Prominent Swelling Research Articles

K wire migration into spinal canal: An infrequent cause of neurological morbidity: A case report

Introduction: K wire is one of the most common implants used for fixation of acromioclavicular joint dislocation. The migration of K wire from the AC joint to the spinal canal is a rare occurrence. In this report, we present a case of a young adult who presented with weakness of left upper limb secondary to migration of K wire from the AC joint to the spinal canal. Case presentation: A 46-year-old male farmer presented with complaints of pain in the neck, tingling sensation in the left upper limb, and a tender palpable swelling on the left side of his neck with weakness of finger flexors and abductors. He had had an open reduction and fixation with K wire for Acromioclavicular dislocation three months back. CT confirmed the K wire passing through neural foramen between C5 and C6 vertebra and extending across the entire diameter of spinal canal. Under intravenous anesthesia, a transverse skin incision was made over the prominent swelling on the neck and the wire was gently removed. Minimal seepage of spinal fluid was observed which stopped on its own after few days. Discussion: Although AC joint stabilization by K wire fixation provides a safe and easy fixation with low morbidity, complications such as a loss of fixation or loosening can occur. Migration of K wire into a spinal canal is a well-known but infrequent complication. Resorption of bone, muscle action, and negative intrathoracic pressures associated with respiration and heat necrosis causes progressive loosening and dislodgement. Spinal migration is very dangerous because it can cause serious damage to the dura mater, spinal cord, and vertebral artery. Conclusion: Early identification and removal of the K wire, once it has migrated from the site of use, is mandatory to prevent its grievous complications.

Osteodystrophy Fibrosa in a Goat Kid: Clinical Assessment and Management

Fibrous osteodystrophy is a mineral based caprine metabolic disease in which bones are resorbed as a result of prolonged hypersecretion of parathyroid hormone. High phosphorus or low calcium in the diet frequently contributes to fibrous osteodystrophy. This was a case of 8 months old kid presented to the Referral Veterinary Polyclinic of ICAR-IVRI with the history of anorexia and prominent bilateral facial swelling. History-taking revealed that owner was regularly feeding wheat bran and barley to the kid in the diet. On clinical examination, goat kid was found to be dull and depressed with rectal temperature lying within the normal reference range. Haematobiochemical analysis exhibited decreased level of serum calcium (7 mg/dl) and increased level of serum phosphorus (8.2 mg/dl). In dorsovental cephalometric radiography, facial bones appeared radiolucent. Treatment of osteodystrophy began with the administration of injection AD3E at the dose of 1 ml I/M for 5 days, injection pheniramine maleate (AvilTM) at 1 ml I/M for 5 days, syrup CalcimustTM at 5 ml PO for 5 days and injection Calcium sandozTM at 10 ml mixed with 200 ml NSS I/V SD and anabolic steroid Nandrolone at 50 mg SD. Concurrently, the owner was advised to immediately stop feeding wheat bran and barley to the kid. After 5 days of the treatment, kid’s condition started to improve and uneventful recovery was achieved 14 days post-therapy.

A case of sacrococcygeal teratoma associated with antenatally acquired urethrovaginal fistula and hydrocolpos

BackgroundSacrococcygeal teratomas (SCTs) are known to cause urological complications, but urethrovaginal (UV) fistula as a complication of SCT is rare. We herein report a case of SCT with UV fistula and hydrocolpos.Case presentationA 1-day-old female neonate presented to our department with prominent swelling in the sacrococcygeal region. She was born at 37 gestational weeks via spontaneous vaginal delivery from a 39-year-old woman. The weight of the baby was 2965 g, and her Apgar scores were 4/10 (at 1 and 5 min). An MRI examination confirmed an 11 × 11 cm Altman classification typeII SCT associated with hydrocolpos, a dilated urinary bladder, and bilateral hydronephrosis. When she was 5 days, the SCT was excised totally and a coccygectomy was performed. After the operation, as her urinary output appeared unstable, a cystoscopic examination was performed on the third postoperative day. This revealed that the UV fistula was located approximately 1 cm from the urethral opening. In addition, the proximal urethra was unobstructed and connected to the bladder. The cystoscope allowed for the passage of a urinary catheter through the urethra. After 1 month of catheter placement, she was discharged from the hospital at 57 days of age. Follow-up was uneventful, with neither urinary infection nor retention.ConclusionsSCTs are associated with not only trouble with rectal function and lower extremity movement but also urinary complications. The pathogenesis of this UV fistula is thought to be the rapid growth of the SCT that developed in the fetal period, resulting in obstruction of the urethra by the tumor and the pubic bone, which in turn caused urinary retention and the formation of a fistula as an escape route for the pressure. Because SCTs can cause a variety of complications depending on the course of the disease, careful examination and follow-up are necessary.

