Healthy Man Research Articles

Sudden Ankle Pain in a Healthy Young Man

Sudden Ankle Pain in a Healthy Young Man

Different femoral tunnel placement in posterior cruciate ligament reconstruction: a finite element analysis

BackgroundAt present, there is no consensus on the optimal biomechanical method for Posterior cruciate ligament (PCL) reconstruction, and the “critical corner” that is produced by the femoral tunnel is currently considered to be one of the main reasons for PCL failure. Thus, the purpose of this study was to identify one or several different tunnels of the femur, thereby reducing the influence of the "critical corner" without reducing the posterior stability of the knee.MethodsCT and MRI data of the knee joint of a healthy adult man were collected, and computer-related software was used to reconstruct the finite element model of the knee joint, to provide different properties to different materials and to allow for the performance of a finite element analysis of the reconstructed model. The position of the femoral tunnel was positioned and partitioned according to anatomical posture, and three areas were divided (the antero-proximal region, the antero-distal region and the posterior region). In addition, we applied a posterior tibial load of 134 N to the reconstructed model, recorded and compared different tunnels of the femur, conducted peak stress at the flexion of the knee joint of 0°, 30°, 60° and 90°, and elicited the displacement of the proximal tibia.ResultsAmong the 20 different femoral tunnels, the graft peak stress was lower in tunnels 4, 12 and 18 than in the PCL anatomical footpath tunnel 13, especially at high flexion angles (60° and 90°). These three tunnels did not increase the posterior displacement of the proximal tibia compared with the anatomical footpath tunnel 13.ConclusionIn summary, among the options for PCL reconstruction of the femoral tunnel, the tunnels located 5 mm distal to the footprint and 5 mm anterior to the footprint could reduce the peak stress of the graft; additionally, it may reduce the "critical corner" and was shown to not reduce the posterior stability of the knee joint.

Immune Thrombocytopenia Secondary to Pleural Tuberculosis: A Case Report

Immune thrombocytopenia associated with tuberculosis is a rare clinical entity. We report immune thrombocytopenia associated with pleural tuberculosis in a 22-year-old Ethiopian previously healthy man who presented to the emergency department with one-month history of fever, night sweats and productive cough. Chest x-ray showed right pleural effusion and pleural biopsy was performed. During his stay in the hospital, his platelets count dropped persistently until reach 16000/μL. pleural biopsy results were consistent with pleural tuberculosis. The patient was diagnosed with pleural tuberculosis associated with immune thrombocytopenia. The patient received antituberculosis treatment, immunoglobulins, and steroid. After completion of antituberculosis treatment, the patient was seen in the clinic he was doing well, and his platelets count was 276000/μL.

Pneumocephalus and Pneumomediastinum from Compressed Air Injury to Conjunctiva

A 30-year-old healthy man presented with bilateral eye swelling and chest and neck pain after compressed air gun injury to the right eye. He had normal ocular vitals with best-corrected visual acuity (BCVA) 20/30 and intraocular pressure of 17 mmHg by tonometry. Anterior segment examination showed multiple conjunctival lacerations as the only point of entry and loculated subconjunctival emphysema (A). Fundus examination was unremarkable. Air presumably tracked through multiple structures leading to orbital emphysema, pneumocephalus (B), and subcutaneous emphysema causing pneumomediastinum extending to the diaphragm (C-D). He was given erythromycin ointment, ocular lubrication, and systemic antibiotics. At follow-up, BCVA was 20/20 with healed conjunctival abrasions and resolution of systemic sequela (Magnified version of Figure A-D is available online at www.aaojournal.org).

