Painful Swelling Research Articles

Intravenous Carbazochrome Sodium Sulfonate Improves Visual Clarity in Patients Undergoing Arthroscopic Rotator Cuff Repair: A Randomised Controlled, Triple-Blinded, Prospective Study.

To investigate the clinical efficacy of intravenous carbazochrome sodium sulfonate (CSS) ,an oxidation substance of adrenaline,in improving visual clarity (VC), perioperative haemostasis, and anti-inflammatory effects during arthroscopic rotator cuff repair. This was a Single-Center,Single-Surgeon,Randomised Controlled, Triple-Blinded, Prospective Study,From August 2023 and August 2024,195 patients Undergoing Arthroscopic Rotator Cuff Repair were enrolled and randomly assigned to 3 groups: Group A received an intravenous infusion of CSS; Group B received an intravenous infusion of tranexamic acid (TXA); and Group C received an intravenous infusion of 0.9% sodium chloride.Patients with massive rotator cuff tear,frozen shoulder,hypertension,severe liver/renal dysfunction,long-term use of anticoagulants or antiplatelet drugs,bleeding disorders or severe cardiopulmonary diseases were excluded.After each surgery,a trained and independent evaluator assessed the clarity of images based on Visual Clarity Scale (VCS),and all related clinically Outcomes were recorded.The primary outcome was arthroscopic VC,The secondary outcomes were operative duration, irrigation fluid volume, discarded irrigation fluid red blood cell count, intraoperative mean blood pressure, inflammatory marker levels, haemoglobin levels, Visual Analog Scale pain scores, and shoulder joint enlargement rate. 195 patients were enrolled in total,and they were randomised into three groups:Group A(65 patients:21 male, 44 female; mean age=56.4 years),Group B(65 patients:29 male, 36 female; mean age=57.0 years),Group C(65 patients:24 male, 41 female; mean age=56.7 years)VC scale scores were not significantly different during an arthroscopic examination(5(4,5) vs 5(4,5) vs 5(4,5) , p=0.859),but Group A had higher scores than Groups B and C during subacromial(5(5,5) vs 4(3,4) vs 3(2,3.5),P <0.001) and rotator cuff repair(5(5,5) vs 4(3,4) vs 3(3,4),P <0.001). Group A showed significant advantages over Groups B and C in operative duration(50.4±8.0 min vs 66.4±13.7 min vs 70.2±17.4 min,P <0.001), intraoperative infusion volume(11338.5±1381.0ml vs 18483.1±1808.7ml vs 19047.7±1984.1ml,P <0.001), postoperative shoulder joint enlargement rate(8.2(3.0,11.7)% vs 14.1(9.2,18.1)% vs 15.4(13.8,16.3)%,P <0.001),and discarded infusion red blood cell count(12.6±2.3*109/L vs 19.6±2.0*109/L vs 20.4±2.2*109/L,P <0.001). On postoperative days (PODs) 1, 2, and 3, haemoglobin levels were significantly lower in Group C than in Groups A and B. Inflammatory marker levels on PODs 1, 2, and 3 were not significantly different between Groups A and B (P > 0.05) but were significantly lower than those in Group C (P < 0.05). A total of 157 patients (80.51% of the overall cohort) showed a change in Visual Analog Scale pain (VAS) scores that met the MCID threshold three days after surgery.VAS scores on PODs 1, 2, and 3 were lower in Group A than in Groups B and C (P < 0.05). No adverse drug reactions or surgical complications occurred in any patients. CSS can effectively improve VC, reduce perioperative blood loss, decrease the inflammatory response, alleviate early postoperative pain and shoulder joint swelling, and does not increase the incidence of adverse reactions and complications.

