Diffuse Lesions Research Articles

Isavuconazole Breakthrough Disseminated *Fusarium fujikuroi* Infection in a Patient with Allogeneic Hematopoietic Stem Cell Transplant: Diagnostic and Therapeutic Challenges – A Case Report

# Introduction This case report illustrates the diagnostic challenges and complexities in the treatment of disseminated fusariosis. # Case An 18-year-old patient received a second allogeneic hematopoietic stem cell transplant (HSCT) 5 months after the first HSCT. Two days post-transplant, the patient presented neutropenic fever with diffuse multiple cutaneous papular lesions under isavuconazole prophylaxis. A diagnosis of disseminated fusariosis due to *Fusarium fujikoroi* was established. Antifungal therapy had to be adapted multiple times for efficacy and safety issues. Long-term combination therapy with posaconazole and terbinafine efficiently controlled the infection and was well tolerated. # Discussion This case report illustrates three major teaching points: (i) high clinical suspicion based on typical clinical and microbiologic findings is a key factor for the diagnosis of fusariosis; (ii) treatment is challenging due to variable antifungal agent minimal inhibitory concentrations (MICs); and (iii) long-term administration of voriconazole can be associated with multiple, less frequently seen adverse events. # Conclusion Typical skin lesions and positive blood cultures for molds should promptly rise suspicion of fusariosis. Amphotericin-B and voriconazole are the first-line agents for the treatment of fusariosis. Second-line agents such as posaconazole and terbinafine can be used.

Nasal Presentations of Rosai-Dorfman Disease: Clinical Manifestation and Treatment Outcomes.

There has been a lack of evidence-based management strategies on the nasal presentations of Rosai-Dorfman disease (RDD). We aim to investigate the clinical manifestation, treatment, and outcomes in patients with nasal RDD. We retrospectively reviewed available medical records of patients diagnosed with nasal RDD from 2014 to 2021 at our department. A total of 26 patients were included with a marked female preponderance (2.25:1). The most common symptom and affected sites were nasal congestion (31%) and nasal cavity (73%), respectively. The average times of biopsies was 1.5 times (range: 1-3). The histiocytes were positive about S100 and CD68 and negative for CD1a with common emperipolesis. The mean duration of follow-up was 34months (range, 3-87). One patient with concomitant nasal small B-cell lymphoma achieved complete remission after chemoradiotherapy. Recommended treatments were endoscopic resection (92%) and oral corticosteroids (21%). Surgery was performed to remove the resectable lesion as completely as possible. Corticosteroids induced almost 100% overall remission. Of the relapses, two patients achieved an overall response and one remained in progressive stage after subsequent excision. Two patients only received dissection biopsy that responded to oral corticosteroid administration and combined therapies of lenalidomide and dexamethasone, respectively. Diffuse lesions in nasal cavity and sinuses, and even widely affected nasal skull base, laryngopharynx, orbit, and cavernous sinus, should be considered the possibility of Rosai-Dorfman disease. Characteristic immunohistochemical staining is helpful for the diagnosis. Endoscopic surgical therapy remains the mainstream treatment for patients enduring an unbearable course. Oral corticosteroid administration serves as an adjuvant therapy for first-line treatments.

Adult-Onset Leukoencephalopathy with Axonal Spheroid and Pigmented Glia: Different Histological Spectrums Presented in Autopsy Cases of Siblings and a Surgical Case of Stereotactic Biopsy

Adult-onset leukoencephalopathy with axonal spheroids and pigmented glia encompasses hereditary diffuse leukoencephalopathy with axonal spheroids and pigmented orthochromatic leukodystrophy. We describe the clinicopathological and genetic findings of three patients with this disorder. All patients presented with dysarthria, with or without cognitive decline. The first and second patients were siblings who died of the disease at ages 42 and 54, respectively, while the third patient has been bedridden. Brain magnetic resonance imaging revealed T2 hyperintensities in the subcortical and periventricular white matter. Pathological diagnosis was established by brain autopsy in cases 1 and 2, and a stereotactic brain biopsy in case 3, followed by genetic analysis of colony stimulating factor-1 receptor gene. A heterozygous c.2345G > A (p.R782H) variant was identified in the autopsy-proven cases, and a c.1765G > A (p.G589R) variant in the biopsy-proven case. Postmortem examination revealed severe white matter degeneration involving the bilateral frontoparietal lobes, but sparing the subcortical U-fibers. All cases revealed widespread loss of myelinated axons in the white matter lesions; however, axonal spheroids and pigmented macrophages were abundant in cases 1 and 3 and much less in case 2. Adult-onset leukoencephalopathy with axonal spheroids and pigmented glia should be considered in patients with presenile dementia and diffuse white matter lesions.