P17 A bend in the road: a patient with rheumatoid arthritis developing multicentric reticulohistiocytosis

P17 A bend in the road: a patient with rheumatoid arthritis developing multicentric reticulohistiocytosis

Expanding the spectrum of neonatal-onset AIFM1-associated disorders.

Pathogenic variants in AIFM1 have been associated with a wide spectrum of disorders, spanning from CMT4X to mitochondrial encephalopathy. Here we present a novel phenotype and review the existing literature on AIFM1-related disorders. We performed EEG recordings, brain MRI and MR Spectroscopy, metabolic screening, echocardiogram, clinical exome sequencing (CES) and family study. Effects of the variant were established on cultured fibroblasts from skin punch biopsy. The patient presented with drug-resistant, electro-clinical, multifocal seizures 6 h after birth. Brain MRI revealed prominent brain swelling of both hemispheres and widespread signal alteration in large part of the cortex and of the thalami, with sparing of the basal nuclei. CES analysis revealed the likely pathogenic variant c.5T>C; p.(Phe2Ser) in the AIFM1 gene. The affected amino acid residue is located in the mitochondrial targeting sequence. Functional studies on cultured fibroblast showed a clear reduction in AIFM1 protein amount and defective activities of respiratory chain complexes I, III and IV. No evidence of protein mislocalization or accumulation of precursor protein was observed. Riboflavin, Coenzyme Q10 and thiamine supplementation was therefore given. At 6 months of age, the patient exhibited microcephaly but did not experience any further deterioration. He is still fed orally and there is no evidence of muscle weakness or atrophy. This is the first AIFM1 case associated with neonatal seizures and diffuse white matter involvement with relative sparing of basal ganglia, in the absence of clinical signs suggestive of myopathy or motor neuron disease.

Lateralized hypostasis of the head on post mortem CT (PMCT) scanning of decomposed bodies—a marker for terminal position

Post-mortem CT (PMCT) scanning was performed on the bodies of two decomposed adult males who had died of natural causes. The bodies both showed changes of marked decomposition with a prominent swelling of tissues on one side of the head compared to the other. A review of police statements confirmed that this matched the positions of the bodies when they were found. Thus, post-mortem hypostasis of putrefactive fluids correlated in both cases with the positions that the bodies had been in when first located. This may be a simple way of identifying or confirming the positions of decomposed bodies after death. It may also assist in indicating whether a body has been moved after putrefactive fluid hypostasis has developed.

Frontal swelling of the forehead in a teenager

A 16-year-old male was admitted to the pediatric emergency department with headache, frontal swelling and fever. Physical examination revealed a prominent frontal swelling, painful on palpation

Reactivation of Herpes Zoster and HHV-6 Following COVID-19 mRNA Vaccine

A case of Herpes Zoster and HHV-6 reactivation following the COVID-19 mRNA vaccine was presented. The case is unique with a severe Herpes-Zoster reaction, with eyelid edema and hair loss. In addition, there was prominent lymph node swelling as well as high HHV-6 titers at 2.11 and Varicella-Zoster V Ab IgG, more than 4,000. Initial infection of HHV-6 in grown-up is rare, but a mononucleosis-like syndrome of different severity with prolonged lymphadenopathy has been reported. Reactive lymphadenitis positive for HHV-6 have been reported with lymphadenopathy and fever. Reactivation of latent virus usually occurs in an immunocompromised host and Primary infection is not frequent in grown-ups. It is a rare cause of lymphadenitis in an immunocompetent adult.