The Perplexing Mental Health Comorbidity of Alice in Wonderland Syndrome (AIWS): A Case Study

The Alice in Wonderland Syndrome (AIWS) is an unusual and uncommon condition that falls under the umbrella of neurology and psychiatry. It is characterized by the presence of complex perceptual and visual discord. Additionally, there are visual hallucinations that are multi-dimensional. This syndrome was first described by John Todd in the 1950s, and it was loosely based on the book Alice in Wonderland. A man in his 30s arrived at his doctor’s appointment with a chief complaint of a pounding cluster headache that lasted over a full day. In addition, he mentioned that there was an aura preceding his headaches. The pain was so intense, it was debilitating him from routine activities. Before the headaches, he explained that he would sense bizarre physical and visual behaviors. During these episodes, he explained that things around him appeared distorted and of various sizes. Things in his room appeared to be more distant than they really were and larger in size (macropsia and micropsia). He described the fingers on his right hand to be much smaller compared to his left hand (micropsia). Objects around him were deformed and distorted (metamorphopsia). His symptoms lasted 45 minutes. He did not suffer from any previous headaches or hallucinations. He was a healthy man with a clean bill of health as per his medical records. Upon examination, the attending physician described the patient as alert, oriented to time and place, and under no obvious distress. All labs performed returned normal including a 10-panel drug test. These were tested to see if he was under the influence of any narcotic, stimulant, or other substances. The physician prescribed 500 mg of valproic acid to take daily. Three months later during his follow-up, he mentioned his symptoms had subsided but were still present. His dose was again increased to 1000 mg/day, eventually stopping all further symptoms from surfacing. He has not had another episode in three months. The Alice in Wonderland Syndrome is known to be associated with headaches with preceding auras. It is common in the pediatric and adult populations. In this paper, I introduce a case of a patient who displays migraines with preceding auras, indicative of AIWS.

Cardiobacterium hominis Endocarditis in a Healthy Adult - Rare but Not to Be Missed

Cardiobacterium hominis is part of HACEK group and an atypical cause of infective endocarditis. It may cause similar clinical presentation to other cause of endocarditis. Establishing the diagnosis is challenging as it is a fastidious organism which rarely affects individual without previous cardiac lesion and requires advanced diagnostic tools for identification of species. A 23-year-old previously healthy man presented with intermittent fever for two months associated with palpitations and lethargy. He had undergone a dental procedure four months before the presenting symptoms. Physical examination revealed a pansystolic murmur best heard over the apex. Three aerobic blood culture bottles were positive and Gram stain consistently showed pleomorphic Gram-negative rods. The organism grew as tiny pin-point opaque colonies on sheep blood agar and chocolate agar after 48 hours of incubation but no growth was seen on MacConkey agar. Unsuccessful identification with VITEK 2 NH and VITEK 2 GN was later confirmed by polymerase chain reaction as C. hominis. He was treated with a six-week course of antibiotics.

Tinea penis - retka lokalizacija dermatofitne infekcije

Background/Aim: Dermatophyte infection of male genitalia is not common and the aim of this paper is to show the rare localization of this disease on the shaft of the penis in a healthy man. Case report: We present a 34-year-old man with pruritic annular erythematous scaly patch on the shaft of the penis. There are no other skin lesions. Sample preparation of changes from the body of the penis made with the addition of potassium hydroxide is positive, and culture revealed Trichophyton mentagrophytes. The patient was treated with a topical antifungal therapy for two weeks and skin lesions resolved. Conclusion: Although genital localization of dermatophyte infection is rare, this disease should be considered, diagnosed and treated early otherwise it may become a focus for recurrent fungal infections.

Facing the Unknown: Idiopathic Giant Cell Hepatitis

Giant cell hepatitis is a rare infiltrative disease associated with several viruses, drugs, malignancies, and autoimmune conditions. To date, treatment aims at controlling the underlying etiology, and there are limited data on the clinical course and treatment of idiopathic cases. We present a case of idiopathic giant cell hepatitis in an otherwise healthy adult man and review the literature regarding treatment and outcomes in this population.

A case of left leg necrotizing fasciitis caused by streptococcus pyogenes in a healthy Japanese man.

•We experienced a case of necrotizing fasciitis (NF) due to Group A streptococcus in a healthy Japanese man.•Cutaneous manifestations with NF can be initially minimal.•It is important to recognize that one of the characteristic symptoms of NF is severe pain out of proportion.•When NF is suspect, emergent surgical exploration and debridement are required.