A case of Pathological Laughter in a patient with recurrent stroke

Introduction Stroke survivors frequently deal with neuropsychiatric sequelae - depression, anxiety and apathy being the most common ones. Pathological laughing and crying (PLC) is a post stroke condition characterized by brief, intense uncontrollable crying and/or laughing due to a neurological disorder. Prevalence of PLC post stroke has been reported to be 15-20%. Pathological laughter (PL) is commonly associated with bilateral or diffuse cerebral lesions. Ischemic injury involving the internal capsule and basal ganglia seems to be associated with emotional disorders. Objectives To discuss an uncommon case of pathological laughter developing after recurrent infarct. Methods A 32-year-old male patient presented to the medical emergency for complaints of slurring of speech since 7 hours. On examination, patient was alert, oriented, with blood pressure 150/90 mmHg. He had a history of similar stroke 2 years prior to current complaints and was on treatment for hypertension since then. Baseline investigations were done. MRI brain revealed acute lacunar infarcts in bilateral ganglio-capsular region, chronic small vessel ischaemic changes in B/L periventricular white matter (Fazeka grade 2) and micro-haemorrhages in various brain regions. Patient was managed conservatively (antiplatelets, statins, antihypertensives). Patient was then referred to Psychiatry department for uncontrollable laughing spells, which started few hours after onset of above complaints. These occurred without any provocation, every 1-2 hours, lasting for several seconds to a minute, and relieved spontaneously. Patient was aware of episodes and found them embarrassing socially. Mental status examination revealed no mood features or other abnormalities. Patient was prescribed Escitalopram, but shifted to homeopathic medicine and was lost to follow up. Telephonic interview one year later revealed that while other complaints have remitted, patient still has laughing spells of similar quality and frequency. Results Discussion: In post stroke PLC, pathological crying represents about 80% cases, while Pure Pathological Laughing, as in the present case, is uncommon. It is generally seen in diffuse CNS pathologies (eg. multiple sclerosis) or bilateral – ischaemic or degenerative. In case of strokes, PL may herald symptom onset, or may immediately follow focal deficits. The aetiology of PLC is unknown; monoaminergic neurotransmission may be altered in post stroke PLC. SSRIs are regarded as first choice treatment agents, given their greater tolerability overall. Conclusions Pathological laughter is a comparatively uncommon but recognisable and treatable post stroke sequela, more commonly seen in bilateral lesions. Patients often describe PL as distressing and socially disabling, but awareness about this condition and available treatments is lacking. Disclosure of Interest None Declared

Abstract Number ‐ 91: A Case of Complex Giant Neck Arteriovenous Malformation Treated with Endovascular Embolization