P-1703. Evaluation of Antibiotic Use for Dental Infections in Dental Clinics Associated with an Academic Safety Net Institution

Abstract Background In 2019, the American Dental Association (ADA) issued guidance on diagnostic criteria and appropriate antibiotic regimens for dental pain and swelling. Limited data exists on adherence to these guidelines. This study aimed to evaluate adherence to these guidelines within outpatient dental clinics. Figure 1 A flowchart for assessing antibiotic indication, selection, dose and duration adapted from the 2019 American Dental Association (ADA) guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intraoral swelling Methods We electronically identified all antibiotic prescriptions written by dentists in seven outpatient dental clinics in Denver Health, an integrated academic safety net institution, from July 2022 to November 2023. Detailed medical record review was performed for 200 randomly selected patients who were prescribed an antibiotic to examine antibiotic indication, selection, dose, and duration. Assessment of whether the prescribed regimens adhered to guidelines was conducted using a flowchart adapted from the ADA guidance (Figure 1). Results Forty-nine dentists dispensed a total of 1,874 prescriptions at 114,231 clinic visits (1.6% of visits). In the 200 patients whose medical records were reviewed, common prescription indications were irreversible pulpitis (15.8%), pulp necrosis with apical abscess (14.3%), caries (14.3%), and concern for post-operative infection (12.8%). Pain was noted in 85.2% of cases, with a median pain scale score of six. Due to incomplete documentation, 46.9% of prescriptions were deemed as "indeterminate" for guideline-directed indication. Only 5.6% of the documented cases met full indication criteria for antibiotic use per ADA guidance. Antibiotic selection was consistent with ADA guidance in 81.6% of cases; amoxicillin was the most prescribed antibiotic (79% of cases), followed by clindamycin (9.5%) and amoxicillin-clavulanate (8%). Durations of therapy were longer than recommended in ADA guidance in 23% of cases. In total, only 3.1% of prescriptions adhered to ADA guideline-directed antibiotic indication, selection, dose, and duration. Conclusion An antibiotic was prescribed in &amp;lt; 2% of dental clinic visits; while this rate aligns with previous literature, there is opportunity to improve adherence to ADA guideline-directed therapy for dental infections. Evaluation of effective stewardship interventions reinforcing these guidelines is warranted. Disclosures All Authors: No reported disclosures

Case report: Tongue metastasis as an initial sign of clear cell renal cell carcinoma and its prognosis

Clear cell renal cell carcinoma (ccRCC) is the most prevalent and lethal subtype of renal cell carcinoma (RCC), characterized by a poor prognosis and a high likelihood of distant metastasis. Nonetheless, metastasis of ccRCC to the tongue remains rare. Diagnosing and planning treatment for patients who initially present with tongue metastasis can be particularly challenging, as few cases have been reported in the literature. We present a case of a 62-year-old man who presented with a painful lump on the right anterior border of his tongue. Histological examination revealed lobulated and nested epithelial cell clusters with moderate dysplasia and frequent mitotic figures within the lamina propria. Immunohistochemistry showed positivity for vimentin, CD10, PAX-8, and epithelial membrane antigen (EMA), but negativity for PAX-2, calponin, S-100 protein, periodic acid-Schiff with diastase (PAS-D), P63, P40, and CK7, confirming the diagnosis of ccRCC metastasis to the tongue. After comprehensive evaluation and multidisciplinary team consultation, the patient underwent cytoreductive nephrectomy (CN), metastasectomy, and targeted therapy. According to the Response Evaluation Criteria in Solid Tumors (RECIST) Version 1.1, the patient maintained stable disease (SD) during systemic treatment. Unfortunately, treatment was discontinued due to adverse drug reactions, and the patient was transitioned to palliative care. His disease progressed to progressive disease (PD), and he ultimately succumbed to systemic infection, with a progression-free survival (PFS) of approximately 15 months. This case highlights the urgent need for improved therapeutic strategies to manage symptoms and prolong survival in patients with this rare metastatic presentation.

A Lady with Unilateral Painful Orbital Swelling with Possible Euthyroid Graves Ophthalmopathy

Background: Thyroid ophthalmopathy is one of the cardinal features of Graves’ disease. But it can also be found in patients with euthyroid, even with hypothyroid status. Case: A twenty-four years old unmarried, non-smoker lady came with complaints of right-sided proptosis for 4 months. The protrusion of her right eye was gradually increasing and there was continuous dull aching pain. There was no history of neck swelling, weakness, palpitation, excessive sweating, weight loss, or tremor. Investigations revealed that she was in euthyroid state but her antibody titer of thyroid stimulating hormone receptor antibody was found beyond the normal range. She was managed conservatively. Conclusion: Euthyroid Graves’ ophthalmopathy is usually a self-limiting condition. However, it can be vision-threatening if proper evaluation and early management are not done. The Journal of Ad-din Women's Medical College; Vol. 12 (2), July 2024; p 26-29

