percentage was 16.3% when the cut-off point of AET was established at 10 mm. There was a significant association for the diagnosis of malignant pathology with this cut-off point. There is a significant association between the 10 mm endometrial thickness cut-off point from which the risk of EC increases in asymptomatic postmenopausal women. Impact statement What is already known on this subject? Several studies have established the cut-off point for asymptomatic endometrial thickening (AET) for atypical endometrial hyperplasia and endometrial cancer at 10 mm. Although no cut-off point has optimal accuracy for the diagnosis of malignant endometrial pathology, it has been found that with a cut-off value of AET >10 mm no cases are missed. Likewise, a cut-off point of AET > 11 mm may provide a balance between cancer detection and histopathological workup extension. What do the results of this study add? A significant association was found at the cut-off point of AET > 10 mm, which suggests that screening postmenopausal women at this thickness is acceptable and unlikely to miss cases of endometrial hyperplasia and endometrial cancer. What are the implications of these findings for clinical practice and/or further research? After analysing our results we can conclude, like other published studies, that by establishing a cut-off point of 10 mm we obtain a good discrimination between benign and malignant pathology, which would allow us to diagnose 100% of malignant pathology. Above this cut-off point, the risk of endometrial cancer increases, and it would therefore be advisable to extend the study. A multicentre study is needed to confirm the cut-off point at which the risk of endometrial cancer increases in postmenopausal women with asymptomatic endometrial thickening.

Palmaris profundus and carpal tunnel syndrome: is it really a palmaris muscle?

The palmaris profundus (PP) is a variable muscle present in the flexor muscle region of the forearms. Its implication in the etiopathogenesis of carpal tunnel syndrome has been discussed in the literature. We present a case of a PP with a characteristic morphology, associated with a bifid median nerve (MN), found during surgery for a recurrence of carpal tunnel syndrome in a 51-year-old female patient. The PP muscle was first described with this morphology by Frohse in 1908. Initially, this muscle was considered an anatomical variation of the palmaris longus, but since 1984 the existence of both muscles has been observed in the same forearm, so the PP is considered an accessory muscle. Some authors associate the existence of a PP with compression of the median nerve in the carpal tunnel. Others, however, argue that it may be an aggravating factor but not the primary cause, or simply a casual finding during surgery. We believe that this tendon is not the primary cause of compression of the MN, but it can aggravate the situation in case of a reduced canal due to any other cause, so we recommend surgeons to resect it if it is found. Furthermore, based on the embryological origin of the forearm muscles, we believe that this PP could actually be the radio-carpal, radio-palmar or short radial forearm muscle described as early as the 19th century.

AN INCIDENTAL FINDING OF NUTCRACKER PHENOMENON ON HRCT THORAX SCAN IN A YOUNG MALE PATIENT-A CASE REPORT.

Nutcracker syndrome is the clinical diagnosis, Whereas nutcracker phenomenon (NCP) refers only to morphologic compression of the left renal vein between the SMA and the aorta, with impaired blood outflow often accompanied by distention of the proximal portion of the vein. [2] Although uncommon, it can clinically manifest with intermittent hematuria, dysuria, flank or abdominal pain. It may be asymptomatic for long period and constitute casual findings. Ultrasound is the first-line imaging which require more accurate study with contrast-enhanced computed tomography.[1,2]

Casual finding of a solitary costal bone plasmacytoma in somatostatin receptor scintigraphy

Casual finding of a solitary costal bone plasmacytoma in somatostatin receptor scintigraphy

Emergency Department capacity to initiate thromboprophylaxis in patients with atrial fibrillation and thrombotic risk after discharge: URGFAICS cohort analysis.