Introduction Arteriovenous malformations (AVM) of the head and neck are vascular malformations composed of a cluster of connecting arteries and veins that form a central nidus without an intervening capillary network1. They make up 1.5% of vascular malformations and more than 90% of AVMs are located intracranially1. Extracranial AVMs are predominantly located in the head and neck and can manifest with pain, ulcerations, fatal hemorrhage, airway compromise, and cosmetic aberrations1,2. Methods We present a case of a 21 year old female with a medical history of multiple suspected neck hemangiomas status post microsurgical and laser resections, with a surrounding port wine stain, who presented to the hospital with growth of one of her posterior neck hemangiomas during and after pregnancy. In the postpartum period she reported increasing neck pain and persistent bleeding from the site. Initially, she was hemodynamically stable and her neurologic exam did not show any focal deficits. She underwent computed tomography angiogram of her neck which showed an extensive dorsal neck AVM with multiple arterial supplies frombranches of the bilateral subclavian, vertebral, and external carotid arteries.Her lesion continued to bleed with a precipitous drop in hemoglobin requiring blood transfusions. Subsequently, she underwent urgentpercutaneousN‐butyl‐2‐cyanoacrylate (n‐BCA) embolizationand endovascular onyx embolization of a left thyrocervical trunk branch.The procedure was completed without complications. Months later, she developed skin exfoliation and underwent successful elective embolization involving vertebral artery branches. This, to reduce profuse venous shunting in the paravertebral venous plexus, avoiding long term spinal cord injury. Results The management of complex head and neck AVMs is both challenging and complex. They may pose significant bleeding risk and can become infiltrative within surrounding tissue3. AVMs may be classified as either focal or diffuse. Focal lesions may be curable with resection, whereas diffuse lesions pose a significant challenge, with relapse in 90% of cases3. Head and neck AVMs require expert management and a multidisciplinary approach. The team may consist of neurosurgery, neuro‐endovascular,plastic surgery, and dermatology services. Treatment options include medical management, surgical resection, endovascular and percutaneous embolization. Percutaenous n‐BCA embolization is employed to prevent hemorrhage during surgical resection, or stabilization in acute hemorrhage4,5. This holds especially true when an endovascular approach is difficult; typically due to tortuous vasculature5. Treatment may require a staged target approach, with endovascular or percutaneous embolization prior to surgical excision. Conclusions This case highlights the complexities of AVM management and the multidisciplinary approach necessary, to provide optimal care. In this case, we believe that pregnancy could have contributed to the overall change in aggressive nature of the AVM. The patient underwent emergent percutaneous and endovascular embolization to prevent life threatening hemorrhage followed by palliative embolization to avoid long term cervical spinal cord injury due to venous hypertension.

SUBCUTANEOUS NODULES WITH A GROUND GLASS ASPECT

Polyarteritis nodosais a necrotic systemic vasculitis, it can manifest in its cutaneous form through ulcero-nerotic lesions with no other systemic manifestations. We report the case of a 73-year-old woman admitted for diffuse multifocal cutaneous lesions seen clinically and on CT scan corresponding to polyarteritis nodosa.

Finger Pain as an Uncommon Primary Manifestation of Lung Carcinoma

A 54-year-old patient presented with progressive pain for one month in the second finger of the right hand with an emphasis on the proximal interphalangeal (PIP) joint. Subsequent magnetic resonance imaging (MRI) showed a diffuse intraosseous lesion at the base of the middle phalanx with destruction of the cortical bone and extraosseous soft tissue. An expansively growing chondromatous bone tumor, e.g., a chondrosarcoma, was suspected. After incisional biopsy, the pathologic findings finally revealed, surprisingly, a metastasis of a poorly differentiated non-small cell adenocarcinoma of the lung. This case illustrates a rare but important differential diagnosis for painful finger lesions.

Effectiveness of arthroscopic excision based on the distribution of the tenosynovial giant cell tumor around knee joint

BackgroundThe mainstay treatment for tenosynovial giant cell tumor (TGCT) is open excision. However, open excision is associated with the risk of stiffness, infection, neurovascular injury, and prolonged hospital stay and rehabilitation. The purpose of this study was to evaluate the efficacy of arthroscopic excision of tenosynovial giant cell tumor (TGCT) of the knee joint, including the diffuse type of TGCT. MethodsPatients who underwent arthroscopic excision of TGCT between April 2014 and November 2020 were retrospectively analyzed. TGCT lesions were divided into 12 distributions (nine intra- and three extra-articular lesions). The distribution of TGCT lesions, portals used, degree of excision, recurrence, and magnetic resonance imaging (MRI) scans were evaluated. The prevalence of intra-articular lesions in diffuse TGCT was also analyzed to validate the existence of a connection between intra- and extra-articular lesions. ResultsTwenty-nine patients were included in the study. Fifteen patients (52%) had localized TGCT, and 14 patients (48%) had diffuse TGCT. The recurrence rates for localized, and diffuse TGCT were 0%, and 7%, respectively. Intra-articular posteromedial (i-PM), intra-articular posterolateral (i-PL), and extra-articular posterolateral (e-PL) lesions were found in all patients with diffuse TGCT. The prevalence rates of i-PM and i-PL lesions among e-PL lesions were both 100% (p = 0.026 and p < 0.001, respectively). Diffuse TGCT lesions were managed with posterolateral capsulotomy and viewed from the trans-septal portal. ConclusionsArthroscopic excision of TGCT was effective in both localized and diffuse TGCT. However, diffuse TGCT was associated with posterior and extra-articular lesions. Therefore, technical modification such as posterior, trans-septal portal, and capsulotomy were required. Study designRetrospective case series; level Ⅳ.