Canal of Nuck Cyst vs. Inguinal Hernia: A Case Report and Further Considerations

Background: Abnormalities in the canal of the Nuck are rare clinical entities with presentation in the early adulthood of females. Given their rarity, they can be misdiagnosed with a strangulated inguinal hernia. Methods: Herein, we report a young female with painful swelling of the right inguinal hernia and its surgical approach. Results: A 37-year-old female presented to the emergency department with pain in the right lower abdominal quadrant and an edematous inguinal mass. Physical examination showed a palpable inguinal mass, setting the suspicion for possible incarcerated inguinal hernia. Laboratory exams were within normal ranges. The patient was subsequently treated surgically. During the operation, a cystic well-rounded mass was identified and completely excised. The mesh and plug technique was the chosen technique for the restoration of the inguinal canal. The hospitalization length was one day, and the post-operative course was uneventful. Conclusions: Although a Nuck cyst is a rare entity, it should be taken into consideration in female adults who present with an inguinal mass.

Spontaneously regressing mass-like soft tissue involvement in a child with chronic non-bacterial osteomyelitis: case-based review.

Chronic non-bacterial osteomyelitis (CNO) is an inflammatory bone disease, usually diagnosed in childhood. It is characterized by the presence of multifocal or unifocal osteolytic lesions that can cause bone pain and soft tissue swelling. CNO is known to have soft tissue involvement. However, soft tissue involvement large enough to give the appearance of a mass is rare. This article discusses a case of CNO with a mass-like appearance that involved soft tissue and spontaneously regressed, as well as presents CNO cases with soft tissue involvement and conducts a literature review on this subject. Our investigation revealed that edema and synovitis were the most frequently observed soft tissue involvements in association with CNO. Moreover, we also encountered myositis, a mass-like appearance, neuritis, and polyserositis within the surrounding muscles. Although, it is well known that bone inflammation tends to regress spontaneously in CNO patients which reflects the autoinflammatory nature of the disease, there is no such patient whose soft tissue involvement which has mass like appearance improved spontaneously. Therefore, we aimed to emphasize the clinical progress which can be easily underdiagnosed of CNO patients by the clinicians by presenting unique features of our patient and our detailed literature review.

The Role of CCL18 in Rheumatoid Arthritis Diseases

Rheumatoid Arthritis (RA) is a chronic auto-immune disease that mostly occurs in joint space with remarkably painful swelling. RA detail pathologies remain unclear, but several C-C motif chemokines factors and Interleukin have been identified as associated factors and correlated disease-associate activities (such as CCL2, CCL18, IL-6). Among these factors, increasing evidence indicates CCL18 could be an appropriate drug target, as it is highly correlated with disease-associated activities (DAS28) (elevated level of CCL18 in both patient serum and local synovial fluids). High-concentration CCL18 in synovial fluids has been reported to facilitate pro-inflammation factor production, finally resulting in painful swelling in joint space. In vivo studies showed significant drug efficiency with anti-TNF-a treatment (CCl18 suppression). Most current approved drugs target TNF, IL-6, or other factors, but do not target CCL18 directly or indirectly. From this perspective, CCL18 has been believed to be a new target for RA therapeutic drug development.

Chronic Recurrent Multifocal Osteomyelitis (CRMO): The Deceptive Disease That Mimics Sarcoma Radiologically but Promises a Complete Recovery

Chronic recurrent multifocal osteomyelitis (CRMO) is a rare and distinct form of chronic non-bacterial osteomyelitis with an unknown etiology. This 11-year-old Asian girl presented with a painful swelling in her right arm, which was suspected to be a Ewing’s sarcoma based on radiological findings. The lesion appeared as a unifocal destructive bone lesion in the proximal diaphyseal region of the right humerus, accompanied by periosteal reaction and soft tissue involvement. She was otherwise clinically well, except for the elevated C-reactive protein, erythrocyte sedimentation rate and alkaline phosphatase. Due to the clinical and radiological suspicion of sarcoma, repeated bone biopsies were performed. All the biopsies revealed mature lamellar bone, normocellular marrow with moderate mixed inflammation, and fibrosis, indicative of a chronic inflammatory process. Given the discordance between the clinical, radiological, and pathological findings, surgical management was withheld and the patient was closely monitored. Over the course of several months, her symptoms gradually improved without any medical or surgical interventions. A follow-up X-ray taken 3 years after the initial diagnosis showed that the lesion had significantly reduced in size, nearly returning to a normal bone contour.