Atrial fibrillation (AF) is the most prevalent heart rhythm disorder in the general population. Stroke prevention is one of the leading management objectives in the treatment of AF patients. The variables associated with the non-initiation of thromboprophylaxis in patients with thrombotic risk consulting for an episode of AF in Emergency Departments (ED) were investigated. This was a multipurpose, analytical, non-interventionist, multicenter Spanish study with a prospective 30-day follow-up. All patients ≥ 18years of age consulting to the ED for the casual finding of AF in an electrocardiogram (ECG) performed 12h prior to the consultation or with symptoms related to AF were enrolled from September 1, 2016 to February 28, 2017. Patients not previously received thromboprophylaxis were selected. Multivariate analysis was performed to calculate the odds ratio (OR) and the 95% confidence interval (CI). A total of 634 patients, not received thromboprophylaxis and at high thrombotic risk, were included. Of these, 251 (39.6%) did not receive thromboprophylaxis at ED discharge. In the multivariate analysis, non-initiation of anticoagulation at discharge from the ED was mostly related to cognitive impairment (OR 3.95; (95% CI 2.02-7.72), cancer history (OR 2.12; (95%CI 1.18-3.81), AF duration < 48h (OR 2.49; (95% CI 1.48-4.21) and patients with re-establishment of sinus rhythm (OR 3.65; (95% CI 1.47-9.06). Reinforcement of the use of CHA2DS2-VASC as a stroke risk scale and empowerment of ED physicians is a must to improve this gap in care.

Predictive factors for requiring heart transplantation in patients with hypertrophic cardiomyopathy: data from a referral center

Abstract Background Heart transplant (HT) remains the last treatment option for patients with non-obstructive hypertrophic cardiomyopathy (HCM) who develop end-stage heart failure (HF). Early identification of patients who may require a HT in the future is crucial in order to advise them, establish the appropriate follow-up and determine the appropriate time to include them in the waiting list. Objectives Our study sought to find predictive factors related with requiring HT during follow-up in patients with HCM. Methods Consecutive patients with HCM referred to a HCM monographic clinic from 2018 to 2020 (HCM controls) and transplanted patients due to HCM in the same tertiary HT hospital since 2003 (cases) were included. Baseline (on the date of HCM diagnosis) and longitudinal data regarding clinical, genetic, ECG and echocardiographic variables were retrospectively evaluated. Follow-up was registered from HCM diagnosis to HT (in cases) or last medical check up (controls). Results A total of 157 patients (24 HCM-HT cases and 133 HCM controls) were included (45±19 yo; 57% male). At the time of MCH diagnosis (Table), cases were significantly younger than controls, were more frequently symptomatic and showed significantly higher BNP levels and more advanced diastolic dysfunction (larger left atrium, higher E/A ratio and lower e'); also, HCM-HT reported more family history and had higher proportion of pathogenic mutations (being MYH7 the most frequently involved). Left ventricular (LV) systolic function was slightly reduced in HCM-HT cases. In contrast, HCM controls were more frequently diagnosed by casual findings or family screening and had more LV outflow tract obstruction at first medical evaluation. LV maximal wall thickness (MWT) did not differ between groups. During a median follow-up since HCM diagnosis of 6.2 years (median follow-up of 8.9 and 7.1 years in cases and controls, respectively), HCM-HT cases presented a higher incidence of sustained ventricular tachycardia or ICD therapy (HR=4.0; CI95%:1.6–10.0 p=0.03) and HF admissions (HR=3.9; CI95%:1.8–8.1 p&amp;lt;0.001). There were no cardiovascular deaths during follow-up. Conclusions The presence of symptoms in a young non-obstructive HCM patient, along with family history and a pathogenic mutation, should advice clinicians a closer follow-up and early transfer to a HT referral center, especially if associated with diastolic dysfunction and high BNP values. Funding Acknowledgement Type of funding sources: None. Table 1

Mallampati Class Zero airway: a narrative review.

Mallampati Class Zero airway describes a visible epiglottis on pharyngoscopic view. It was first noted by Tobold A in 1869 and was proposed as a new class in modified Mallampati Classification by Ezri T. et al. We aim to summarize the current knowledge about Mallampati Class Zero airway and its implication on airway management. We reviewed the reported studies about visible epiglottis on pharyngoscopy and 34 publications were selected. The diagnosis of Mallampati Class Zero airway is usually achieved as a casual finding during airway assessment of Mallampati Test, during a regular checkup at the dentist, or even after a medical consultation due to a suspected visualization of a foreign body at the back of the throat. Mallampati Class Zero airway has a low prevalence in the general population (prevalence of 0.7-1.7% of adults and 0.3-6% of children) and it is more frequent in children and female. The cause for this phenomenon is not well understood but in clinical practice it is associated with an easy airway. Interestingly, in the pediatric population with Mallampati class zero airway, the difficult airway has not been reported to date. Mallampati Class Zero is associated with an easy airway and it should be included as a different class in the modified Mallamapti classification, which would also contribute to its spread between professionals involved in the airway management and will favour increasing investigation and knowledge about it.