Diagnosis, treatment, and potential causative mutations of cryptogenic plastic bronchitis.

Diagnosis, treatment, and potential causative mutations of cryptogenic plastic bronchitis.

Clinical Efficacy of Levonorgestrel Releasing Intrauterine System versus Dienogest for Women having Symptomatic Adenomyosis

Introduction: Adenomyosis is a common, estrogen-dependent, a benign gynaecological disease characterized by endometrial glands and stroma invading, implanting, and proliferating within the myometrium to form diffuse or localized lesions. Adenomyosis is common in women of childbearing age. The signs and symptoms include dysmenorrhea, menorrhagia, abnormal uterine bleeding, enlarged uterus, dyspareunia, and infertility, which can seriously affect the patient’s quality of life. The prevalence of adenomyosis varies widely from 5% to 70%, depending on the method used for diagnosis and the rate of diagnosis during hysterectomy is approximately 20– 30%. Aim of the Study: The aim of this study was to evaluate and compare the effectiveness between LNG-IUS and Dienogest among the woman with symptomatic adenomyosis. Methods: This was a randomized controlled trial and was conducted in the Department of Reproductive Endocrinology and Infertility, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka, Bangladesh during the period from July, 2021 to June, 2022. We included 20 patients with symptomatic adenomyosis diagnosis confirmed by transvaginal ultrasound in this study. All patients were divided by sequentially numbered sealed opaque envelops into two groups- Group A (who received LNG-IUS) &amp; Group B ( who received dienogest). Among of 20 patients, 10 were in each group. Group A patients received LNG-IUS and group B patients received tablet dienogest(2mg) daily. VAS (visual analog scale) score, amount of uterine bleeding was assessed and uterine volume was measured by transvaginal ultrasound 3 months later. Result: In total 20 patients from both the groups completed the study. In our study we found majority of our patients (75%) were aged between 25 to 34 years old and 25 % were aged between 35 to 45 years old. We found the Mean ± SD of age was 34.80 ± 3.79 &amp; 28.60 ± 3.17 respectively in group A &amp; B. In group A and group B the mean of VAS at baseline &amp; 3rd month was 9.10 ± 0.84 &amp; 1.10 ± 1.10 and 8.75 ± 1.14 &amp; 4.30 ± 2.41 respectively. At baseline the uterine volume was 268.08 ± 118.28 &amp; 202.32 ± 117.76 and at 3rd month was 210.10 ±105.49 &amp; 202.77 ± 118.33 among group A &amp; B respectively the mean of hemoglobin level was 10.87 ±1.42 &amp;10.82±0.64 at base line and 11.57 ±1.33 &amp; 11.09± 0.53 after 3rd months in group A and group B respectively. Before treatment heavy menstruation was found 80% &amp; 80% in group A &amp; B respectively. After 3rd month correction of heavy menstruation was found 100% in group A. Among them amenorrhea was found 20% and regular menstruation was found 80%. Correction of heavy menstruation was found 50% in group B. Among them amenorrhea was found 20% and regular menstruation was found 30 %. Conclusion: In our study, we tried to evaluate the effects of LNG-IUS and dienogest on patients with symptomatic adenomyosis. We found that LNG-IUS is a useful tool for HMB and dysmenorrhea in women of all ages. In this study the LNG-IUS is proved to be an effective approach compared to dienogest to treat adenomyosis. Its use effectively reduced the severity of symptoms including heavy menstrual bleeding and dysmenorrhoea, uterine volume and improved laboratory outcomes.