Cellulitis Induced by Jellyfish Sting in A 3-Year-Old Boy: A Case Report, Jazan, Saudi Arabia

Background: Jellyfish stings, though often perceived as benign encounters of the sea, can precipitate severe complications, particularly in the pediatric population engaging in aquatic activities. While these injuries are rare in Saudi Arabia, they can still present as a distressing condition and warrant preparedness. Case presentation: This case report presents a rare occurrence of cellulitis induced by a jellyfish sting in a 3-year-old boy from Jazan, Saudi Arabia. Following the initial sting, the patient exhibited distressing symptoms, including intense pain, erythema, and pronounced swelling in his left leg. Despite initial medical intervention, his condition worsened, necessitating hospitalization and a comprehensive treatment regimen involving antipyretic, corticosteroid, and antibiotic therapies. Conclusion: This case report underscores the imperative of timely and efficacious management of jellyfish sting injuries, particularly in regions where such incidents are infrequent. It also advocates for heightened awareness among healthcare practitioners regarding potential complications and the formulation of standardized protocols for optimal patient care.

Melioidosis in a child with nephrotic syndrome

Abstract Melioidosis, caused by Burkholderia pseudomallei, presents with a wide range of clinical manifestations. We report the case of an 8-year-old boy with nephrotic syndrome in remission, presenting with high-grade fever and painful limb swellings. Initial investigations revealed mild leukocytosis, thrombocytosis, and Pseudomonas aeruginosa in urine culture. Despite treatment, fever persisted until blood cultures identified B. pseudomallei. Antibiotics were upgraded to meropenem and doxycycline. Following abscess drainage and adjusted therapy, the patient stabilized. This case highlights the importance of considering melioidosis in pediatric patients with persistent fever and abscesses in endemic areas.

Data Insights on the Risks of Local Heat and Massage in Gouty Arthritis Treatment.

Gouty arthritis is a common inflammatory condition caused by the deposition of uric acid crystals in the joints, leading to intense pain, swelling, and functional impairment. Thermal therapies, including hot and cold fomentation, are often used as adjunctive treatments for managing inflammation and pain in various musculoskeletal conditions. However, the efficacy of these therapies in acute gout remains underexplored. This study aims to compare the effects of hot fomentation versus cold fomentation in patients experiencing acute gout flares, assessing pain reduction, swelling, joint mobility, and overall patient satisfaction. A randomized controlled trial was conducted with 2,400 patients diagnosed with acute gouty arthritis, divided into two equal groups: Group A received hot fomentation (38°C-42°C) and Group B received cold fomentation (5°C-10°C). Both interventions were applied twice daily for 20 min over 5 days, alongside standard gout care. Pain intensity was measured using the visual analog scale (VAS), while joint circumference, range of motion, and patient satisfaction were recorded at baseline, day 3, and day 5. Statistical analyses compared outcomes between the two groups. Cold fomentation significantly reduced pain intensity (VAS score reduction of 68% by day 5) compared to hot fomentation (26% reduction, P < 0.001). Joint swelling decreased by 25% in the cold group versus 5% in the hot group, with cold therapy also leading to greater improvements in joint mobility (average increase of 15° vs. 5°, P < 0.01). Notably, 35% of patients in the hot fomentation group experienced flare-ups, compared to only 2% in the cold fomentation group (P < 0.001). Patient satisfaction was also higher in the cold group, with 85% of participants reporting satisfaction versus 30% in the hot group. This study demonstrates that cold fomentation is significantly more effective than hot fomentation in managing acute gouty arthritis. Cold therapy provided superior pain relief, reduced swelling, improved joint mobility, and minimized the risk of symptom exacerbation. In contrast, hot fomentation often worsened symptoms, making it unsuitable for acute gout management. These findings suggest that cold fomentation should be the preferred thermal therapy for gout flare-ups, while heat applications should be avoided.