A Missense Variant in LAMA3 Gene Causes Microcephaly and Epidermolysis Bullosa in a Pakistani Family

OBJECTIVE: To identify the disease-causing mutation in a family with autosomal recessive primarymicrocephaly (MCPH).METHODOLOGY: This cross-sectional study was the continuation of an ongoing family-based studyinitiated in 2016 at the Department of Biochemistry, Quaid-e-Azam University, Islamabad. The family wasselected randomly and recruited from Sahiwal and has three members with MCPH. DNA was isolatedfrom blood samples and the genome-wide scan was performed to map homozygous regions. Wholeexome sequencing (WES) was performed to identify the plausible gene variant.RESULTS: Whole genome data analysis identified multiple homozygous regions, but none of thesecontain known MCPH genes. Whole exome sequencing (WES) data identified six potentially pathogenic variants but only the Laminin subunit alpha-3 (LAMA3) (c.5260C/T) variant segregates in the family andis also present within the genomic region mapped on chromosome 18. The reevaluation of affectedmembers of the family revealed the presence of blisters on their hands and feet indicating the presenceof epidermolysis bullosa along with microcephaly.CONCLUSION: The casual finding of the LAMA3 variant (c.5260C/T; p. Arg1754Trp) and absence of anyother MCPH causing variant in affected members of this family expands the phenotypic spectrum ofLAMA3 associated phenotype. Therefore, we can conclude that the LAMA3 variant can probably causerecessive microcephaly and epidermolysis bullosa, but additional studies are needed to establish therole of LAMA3 in microcephaly. KEY WORDS: MCPH, LAMA3, Laminin-5, Genome scan, homozygous regions, whole-exome sequencing.

Venous sinus thrombosis in pediatrics. Case series of a tertiary hospital.

Venous sinus thrombosis (VST) is a rare entity in pediatrics, probably under-diagnosed and poten tially serious, described as a cause of stroke in childhood. To describe the clinical presenta tion, risk factors, treatment, and evolution of pediatric patients with VST. Re trospective study of patients admitted to a referral hospital, diagnosed with VST, aged between one month and seventeen years, from January 2011 to December 2019. The following data were re viewed: age at diagnosis, sex, signs and symptoms of presentation, predisposing mechanisms, study of thrombophilias, treatment and duration of treatment, follow-up protocol, long-term sequelae, and mortality. Due to their differences in clinical presentation, the sample was divided into two age groups: young children between 1 month and 5 years and older children and adolescents between 6 and 17 years. 17 patients were diagnosed with VST, 45% were women, with a median age of 4.5 years. The most frequent symptoms in older children (6-17 years old) were headache (80%) and diplopia (60%). In children under 5 years old, the most frequent clinical presentation was cerebellar ataxia (42%), asymptomatic (34%), and headache (25%). In 23.5% of the total, VST was a casual fin ding in neuroimaging. 13 patients presented relevant histories such as complicated otitis media with mastoiditis (53%), severe traumatic head injury (6%), and resection of a space-occupying lesion of the brain (6%). 23% of the cases were idiopathic and in 23% there were prothrombotic factors. The treatment of choice in all patients was low-molecular-weight heparin. During the short-term follow- up, 11.8% presented self-limited neurological symptoms. One patient presented long-term paresis of the sixth paired cranial nerve. There were no deaths or recurrences of the episode in our series. VST is a rare entity and it usually appears with signs and symptoms of intracranial hy pertension. It is a potentially serious condition and early diagnosis and treatment can help minimize long-term sequelae.

Hallazgo casual de un plasmocitoma óseo solitario de costilla en una gammagrafía de receptores de somatostatina

Hallazgo casual de un plasmocitoma óseo solitario de costilla en una gammagrafía de receptores de somatostatina