High thrombotic risk is associated with higher prevalence of suboptimal stent results in patients with high bleeding risk

Abstract Funding Acknowledgements Type of funding sources: None. Background Shorter duration of dual antiplatelet therapy after drug-eluting stent implantation is required in patients with high bleeding risk (HBR) irrespective of the presence of concomitant high thrombotic risk (HTR). The prevalence of post-stent suboptimal findings in patients with HBR remains unclear. Purpose To clarify the prevalence of post-stent suboptimal findings assessed by optical coherence tomography (OCT) in patients with HBR according to the presence of HTR. Methods A total of 607 consecutive patients with stable coronary disease, who underwent OCT imaging of the culprit lesion were included. HBR was defined based on the Academic Research Consortium for High Bleeding Risk (ARC-HBR). HTR was defined as lesions with diffuse long (≧60 mm), treated with more than three stents, chronic total occlusion or diffuse long lesion (≧32 mm) in patients with diabetes mellitus. Post-stent suboptimal OCT criteria was defined as minimum stent area (MSA) &amp;lt;4.5 mm2, edge dissection and stent malapposition. Results The prevalence of HBR was 55.8%. The prevalence of HTR was significantly higher in patients with HBR than in those without HBR (35.0 vs. 26.6%, p=0.028) (Figure A). Among patients with HBR, the prevalence of post-stent suboptimal OCT criteria was significantly higher in patients with HTR than in those without HTR (86.2 vs. 64.7%, p&amp;lt;0.001), mainly due to the higher prevalence of MSA &amp;lt;4.5 mm2 (Figure B) in patients with HTR. Conclusions HTR was associated with a higher prevalence of post-stent suboptimal findings among patients with HBR. The present results may suggest the importance of optimal stenting in patients with HBR, particularly in those with concomitant HTR.

Exfoliative Cytology and Genetic Analysis for a Non-Invasive Approach to the Diagnosis of White Sponge Nevus: Case Series

White Sponge Nevus (WSN) is a rare benign disorder associated with mutations in genes coding for cytokeratin 4 (KRT4) and 13 (KRT13) characterized by dyskeratotic hyperplasia of mucous membranes. This study was aimed at examining different approaches (cytology, pathology and genetic analysis) to WSN diagnosis. A series of four patients with asymptomatic white diffuse oral lesions were evaluated and, before performing an incisional biopsy for pathology, an oral brush Thin Prep was collected for exfoliative liquid-based cytology (LBC). DNA for genetic analysis was also obtained from patients and both their parents, using buccal swabs. Pathology and cytology showed similar results, leading to the same diagnosis of hyperkeratotic epithelium with acanthosis and spongiosis, without atypia, demonstrating the efficiency of LBC for the differential diagnosis. Sequencing analysis revealed at least 6 rare variants in the KRT4 and KRT13 genes in each patient, contributed in part by both unaffected parents. Thin Prep for oral exfoliative cytology and genetic analysis are sufficient for an accurate diagnosis of WSN. The combination of cytological and genetic analyses could substitute the histologic exam, providing a non-invasive alternative for incisional biopsy.

Multiple pulmonary masses with diffuse cystic lesions

A 50-year-old female patient, presenting with a past history of Reynaud's syndrome, xerostomia and xerophthalmia, was admitted to Fujian Provincial Hospital because of coughing for 10 days and left anterior chest pain for 1 day. Chest imaging showed multiple nodules and masses, and diffuse cystic lesions in both lungs. Based on the differential diagnosis of multiple pulmonary masses and diffuse cystic lesions respectively, autoantibodies, radionuclide dynamic imaging of the parotid, positron emission tomography-CT, CT-guided percutaneous transthoracic needle biopsy, and other examinations were performed. The diagnosis of diffuse large B-cell lymphoma stage ⅣA (lung, parotid gland) and Sjögren's syndrome was confirmed. By analyzing the imaging features and pathogenesis in detail, the diffuse cystic lesions of both lungs were considered to be related to lymphocytic interstitial pneumonia caused by Sjögren's syndrome. The pulmonary space-occupying lesions in the lungs were significantly absorbed after RCHOP regimen for lymphoma.

High-resolution diffusion-weighted imaging compared with conventional diffusion-weighted imaging and dynamic contrast-enhanced magnetic resonance imaging with regard to image quality and assessment of breast cancer morphology