Extramedullary Plasmacytoma of the Oral Cavity: A Rare Case in the Buccal Mucosa.

Extramedullary plasmacytomas (EMP) are uncommon solitary tumors composed of neoplastic plasma cells occurring outside the bone. These lesions are of clinical significance due to their potential progression to multiple myeloma (MM), a more systemic and serious plasma cell malignancy. Although EMPs primarily arise in the head and neck region, cases involving the oral cavity are particularly rare. This report presents a case of EMP in a 59-year-old Iranian female, who developed a mass on the left buccal mucosa, an atypical site for this type of lesion. The patient presented with a 1-month history of a painful swelling on her left buccal mucosa. Clinical examination revealed a firm, exophytic lesion with a smooth surface. Histopathological analysis, supported by immunohistochemical staining, confirmed the diagnosis of EMP. The lesion was treated successfully through a combination of surgical excision and radiotherapy at a dose of 40 Gy. This case underscores the importance of early diagnosis and treatment of EMP, particularly in rare locations, to prevent progression to MM and improve patient outcomes. Our findings contribute to the limited body of literature on EMPs in the oral cavity, highlighting the need for awareness of such presentations among clinicians.

Fungal keratitis caused by Neurospora: a case report

BackgroundWe report a rare case of fungal keratitis caused by Neurospora, a filamentous fungus that is widely distributed in soil and graminaceous plants.Case presentationA 40-year-old Mongoloid male patient came to our outpatient clinic with painful swelling of the left eye and redness, after being cut by a tree branch 1 week prior. After examination, the patient was diagnosed with a corneal ulcer of the left eye, and was given levofloxacin eye drops and levofloxacin ophthalmic gel. However, the patient did not respond to the treatment. After admission to the hospital, fungal mycelium was found in the corneal smear. To further identify the pathogen, a corneal scraping culture was used to extract fungal DNA and PCR amplification was performed using ITS universal primers, which was later sequenced and identified as Neurospora. We used fluconazole injections (0.2 g/100 mL) as eye drops to treat the patient once every hour, and itraconazole (200 mg) was administered orally once a day. After a few days, the patient’s condition improved.ConclusionTo the best of our knowledge, this is the first reported case of fungal keratitis caused by Neurospora in China. In this case, conventional topical and systemic treatment resulted in a favorable outcome. In patients with suspected fungal keratitis, medical treatment should be started urgently, and the treatment plan should be adjusted according to the subsequent experimental results and the patient’s condition.

In situ size amplification strategy reduces lymphatic clearance for enhanced arthritis therapy

Rheumatoid arthritis (RA) is an autoimmune disorder characterized by painful swelling and inflammation, arising from the immune system attacking on healthy cells. However, arthritic sites often experience increased lymph flow, hastening drug clearance and potentially reducing treatment effectiveness. To address this challenge, an in situ size amplification has been proposed to reduce lymphatic clearance and thereby enhance arthritis therapy. This system has been developed based on a conjugate of dexamethasone (Dex) and polysialic acid (PSA), linked via an acid-sensitive linker, supplemented with bis-5-hydroxytryptamine (Bis-5HT) on the PSA backbone. Under physiological conditions, the system autonomously assembles into stable nanoparticles (PD5NPs), facilitating prolonged circulation and targeted delivery to inflamed joints. Upon arrival at arthritic joints, Bis-5HT reacts to elevated myeloperoxidase (MPO) levels and oxidative stress, prompting particle aggregation and in-situ size amplification. This in situ size amplification nanocarrier effectively reduces lymphatic clearance and serves as reservoirs for sustained Dex release in acidic pH environments within arthritic sites, thus continuously alleviating RA symptoms. Moreover, investigation on the underlying mechanism elucidates how the in situ size amplification nanocarrier influences the transportation of PD5NPs from inflamed joints to lymphatic vessels. Our study offers valuable insights for optimizing nanomedicine performance in vivo and augmenting therapeutic efficacy.Graphical

A Rare Case of Limited Granulomatosis with Polyangiitis Presenting as Bilateral Parotitis.