Retinal pigment epithelium tear in an idiopathic acute onset bullous central serous chorioretinopathy

Although retinal pigment epithelium (RPE) tears are common in patients with chronic conditions such as exudative age-related macular degeneration or may occur in response to anti-vascular endothelial growth factor or laser treatment, a spontaneous RPE tear can occur in patients with acute and new-onset bullous central serous chorioretinopathy (CSCR). We present a rare case of a healthy young Asian man with unilateral massive subretinal fluid (SRF). An idiopathic acute-onset bullous CSCR with an RPE tear was diagnosed through ancillary examinations. This patient exhibited good visual recovery as indicated by foveal sparing, spontaneous resolution of SRF, and the lack of a need for unnecessary surgery.

Endoscopic observation of a rare duodenal tumor.

A 30-year-old young previously healthy man presented to our hospital with middle and upper abdominal discomfort. Abdominal computerized tomography (CT) showed no significant abnormalities. White light endoscopy showed the local mucosa in the descending part of the duodenum had granuloid uplift, some of which were fused into pieces with red color, and some other areas showed fading tone. Magnifying endoscopy with indigo-carmine staining and narrow-band imaging showed a finger-like, loose villous structure with irregular microvessels on the surface. Pathological examination of biopsy specimens showed that lymphocytes were diffused and dispersed in the mucosa with relatively simple morphology, no lymphoid follicles were observed, and local compression was obvious. Immunohistochemical staining revealed a lymphoid population highly positive for CD20 and CD10. These results were consistent with duodenal-type follicular lymphoma (D-FL).

Virtual reality visualization of the right and left heart chambers anatomical position

Objective(s). To create a normal heart virtual model and visualize the anatomical position of the right and left chambers.
 Methods. The material for the investigation was cardiac CT scan results of a young healthy man. From these data, a three-dimensional heart model was created and anatomical position of the right and left chambers investigated.
 Results. Three-dimensional model of a normally formed, normally located heart was created. Segmentation, rotation of the virtual model, virtual horizontal dissection at the level of the middle of the interventricular septum were carried out, the created model was rotated in virtual reality. It was found that in the anatomically correct position the right chambers of the heart are located in front, and the left chambers are located behind.
 Conclusion. Virtual heart reconstruction reproduces digital data taken from a living person, so virtual reality shows the functioning structure of the heart and its chambers. In the anatomical position of the heart, the right atrium and ventricle are located ventrally, and the left atrium and ventricle are located dorsally. It is advisable for morphologists, cardiologists, and surgeons to take into account the identified discrepancies between the terms and the actual location of the heart chambers.

The Reaction of Myocardial Capillaries to Crystalloid Cardioplegia of Different Durations in Patients with Valvular Pathology and Coronary Heart Disease

The aim. To study the morphological manifestations of the response of the myocardial capillaries to cardioplegia in patients with valvular defects and coronary heart disease.
 Materials and methods. Morphological research of operative and sectional material was carried out. Myocardium fragments for microscopical study were obtained from patients at different stages of an open-heart surgery and patients who died at the stage of conservative treatment without surgical intervention. Similar samples of the myocardium of a healthy young man who died from injuries incompatible with life were studied as a control. For electron microscopy study, samples of myocardium were taken from patients at the 185th minute of perfusion.
 Results. Histological preparations of the myocardium showed pronounced diffuse hypertrophy of cardiomyocytes (CMCs), sometimes at the stage of decompensation (perinuclear edema, loss of myofibrils, apoptosis). This transformation of CMCs was obviously related to their functional overload caused by combined defects of the mitral and aortic valves. Changes in muscle fibers were accompanied by interstitial and perinuclear fibrosis. In the pool of coronary arteries affected by atherosclerosis, signs of small focal coronary fibrosis were visible, as well as rough post-infarction scars in 3 patients. All the patients had signs of acute hypoxic damage to the myocardium in the form of CMCs shortening and interstitial edema.
 Conclusions. In patients with combined defects of the aortic and mitral valves of the heart with coronary artery disease, the phenomena of myocardial fibrosis prevail. Heart valve disease combined with coronary heart disease lead to the development of both alterative and compensatory-adaptiveprocesses in the vessels of the microcirculatory bed. The greatest loss of vital organelles in small vessels is observed at 185 min after administration of cardioplegic solution, irreversible changes develop 3 h after perfusion.