To evaluate the image quality and tumor morphology depiction ability of high resolution (HR) diffusion- weighted imaging (f-DWI) in comparison to conventional DWI (c-DWI) and dynamic contrast- enhanced magnetic resonance imaging (DCE-MRI) in the primary breast cancer setting. The f-DWI, c-DWI, and DCE-MRIs of 160 malignant breast masses were evaluated retrospectively by two independent radiologists. Data on image quality [sharpness, distortion, and perceived signalto- noise ratio (SNR)], apparent diffusion coefficient (ADC) value, lesion size, and tumor morphology (shape, margin, and internal pattern) obtained on f-DWI, c-DWI, and DCE-MRI were compared. Consistency between the readers and imaging methods for morphological parameters was analyzed. The ADC values measured on f-DWI were significantly lower than those measured on c-DWI for both readers (P < 0.001 for each), whereas mean lesion size was significantly larger in c-DWI than in f-DWI and DCE-MRI for both readers (P < 0.001 for each). Higher consistency values were obtained for f-DWI compared with c-DWI when correlated with DCE-MRI for each morphological parameter. The least distorted images were obtained using DCE-MRI compared with c-DWI and f-DWI for both readers, whereas the highest distortion scores were obtained using c-DWI. Sharpness and perceived SNR scores were rated as significantly higher for f-DWI and DCE-MRI images compared with c-DWI by both readers (P < 0.001 for all). The concordance between c-DWI and DCE-MRI was fair to slight (κ = 0.15 to 0.41), whereas concordance between f-DWI and DCE-MRI was significantly better (κ = 0.68 to 0.87) for each reader and for all morphological parameters (P < 0.001). The highest concordance between the readers was achieved in margin assessment (κ = 0.87 to 0.89) regardless of the MRI method, followed by shape and internal pattern parameters (κ = 0.63 to 0.79). The results demonstrated that f-DWI produces higher-quality images than c-DWI, enabling the morphological features to be identified in similar detail to that offered by HR DCE-MRI. Accordingly, f-DWI, as a method that highly correlates with DCE in determining the morphological characteristics of breast cancers, seems to have potential in the evaluation of breast tumors in patients for whom the use of contrast media is contraindicated.

Comparison of outcomes between single long stent and overlapping stents: ameta-analysis of the literature.

There is no consensus on whether to treat diffuse coronary artery lesions with asingle long stent (SLS) or by overlapping two or more stents (OLS). The goal of this review was to compare the outcomes of these two approaches through ameta-analysis of the literature. We searched for relevant studies in MEDLINE, Scopus, EMBASE, Google Scholar, and the Cochrane Library. Our meta-analysis included 12studies (n = 6414) that reported outcomes during the follow-up period. Individuals who received OLS had agreater risk of cardiac mortality and target lesion revascularization (TLR) than those who received SLS (RR: 1.51, CI: 1.03-2.21, p = 0.03, I2 = 0% and RR: 1.64, CI: 1.02-2.65, p = 0.04, I2 = 38%, respectively). The fluoroscopy period in the OLS group was longer than in the SLS group (SMD: 0.35, CI: 0.25-0.46, p < 0.01, I2 = 0%). more contrast volume was sued for the OLS group; however, there was substantial variability in the pooled analysis (I2 = 95%). In terms of all outcomes, there were no differences between stent generation types. In the first meta-analysis of mainly observational data comparing OLS vs. SLS for long coronary lesions, OLS had higher rates of cardiac mortality and TLR as well as longer fluoroscopy times compared to SLS.

Post-traumatic epilepsy in Cameroon: a retrospective study in a referral hospital

BackgroundPost-traumatic epilepsy is defined as the onset of at least one seizure beyond the first week following a traumatic brain injury (TBI). High prevalence of TBI in our setting may contribute to the burden of epilepsy in adult population. This is a retrospective review of medical records of patients admitted from January 1st, 2010 to December 31st, 2019) at Douala General Hospital. We included patients aged ≥ 18 years with seizure onset at least one week after TBI. Incomplete files and previously known epilepsy were excluded. Data on sociodemography, clinical and para-clinical features, treatment and outcome were analysed using R software version 36.2.ResultsWe finally included 65 patients with post-traumatic epilepsy among 993 medical records of epilepsy. The mean age was 35.1 ± 12.6 years, with 64.6% of male. Road traffic accident was the main aetiology of brain trauma (78.5%), resulting in haemorrhagic contusions (21.5%), sub-dural haematoma (15.4%), and diffuse axonal lesions (15.4%) mainly. Seizure onset was within 2 years post-trauma in 73.8% of cases. Generalized tonic–clonic seizures were the commonest seizure’s type. Electroencephalogram was abnormal in 81%, including 47% of focal discharges. Antiepileptic drugs were mainly sodium valproate, carbamazepine, and phenobarbital. Seizure freedom was obtained in 67.7% of cases.ConclusionsPost-traumatic epilepsy is a heterogeneous, frequent and often disabling complication of traumatic brain injury. Road traffic accident is the main cause of brain trauma. It affects a young and active population. About half of cases presented GTCS. With antiepileptic drugs, more than two-thirds of patients become seizure-free.