Case report on surgical removal of 3.5 kg benign mesenchymal tumor from the mandible region

BackgroundBenign mesenchymal tumors are rare tumors accounting for 5% of all salivary gland tumors and less than 10% of submandibular or sublingual gland tumors.Case presentationThe present case study represents a rare case of large-size benign mesenchymal tumors arising from the mandible region. The patient comes with the complaint of prominent swelling on the right side of the lower jaw. Clinical history revealed that the swelling appeared around 5 years ago and enhanced over time to form a large tumor. The patient presented with signs of anemia and hypoproteinemia, which were developed due to dysphagia and bleeding in the tumor. A worm infestation was also found during the clinical examination, and severe pain, foul smell, fungating tumor, frequent pus discharge, and bleeding were also reported. The patient was treated by surgical removal of tumors within 8 h of surgery. Right segmental mandibulectomy with wide local tumor excision was performed under general anesthesia and prophylactic tracheostomy to maintain a secure airway. A huge defect of 8 cm × 6 cm was generated on the right side of the face after tumor removal, which was repaired with the help of local advancement flap reconstruction. The tumor size was 30 cm × 20 cm with a weight of 3.5 kg.ConclusionTo our best knowledge, the present study is the first in the literature that has reported such a large tumor in the mandible region. The success of surgery presented in the current case is very rare to achieve in developing countries. By reporting the detailed procedures, the present case study will help increase the misdiagnosis, improper treatment, treatment delays, or associated complications.

Preparation of pH-Responsive Hydrogels Based on Chondroitin Sulfate/Alginate for Oral Drug Delivery.

This study investigates pH-sensitive hydrogels based on biocompatible, biodegradable polysaccharides and natural polymers such as chondroitin sulfate and alginate in combination with synthetic monomer such as acrylic acid, as controlled drug carriers. Investigations were conducted for chondroitin sulfate/alginate-graft-poly(acrylic acid) hydrogel in various mixing ratios of chondroitin sulfate, alginate and acrylic acid in the presence of ammonium persulfate and N′,N′-Methylene bisacrylamide. Crosslinking and loading of drug were confirmed by Fourier transform infrared spectroscopy. Thermal stability of both polymers was enhanced after crosslinking as indicated by thermogravimetric analysis and differential scanning calorimeter thermogram of developed hydrogel. Similarly, surface morphology was evaluated by scanning electron microscopy, whereas crystallinity of the polymers and developed hydrogel was investigated by powder X-ray diffraction. Furthermore, swelling and drug-release studies were investigated in acidic and basic medium of pH 1.2 and 7.4 at 37 °C, respectively. Maximum swelling and drug release were detected at pH 7.4 as compared to pH 1.2. Increased incorporation of hydrogel contents led to an increase in porosity, drug loading, and gel fraction while a reduction in sol fraction was seen. The polymer volume fraction was found to be low at pH 7.4 compared to pH 1.2, indicating a prominent and greater swelling of the prepared hydrogels at pH 7.4. Likewise, a biodegradation study revealed a slow degradation rate of the developed hydrogel. Hence, we can conclude from the results that a fabricated system of hydrogel could be used as a suitable carrier for the controlled delivery of ketorolac tromethamine.

The First Report of Isolated Clitoral Hood Hair-Thread Tourniquet Syndrome: A Study of Six Patients.