Granulomatosis with polyangiitis (GPA) is a rare autoimmune vasculitis affecting small and medium-sized vessels, commonly involving the respiratory tract and kidneys. Salivary gland involvement, particularly bilateral parotitis, is an uncommon presentation of GPA. We report the case of a 38-year-old Asian male who presented with left ear pain and parotid swelling after a water park visit. Initially treated with antibiotics for suspected otitis externa, his symptoms worsened, leading to bilateral parotitis, facial palsy, and otomastoiditis. Imaging revealed parotid abscesses and lab results showed elevated antineutrophil cytoplasmic antibodies (ANCA), specifically cytoplasmic ANCA directed against proteinase 3, confirming the diagnosis of GPA. Cultures and autoimmune workups for other causes, such as Sjogren's syndrome and immunoglobulin G4-related disease, were negative. Treatment with high-dose corticosteroids and methotrexate resulted in significant clinical improvement. This case highlights the importance of considering GPA in atypical presentations such as parotitis, even in the absence of renal involvement. Early diagnosis and appropriate immunosuppressive therapy are critical to prevent further complications in multisystem involvement. This case highlights the importance of recognizing atypical manifestations of granulomatosis with polyangiitis (GPA), such as bilateral parotitis, which aids in diagnosing and treating rare presentations more effectively.It emphasizes the need to expand differential diagnoses of salivary gland involvement, guiding the distinction of GPA from other similar conditions when antibiotics fail.By highlighting a rare presentation of GPA, this case improves diagnostic understanding in autoimmune diseases, enabling earlier interventions and leading to better patient outcomes.

Pseudoaneurysms of lower limb of orthopaedic traumatological origin: a literature review and our experience of 18 cases.

Arterial pseudoaneurysm is a rare yet potentially life-threatening complication that can arise as a late sequelae of penetrating injuries or orthopaedic procedures. We aim at sharing our institutional experience of managing 18 cases of lower limb arterial pseudoaneurysms in orthopaedic practice and to provide technical tips for emergency management of severe bleeding. A comprehensive literature review resulting from fractures and orthopaedic surgeries is also presented. The study group consisted mainly of male patients with a mean age of 48.5years. The mean duration between injury and pseudoaneurysm diagnosis was 86.7days. CT angiography and USG Doppler were the main diagnostic modality. Among the cases, five resulted from fracture fragments and 13 from iatrogenic injuries. Surgical interventions varied based on the artery involved and included excision and ligation, bypass grafting with dacron or vein graft, primary repair, and amputation in two cases. Complications included one patient with blowout at the anastomotic site and another case of deep infection. The literature review encompassed 108 cases of pseudoaneurysm of lower limb associated with fractures and iatrogenic injuries during orthopaedic procedures. Clinical manifestations varied widely which included painful swelling, pulsatility, bleeding, and neurological deficits. CT angiography was the most utilized diagnostic modality, while therapeutic embolization was the most common treatment method. Iatrogenic arterial injuries contributed to more than 60% of the cases as per the literature review. The most frequent mechanisms related to instrumentation were the placement of the third and fourth screws of the DHS plate, and the distal screw of a short nail in treating pertrochanteric fractures. This can be avoided by external rotation and abduction of the limb during distal screw insertion. A high index of clinical suspicion is needed especially when bleeding from the hardware site is noted. A swelling in the previously operated site should raise a suspicion of pseudoaneurysm and incision and drainage must be avoided without further imaging (Duplex USG or CT angiography). This study highlights the importance of cautious surgical techniques to minimize the occurrence of vascular injuries during orthopaedic surgeries.

A Solitary Osteochondroma Originating from the Spinous Process of the Third Cervical Vertebra: A Case Report and Comprehensive Literature Review

Background Osteochondroma is one of the most common solitary bone lesions. Multiple lesions are possible only in some genetic abnormalities, such as hereditary multiple exostoses (HME). Half of spinal osteochondroma is documented at the cervical level, although there are some levels and locations where it is rare to find an osteochondroma. Methods An advanced search of the PubMed database was performed for case reports and case series of spinal cervical osteochondroma. After data extraction, information was organized in one table and many figures to facilitate data comprehension. Result Osteochondroma was common in younger patients, with 26% of all cases in the literature being in those aged 18 to 35 years, and 24% of patients were aged 36 to 50. Over half (55%) of cases were in males. The most common presentation among all patients was neck pain and swelling or lump sensation. Moreover, 38% of cases were osteochondroma at the C1 level, and 33% were noted to affect the posterior arch. The majority of the cases had a favorable prognosis as most of them underwent total surgical resection of the tumor and decompression of the neural compartment. Conclusion Solitary cervical osteochondroma is a bony, benign lesion that can have devastating sequelae such as severe painful radiculopathy and quadriplegia if it is not approached correctly. History, examination, and radiological investigation are all crucial to making the best clinical judgment for the patients.