Peculiar form of rapidly progressive pneumonia in healthy man

Peculiar form of rapidly progressive pneumonia in healthy man

Partial Empty Sella Syndrome Presenting with Panhypopituitarism and Masked Central Diabetes Insipidus

Empty sella syndrome (ESS) is an uncommon cause of hypopituitarism. It is usually detected incidentally or with neurological symptoms whereas it is rare to present with symptomatic endocrine dysfunction. A 48-year old previously healthy man presented with generalized body weakness, lethargy, fatigue and pos­tural dizziness of one month with no headache or visual disturbance. He also had features suggestive of hypo­gonadism and hypothyroidism. Panhypopitutarism secondary to partial ESS was diagnosed based on pituitary hormone testing and MRI brain. After starting glucocorticoid (GC) replacement patient developed polyuria and polydipsia and was diagnosed to have partial central diabetes insipidus (DI). He was successfully treated with hydrocortisone, thyroxin, intranasal vasopressin and testosterone. ESS causes significant pituitary dysfunction in considerable proportion of patients.

126: A CASE REPORT OF ELECTRICAL STORM POST-COVID-19 VACCINATION

Introduction: Post-vaccination arrhythmia is reported as a possible cardiovascular side effect of COVID-19 vaccination. We present a case of ventricular tachycardia (VT) storm in a young healthy man following the 2nd dose of COVID-19 vaccination in the absence of underlying structural heart disease, myocarditis or arrhythmic syndromes. Description: A 38-year-old male with no medical history was admitted after an out-of-hospital cardiac arrest and found to be in VT storm within 24 hours of receiving his 2nd dose of COVID-19 vaccination. He received 4 shocks en route and had another episode of pulseless VT on arrival where Amiodarone was initiated. Laboratory values showed elevated inflammatory markers, and COVID tests were negative. Troponin peaked at 1.5 ng/ml. Initial transthoracic echocardiogram (TTE) revealed normal left ventricular ejection fraction (LVEF) without regional wall motion abnormality. On Day 2, he developed VT storm and was given magnesium sulfate, lidocaine and an additional bolus of amiodarone. Repeat TTE revealed a significant decrease in EF. He became hypotensive requiring inotropes and was emergently taken to the cath lab where intra-aortic balloon pump (IABP) and temporary transvenous pacing (TVP) were placed. Cardiac catheterization revealed normal coronary arteries, elevated left ventricular end diastolic pressure and mildly dilated LV with global hypokinesis and EF of 30%. His condition slowly improved without further occurrences of VT storm. Follow up TTE revealed normal LVEF, IABP and TVP were removed, and he was extubated. Cardiovascular magnetic resonance imaging showed no evidence of myocarditis with normal LV size. An automatic implantable cardioverter-defibrillator was placed. Genetic testing for Brugada syndrome was negative. Discussion: VT storm typically occurs with underlying structural heart disease, inherited arrhythmic syndromes or myocarditis, and is often difficult to identify a specific trigger. Although this is the first case report of VT storm occurring after the COVID-19 vaccine, it is important to note that the lack of a definitive test to diagnose myocarditis such as biopsy is a major limiting factor. This case report also supports the need for structured studies regarding a possible relationship between VT storm and COVID-19 vaccination.

A case of hydrocele repair: Legal aspect of consenting and post-operative complication

Introduction: The duties of a doctor are not only limited to providing medical treatment or surgical interventions to patients but also involve appropriate communication with them. Providing adequate information, addressing patients’ concerns, and respecting their decision making is all part of a doctors’ work ethics. The case describes a patient who had a hydrocele repair and developed early post-operative complications. The concern raised is whether adequate information regarding the procedure was given to the patient. Case Report: A 45-year-old medically healthy man was referred to the urology department by his general practitioner for an enlarging right-sided hydrocele. The main reason for seeking treatment was cosmetic. Due to the coronavirus (COVID-19) pandemic, he had a non-face-to-face urology clinic appointment only a few months later. After having discussed the various management options with the urologist, he opted to have a hydrocelectomy. On the day of the surgery, several months later, the operating surgeon consented the patient whereby he again explained the procedure and the associated risks. The surgery itself was uneventful, unfortunately, he developed early post-operative complications. He presented with increasing scrotal pain and swelling, features suggestive of an infected hematoma. He was managed conservatively with oral analgesia and antibiotics after which his symptoms improved. However, a Doppler ultrasound scan performed two weeks later, showed an avascular right testicle. He was immediately admitted to the hospital and was taken to theater for a scrotal orchidectomy. The outcome of the procedure was unexpected and even more undesirable cosmetically. The patient was dissatisfied and eventually lodged a formal complaint in the Patient Advice and Liaison Service (PALS). Conclusion: Post-operative complications can occur. However, providing patients with timely and adequate information ensures that the standard of care is met.