Background and objectiveHair-thread tourniquet syndrome (HTTS) is a rare and potentially dangerous condition that occurs when a hair strand or fabric thread is wrapped around the penis, clitoris, toes, fingers, or other appendages, leading to focal edema, ischemia, and necrosis. This study aimed to examine the cases of six female patients with isolated clitoral hood HTTS.MethodsThis was a retrospective study involving six female patients (age range: two to six years) with isolated clitoral hood tourniquet who presented to the outpatient department (OPD) and emergency room (ER) of the pediatric and adolescent gynecology service at King Abdulaziz University Hospital, Jeddah, Saudi Arabia between January 2010 and December 2021. Data related to patients’ clinical presentation, symptom duration, and management were recorded.ResultsThe most common symptom of isolated clitoral hood HTTS in all six cases was pain, followed by redness, itching, discomfort while sitting, and dysuria. Local signs included edema in three cases, tight hair tourniquet around a portion of the clitoral hood in four cases, and loose hair tourniquet around a portion of the clitoral hood in two cases, one of which was during the first episode in a patient who had recurrence (Case 1). Sedation and local anesthetic were used in five cases involving the local removal of four hairs and a strangulated skin. This was followed by local care and antibiotic ointment application. The edges were closed by interrupted stitches in two of the cases as the resulting wounds were broad. Limited clitoral unhooding was performed under general anesthesia in one patient, who had repeated bouts of autoamputation of parts of the hood tissue with resulting disfiguration of the remaining redundant hood, to avoid the additional risk of organ loss. Only two patients experienced recurring episodes.ConclusionsA high index of suspicion should be maintained when encountering these patients, which can facilitate a prompt resolution to save the affected tissue. HTTS should be suspected in all females presenting with a prominent clitoral hood, genital pain, structural abnormality, swelling, or discomfort. This is the first study to report isolated clitoral hood HTTS; it describes the presentation, manifestation, and management of patients with HTTS. It also addresses preventive strategies to alert mothers and treating physicians of the pediatric and adolescent-age group females to the defect and its underlying causes, particularly when patients have genital structural abnormalities such as excessive clitoral hood labial hypertrophy or ambiguous genitalia.

Temperature-Dependent Conformation Behavior of Isolated Poly(3-hexylthiopene) Chains.

We use atomistic as well as coarse-grained molecular dynamics simulations to study the conformation of a single poly(3-hexylthiopene) chain as a function of temperature. We find that mainly bundle and toroid structures appear with bundles becoming more abundant for decreasing temperatures. We compare an atomistic and a Martini-based coarse-grained model which we find in very good agreement. We further illustrate how the temperature dependence of P3HT can be connected to that of simple Lennard–Jones model polymers in a vacuum. Upon adding solvent (THF) we observe the occurrence of a prominent swelling of the molecular size at a temperature of about 220 K. This swelling is in close agreement with the interpretation of recent spectroscopic experiments which allows us to explain the experimental observations by an increased frequency of bundle structures.

Herpetic gingivostomatitis in a young adult.

An 18-year-old woman presented with a 7-day history of fever up to 39.2°C followed by painful oral enanthema. She had taken acetaminophen as a palliative medicine. Her past history was unremarkable. Physical examination showed hemorrhagic crusts and necrotic ulcers on the lips. Prominent swelling with dilated capillaries and white sloughs of the attached gingiva over the teeth were observed (A, B). Laboratory investigations were unremarkable, except for elevated C-reactive protein at 3.81 mg per deciliter (reference < 0.30). Serum anti-herpes simplex virus (HSV) IgM was positive, but IgG was negative. The Tzanck test was positive, and polymerase chain reaction detected HSV type 1 (HSV-1) DNA. Primary HSV-1-induced herpetic gingivostomatitis were diagnosed. She was treated with oral valacyclovir, and the lesion completely resolved in 10 days.

Erizipel nakon ujeda mačke izazvan bakterijom "Pasteurella multocida" - prikaz slučaja