Multiple myeloma with disseminated sclerotic lesions mimicking metastatic bone lesions; a rare case series

Background: Lesions characterized by myeloma are lytic lesions surrounded by sclerosis. Diffuse or wide-length sclerotic bone lesions associated with myeloma are infrequent. Case presentation: Two men, 70 and 72 years old, were referred from oncology to hematology for diffuse, large-length sclerotic bone lesions. Their findings were interpreted as having bone metastasis of primary cancer in orthopedics, internal medicine, and oncology due to diffuse sclerotic bone lesions found incidentally during the examinations performed for another reason. The probable causes (prostate, lung, and gastrointestinal cancer) of metastasis were investigated, and they were referred to hematology after a nearly 2-month examination period. Conclusion: The remarkable extensive sclerotic bone lesions may mask the myeloma and may not be considered in the differential diagnosis. However, these cases had the typical clinical findings and laboratory results of MM, except for bone disease. Therefore, we aimed to highlight this issue.

In-hospital results of coronary artery bypass grafting with arterial conduits in patients with diffuse coronary artery lesion

In-hospital results of coronary artery bypass grafting with arterial conduits in patients with diffuse coronary artery lesion

RELATO DE CASO: SINDROME DE KLIPPEL-TRENAUNAY

INTRODUCTION: Klippel-Trenaunay syndrome (KTS) is a rare congenital disease, characterized by the triad: capillary malformations that manifest as port wine stain, typically venous varicosities, bone and soft tissue hypertrophy. CASE REPORT: LFRR, term newborn weighing 3360g, male, cesarean delivery due to imminent eclampsia (G3P2C0). Apgar score 9/9 with physical examination showing left lower limb with port wine stain, increased volume and diffuse violaceous lesions extending from the toes to the buttocks, palpable and symmetrical peripheral pulses. DISCUSSION: KTS management does not have a wellestablished consensus, and conservative treatment can be performed using non-invasive measures (elastic or non-elastic compressive stockings) associated or not with psychological support, elevation of the affected limb and physiotherapy. Active conducts such as sclerotherapy can be used in small areas, as well as the use of laser therapy on port wine stains and ulcerations. Sirolimus may be a promising therapeutic option for the management of venous malformations, including KTS, leading to an improvement in symptoms such as pain and a decrease in the size of the lesions. CONCLUSION: KTS, as a rare syndrome, has scarce literature. The main management is based on the use of conservative therapies, others related to the complications presented and now begins the phase of using off-label drugs (Sirolimus) that slow down the progression of the disease.

Diagnostic edge of SPECT/CT scintigraphy over planar bone imaging for detection of bone metastases in prostate cancer patients

Background: Bone scintigraphy with 99mTc-labelled diphosphonates can identify prostate cancer (PCa) bone metastases with high sensitivity but relatively low specificity. Single photon emission computed tomography /computed tomography (SPECT/CT) can add value to the planar bone scintigraphy in the detection of bone metastases. Case presentation: We present a diagnosed case of Prostatic Adenocarcinoma of a 62 year old male patient who underwent 99mTc-Methyldiphosphonate (MDP) planar bone scintigraphy followed by SPECT/CT as a part of staging algorithm. Planar bone imaging showed homogeneous and symmetrical tracer uptake throughout the visualized skeleton. As the patient had complaints of urinary obstruction and severe backache: so, the sacrum could not be adequately assessed on planar bone imaging; therefore SPECT/CT of lumbar spine and pelvic region was performed. His regional SPECT-CT study of the lumbar and pelvic region, revealed widespread diffuse tracer avid osteoblastic lesions throughout the visualized lower lumbar spine, sacrum, pelvis and proximal femori, suggestive of skeletal metastases. Conclusion: We conclude that SPECT/CT scintigraphy has a diagnostic edge over planar bone imaging in detecting bone metastases in prostate cancer patients.