A 68-Year-Old Male with Giant Urethral Diverticulum Stone

Introduction: Urolithiasis primarily affects the kidneys, ureters, or bladder, but urethral stones are rare, making up less than 1% of all urinary tract stones. Their prevalence is 0.3% to 2%, with a higher incidence in men due to the longer male urethra. Symptoms range from asymptomatic to severe pain, dysuria, and urinary retention, often complicated by fever or renal failure. Urethral diverticulum, a rare malformation, can cause recurrent infections and stone formation. Diagnosis involves imaging, urethrography, and cystourethroscopy, while treatment depends on stone size and location. Delayed diagnosis can lead to significant morbidity. Case Presentation: A 68-year-old male presented to the clinic with a painful lump in the left scrotum, which had progressively enlarged and hardened. He reported experiencing painful, incomplete urination along with right-sided back pain. The patient had a history of similar lumps that had been surgically removed. Upon examination, a tender, hard mass measuring 4x3 cm was found in the left scrotum. Urethrography revealed a solitary opaque stone in the posterior urethra, while post-contrast imaging confirmed diverticulolithiasis in the bulbo-cavernous urethra, leading to stenosis and partial obstruction, confirming urethral obstruction due to stones. Laboratory tests returned normal results. Conclusion: Urethral stones are rare, constituting less than 1% of urinary tract stones, mainly affecting men. Symptoms range from asymptomatic to severe pain, with potential complications like fever and kidney failure. Diagnosis involves imaging, and timely management is crucial to prevent morbidity.

BMP-9 mediates fibroproliferation in fibrodysplasia ossificans progressiva through TGF-β signaling.

Fibrodysplasia ossificans progressiva (FOP) is a rare genetic disorder presenting with progressive heterotopic ossification (HO) in soft tissues. Early-stage FOP is characterized by recurrent episodes of painful tissue swelling (flare-ups), with numerous proliferation-activated mesenchymal stromal cells (MSCs) subsequently causing HO. However, the mechanisms underlying flare-up progression remain unclear. In this study, we evaluated the proliferation of MSCs obtained from FOP patient-derived induced pluripotent stem cells (FOP-iPSCs) to elucidate the mechanisms underlying flare-ups and found that bone morphogenetic protein (BMP)-9 mediated enhanced proliferation by abnormal activation of transforming growth factor (TGF)-β signaling pathway in MSCs from FOP-iPSCs. In FOP model mice, elevated BMP-9 levels correlated with elevated phosphorylation of SMAD2/3 and increased cellular proliferation in the affected tissues, while systemic BMP-9 neutralization and knockout mitigated flare-ups and HO. Thus, BMP-9 aberrantly transduces TGF-β signaling and induces fibroproliferation, initiating flare-ups. This study provides novel insights into the development of future FOP therapies.

Unveiling the Enigma: The Rare Non-Calcifying Variant of Calcifying Epithelial Odontogenic Tumor

ABSTRACT Calcifying epithelial odontogenic tumor (CEOT), first identified by Jens Jorgen Pindborg in 1955, is a rare developmental odontogenic tumor, accounting for approximately 0.4% of all such tumors and most commonly occurring in the third and fourth decades of life. A 63-year-old man presented with a painful swelling in the right lower face, which had progressively enlarged over four months. Clinical and radiological findings revealed a dentoalveolar abscess with an osteolytic lesion mimicking involving the mandibular ramus and an impacted tooth. Histopathological examination confirmed CEOT. This case is notable due to its unusual presentation, mimicking dental osteomyelitis and occurring in an older individual, emphasizing the need for thorough diagnostic evaluation in atypical cases.