Introduction: Erysipelas is a characteristic form of acute superficial streptococcal cellulitis, usually treated in outpatient service, primarily with penicillin, or erythromycin, in cases where the patient is allergic to penicillin. We are reporting the case of a patient who was preventively treated with erythromycin, after a cat bite, but during treatment developed erysipelas, which, after a swab sample from the wound was analyzed, proved to be caused by Pasteurella multocida, resistant to erythromycin. Case report: A 53-year-old woman came to the outpatient clinic with clinical signs of erysipelas cruris. Seven days before, she had been bitten by her own cat. The wound was surgically treated, and erythromycin, 500 mg qid, was prescribed as prophylaxis of wound infection. There were no signs of infection. On the 5th day following the bite, the patient was running a very high fever (39.2°C), but she was without other symptoms, thus the fever was considered to be a symptom of the flu. On the following day, prominent erythematous swelling appeared around the site of the wound, with localized lymphangitis and regional lymphadenitis, and discharge from the wound. The diagnosis of erysipelas was made. The peripheral blood test results were as follows: WBC = 13.9 x 109 /l; NE = 82%, CRP = 43 IU. A swab sample was collected from the wound and the patient was started on penicillin. On the 7th day of penicillin administration, there were no signs of inflammation, while the blood test results were as follows: WBC = 5.1 x 109 /l; NE = 52%; CRP = 24 IU. Pasteurella multocida, resistant to erythromycin but sensitive to penicillin was isolated from the swab sample. Conclusion: Erysipelas, although an easily recognized clinical entity, can be caused by other microorganisms, besides streptococcus. It is very important to consider this in order to make an accurate diagnosis and prescribe the appropriate therapy.

THE FEATURES OF REPRODUCTIVE ADAPTION OF CARNIVOROUS PLANT Utricularia aurea

Carnivorous plant (Utricularia aurea) is a suspended aquatic. Inflorescence erect, glabrous, scales absent, bracts basifixed, broadly ovate to orbicular. Calyx lobes ovate, subequal, apex rounded to subacute; lower lobe often slightly broader than upper lobe. Corolla pale yellow, pubescent or glabrous; lower lip transversely elliptic, base with a prominent 2-lobed swelling, apex rounded to emarginate. Filaments 1- 1.5 mm, curved; another thecae confluent. Ovary ovoid; style evident; stigma lower lip semicircular, upper lip obsolete. Fruit: capsule, ovoid, many seeds. The pollen of Utricularia aurea has one morphological form: heterocolpate (polar view). The diameter of fertile pollen is 32,97 ± 0,20 µm, the diameter of infertile pollen is 28,17 ± 0,20 µm. The percentage of fertile pollen is low (&lt; 50%): 26,92% (in peak flowering) and 23,94% (in rare flowering). The percentage of fertile pollen has a positive and close correlation with the diameter of pollen (R = 0,95). Although this species has two reproductive forms (vegetative and sexual), the efficiency of sexual reproduction isn’t high. Vegetative reproduction is always dominant.

Dermatologic Manifestations of Systemic Diseases in Childhood

Dermatologic Manifestations of Systemic Diseases in Childhood

Acute Appendicitis with Neuronal Hyperplasia and Swelling: A Novel Histologic Mimic of Appendiceal Goblet Cell Adenocarcinoma and Signet-Ring Cell Adenocarcinoma

Goblet cell adenocarcinoma and signet-ring cell adenocarcinoma are well-known diagnostic pitfalls of routine appendectomy specimens. Here we present a case of acute appendicitis with prominent neuronal (ganglion cell) hyperplasia and swelling which histologically mimics goblet cell adenocarcinoma and signet-ring cell adenocarcinoma. Attention to the cytologic features of the lesional cells (absence of atypia, mitotic activity) and their close association with nerves and classic ganglion cells, along with the use of a limited panel of immunostains, ensures proper classification of this rare but striking benign process.

MiR-106b-5p upregulation is associated with microglial activation and inflammation in the mouse hippocampus following status epilepticus.