Neuroinvasive West Nile Virus Disease Presenting as Opsoclonus-Myoclonus-Ataxia Syndrome

Objective Describe a case of probable Neuroinvasive West Nile Virus (WNV) disease presenting as opsoclonus-myoclonus-ataxia syndrome (OMS). Background Opsoclonus-myoclonus-ataxia syndrome is a well described condition which is thought to be often of paraneoplastic or autoimmune etiology in adults. Specific pathogenic antibodies have yet to be identified in most cases. It can also be seen in association with CNS infections, although it is unclear if the pathophysiology aligns more with an infectious or a para-infectious process. Here we describe a clinical case where a patient presented with OMS, with CSF findings indicative of a diagnosis of Neuroinvasive West Nile Virus disease. Design/Methods Case Report. Results A 65-year-old previously healthy man presented with 3 weeks of progressive generalized tremors, oscillopsia and inability to ambulate. Exam revealed opsoclonus, stimulus-induced myoclonus, and generalized ataxia. CSF showed neutrophil-predominant pleocytosis (325 WBCs with 78 neutrophils), which converted 3 days later to lymphocytic predominance (44 WBCs with 36 lymphocytes). CSF cultures, meningitis/encephalitis multiplex PCR array, brain MRI with and without contrast, body PET-CT and serum autoimmune encephalopathy panel were unrevealing. CSF WNV IgG and IgM were elevated to 2 times and 5 times the upper limit of assay respectively, concerning for Neuroinvasive WNV disease. He received 5 days of intravenous methylprednisolone and immunoglobulins with clinical improvement, and had ultimate resolution of symptoms over the next 6 months. Conclusions WNV has been associated with a wide spectrum of movement disorders, and should be considered in the differential diagnosis, especially with CSF pattern as described above. Idiopathic and paraneoplastic opsoclonus-myoclonus-ataxia syndrome remains the most common subtype, however it is important to perform an evaluation for infectious etiologies as well to guide further management and counseling regarding outcome.

A Case of a Curious Skin Lesion

Question: A 30-year-old previously healthy man presented as a transfer from an outside hospital for 2–3 weeks of bullous ankle rash and new migratory arthralgias, Three weeks before presentation, he developed severe nontraumatic left-side shoulder pain of unclear etiology. He denied any inciting triggers, though noted he had removed a tick of unknown duration from his leg a month earlier. There were no rashes noted at that time. His shoulder pain progressed, and he subsequently developed left ankle and back pain. Along with the progression of pain, he developed an erythematous raised rash above his left medial malleolus, which developed purple bullae (Figure A) and then ruptured into a large open wound with purulent discharge (Figure B). He developed another pustular lesion on the medial surface of his left thigh which increased in size before rupturing into a similar wound (Figure C). He developed associated fevers up to 104°F. He was subsequently admitted to the general medicine service.

Digital Mucous Cyst: An Educational Image and Mini-Review

Background: Digital mucous cyst is a benign painless skin lesion most commonly observed on the dorsum of the terminal digits, and sometimes on the toes. The lesion generally solitary and less than 10 mm in diameter. It can be opalescent or has the color of the skin. Diagnosis of the condition can be established on clinical basis. Patients and methods: A healthy man who was born in 1983 consulted us about a small lump on the dorsum of the left thumb. Images are presented, diagnosis is described, and a brief educational review is presented. Results: The lump was painless and has been noticed more than two years ago. It was cystic in nature and located on the dorsum of the terminal phalanx of the left thumb. It was less than 10 mm in diameter. The diagnosis of digital mucous cyst was made. Conclusion: Although consensus has not been confirmed regarding the treatment of digital mucous cyst, small and asymptomatic lesion needs no further treatment or follow-up.