To investigate the association of miR-106b-5p with neuroinflammation and microglial activation in a status epilepticus (SE) mouse model. We examined changes in the expression of microRNA-106b-5p (miRNA-106b-5p), repulsive guidance molecule A (RGMa), triggering receptor expressed on myeloid cells 2 (TREM2), and the microglia-related markers interleukin (IL)-1β, IL-4, IL-6, IL-10, inducible nitric oxide synthase (iNOS), and arginase-1 (Arg-1) in the mouse hippocampus of the lithium-pilocarpine-induced SE mouse model. Eighty-four female C57BL/6 mice were randomly divided into a normal control group (n = 12), and six SE groups (n = 12/group), which were monitored at 6h and at 1, 3, 7, 14, and 21days (d) post-SE induction. Unlike in the dentate gyrus, immunohistochemical staining revealed prominent neuronal swelling at 6h, significant neuronal loss and apoptosis on day 3, and recovery by day 14 in the hippocampal cornu ammonis (CA)1 and CA3 pyramidal cells in SE mice. We noted elevated levels of miRNA-106b-5p and all microglia-related markers, which peaked at 3days post-SE, except IL-4, which peaked at 7days post-SE, indicating inflammation and microglial activation. RGMa and TREM2 levels decreased at 6h post-SE. All markers but miRNA-106b-5p, RGMa, and TREM2 returned to baseline levels at 21days post-SE. Dual luciferase reporter gene assay showed that microRNA-106b-5p can interact with RGMa. We observed that miR-106b-5p level increased while both RGMa and TREM2 levels decreased post-SE and showed associations with microglial activation and inflammation in the mouse hippocampus, suggesting their potential as SE therapeutic targets.

Osteopetrosis - A Case Series Exploring Complications and Multidisciplinary Management

Background: Osteopetrosis is a group of rare inherited skeletal dysplasias, with each variant sharing the hallmark of increased bone mineral density (BMD). Abnormal osteoclast activity produces overly dense bone predisposing to fracture and skeletal deformities. Whilst no cure for these disorders exists, endocrinologists play an important role in surveillance and management of complications. Clinical Cases: A 43-year-old female had findings suggestive of increased BMD on radiographic imaging performed to investigate shoulder and back pain. X-ray of lumbar spine demonstrated a ‘rugger jersey’ spine appearance, while shoulder X-ray revealed mixed lucency and sclerosis of the humeral head. DXA scan showed T-scores of +11 at the hip and +12.5 at the lumbar spine. MRI of head displayed bilateral narrowing and elongation of the internal acoustic meatus and narrowing of the orbital foramina. Genetic assessment confirmed autosomal dominant osteopetrosis with a CLCN7 variant. Oral colecalciferol supplementation was commenced and multi-disciplinary management instigated with referral to ophthalmology and ENT teams. A 25-year-old male presented with a seven-year history of low back pain and prominent bony swelling around the tibial tuberosities and nape of neck. Past medical history included repeated left scaphoid fracture in 2008 and 2018. Recovery from his scaphoid fracture was complicated by non-union requiring bone grafting with open reduction and fixation. Plain X-rays of the spine again demonstrated ‘rugger jersey’ spine. DXA scan was notable for elevated T scores; +2.9 at hip and +5.8 lumbar spine. MRI spine showed vertebral endplate cortical thickening and sclerosis at multiple levels. The patient declined genetic testing and is under clinical review. A 62-year-old male was referred to the bone metabolism service following a DXA scan showing T scores of +11. 7 at the hip and +13 at the lumbar spine. His primary complaint was of neck pain and on MRI there was multi-level nerve root impingement secondary to facet joint hypertrophy. Past medical history was significant for a long history of widespread joint pains; previous X-ray reports described generalized bony sclerosis up to 11 years previously. Clinical and radiological monitoring continues. Conclusion: Individuals with osteopetrosis require a multidisciplinary approach to management. There is no curative treatment and mainstay of therapy is supportive with active surveillance for complications.

Functionalization of polyamide microfiltration membranes by supercritical solvent impregnation

The study reports the application of supercritical solvent impregnation to deliver antibacterial substance thymol to the defined polymeric structure of commercial polyamide microfiltration membranes. The process performed at a temperature of 40 °C and pressures of 10, 15, and 20 MPa was characterized by the fast impregnation in the first 30 min with thymol loadings up to 29 wt%. The maximal achieved thymol loading in the process was around 42 wt%, regardless the pressure. The scanning electron and ion microscopy analyses revealed that the membranes’ microstructure was preserved with a thymol content of 20 wt%, while a more prominent swelling effect was observed in samples with 35 wt% of thymol. The cross-flow filtration tests showed that the impregnation process did not harm the membranes’ functionality in samples with 20 wt% of thymol. These membranes exhibited strong anti-biofilm activity, and were less prone to the blockage with bacteria in comparison to neat membranes.