bluuebunny/crossref_metadata_2025_split huggingface dataset:
632 A Rare Case of Genitourinary Tuberculosis Presenting as Occult Compensated Renal Failure
Authors: Shkoukani ZW , Nandakumar A 
Published: November 2022

Abstract
It is acknowledged in the literature that genitourinary TB is a diagnostic challenge due to its rarity and insidious presentation.
We herein report a case of a 64-year-old gentleman originally from Peru with an unremarkable past medical history that attended his GP practice on multiple occasions complaining of recurrent left sided loin pain, headaches, and microscopic haematuria. Abdominal ultrasonography revealed an atrophic left kidney and dilated renal pelvis. This was interpreted to either be a complication of chronic renal calculi, or secondary to malignancy.
Further investigations including CT urogram, MAG3 renogram, cystoscopy and anterograde pyelogram effectively ruled out malignancy, revealing hydronephrosis and loss of cortical thickness. And although this was initially dismissed, further deterioration prompted more robust investigations.
A complication of testicular pain and swelling with an associated lack of response to prolonged courses of antibiotics and associated scrotal abscess on ultrasonography prompted rapid surgical decompression and drainage. Histopathological results reported findings of acute necrotising granulomatous inflammation with positive acid-fast bacilli on Ziehl-Neelsen staining – consistent with tuberculosis. Routine follow up since commencing anti-TB therapy showed marked improvement with no further episodes of haematuria or flank pain, and kidney function remained at baseline.
By raising awareness of potential imaging features as well as more subtle clinical presentations, it is hoped that clinicians can consider genitourinary tuberculosis as a differential, if there is no improvement with conventional antimicrobial agents.
662 Bilateral Vocal Cord Paralysis and Cranial Polyneuropathy: A Rare Presentation of Ramsay Hunt Syndrome
Authors: Dhar P , Brimioulle M , Nair D 
Published: November 2022

Abstract

Case Presentation
A 61-year-old gentleman with chronic lymphocytic leukaemia presented with right sided disseminated vesicles, otalgia, hearing loss, facial weakness, dysphagia, hoarseness, breathlessness, and stridor. In the preceding 48 hours he had two A&E presentations with only right otalgia, facial weakness, throat tightness and mild breathlessness. Cranial nerve (CN) examination demonstrated right cheek numbness and absent jaw jerk reflex (CNV), right grade 6 lower motor neuron facial palsy (CNVII), impaired hearing (CNVIII), dysphonia, dysphagia, and asymmetric palate elevation (CNIX and X). Fibreoptic nasendoscopy (FNE) demonstrated bilateral vocal cord palsy. He was diagnosed with Ramsay Hunt syndrome (RHS) and disseminated herpes zoster (HZ) requiring intubation and ventilation, intravenous steroids, aciclovir, antibiotics and a prolonged intensive care admission. He was discharged after three months. Eight months later, he has a long-term tracheostomy, gastrostomy, and live-in carer.

Discussion
This is the only case found in the literature of RHS and associated bilateral vocal cord palsy with cranial polyneuropathy requiring a long-term tracheostomy. It highlights the significant morbidity attached with RHS complications, particularly in a patient with underlying malignancy. Awareness of these rare and potentially life-threatening complications should be raised to avoid investigation and treatment delay. HZ should be considered in patients with CNVII palsy and otalgia, with or without vesicles. Clinicians should perform full CN examination including FNE to assess for cranial polyneuropathy. RHS can present without vesicles, making it indistinguishable from Bell's Palsy. Therefore, we should consider treating Bell's Palsy with aciclovir. Furthermore, multidisciplinary management of disseminated HZ is essential.
666 Rugby Tackle: A Cause of Delayed Onset Laryngeal Oedema
Authors: Dhar P , Brimioulle M , Nair D 
Published: November 2022

Abstract

Case Presentation
A 14-year-old boy presented to the emergency department with facial and neck swelling, hoarseness and dysphagia. The symptom onset was 24 hours after a rugby tackle to the neck and shoulder. Examination found significant bilateral lower facial and neck swelling. Blood results and observations were normal. Fibreoptic nasendoscopy (FNE) revealed diffuse oedema of arytenoids and soft tissue around the larynx. Computed Tomography (CT) neck with contrast demonstrated diffuse inflammatory changes in the submental and submandibular regions extending to the suprasternal notch, the aetiology for this was indeterminate. He responded to medical treatment with regular intravenous dexamethasone, intravenous antibiotics and as required, adrenaline nebulisers. He was discharged after two days and was able to return to school the following week.

Discussion
Laryngeal oedema is an ear, nose and throat emergency which can result in airway obstruction. It is commonly caused by bacterial infection. However, rarely other precipitants including blunt trauma are reported. This is the first case reported in the literature of delayed laryngeal oedema from a common sporting injury. It is important to recognise and consider trauma as a cause in patients with delayed laryngeal oedema, especially when no other obvious underlying cause is present. This case highlights the importance of thorough history taking to detect trauma. After ensuring a secure airway, systemic steroids are effective against trauma-induced laryngeal oedema and prophylactic antibiotics should be considered to avoid oropharyngeal contamination. FNE, CT and a minimum 24-hour observation period with specialist involvement are essential for neck trauma management.
674 A Rare Cause of Dysphagia in an Adult: Laryngeal Cleft, a Case Report from a Tertiary Care Centre
Authors: Mehtani N , Dall'Amico G , Sandhu G 
Published: November 2022

Abstract

Introduction
Laryngeal cleft is a rare congenital anomaly where the laryngotracheal wall fails to fuse posteriorly resulting in a gap. Embryologically, larynx develops from IV and VI branchial arches and is separated from foregut by trachea-esophageal septum, which closes from caudal to cranial end. Symptoms can vary, depending on where these fusion arrests, from none in mild cases to aspiration, recurrent pneumonia, dysphagia, and hoarseness of voice in severe. The condition is almost always detected in childhood and rarely diagnosed in adults.

Method
We present a case of 41-year-old male with dysphagia and choking episodes, having previously been treated for cleft palate and larynx as a child alongside a literature review of such published cases.

Results
A 41-year-old male developed swallowing problems with choking episodes on a background of having had a successful repair of a type 3 cleft in childhood. He underwent video fluoroscopy which demonstrated evidence of aspiration. He subsequently underwent a diagnostic microlaryngoscopy, which disclosed a type III laryngeal cleft. He was treated surgically with open laryngeal cleft repair, following which the postoperative fibreoptic endoscopic evaluation of swallowing demonstrated strong swallow. He was discharged home on successful resumption of his baseline diet.

Conclusion
Laryngeal clefts in adults are very rare and can be successfully treated surgically. The case report showcases the condition can still present in adult life with late failure (breakdown) and the need for awareness about the disorder. A review revealed very few reported adult cases in the current literature.
680 An Incidental Finding of Pneumatosis of the Colon in a Patient with Mesothelioma Being Treated with Nivolumab
Authors: Gopaul S , Lam S 
Published: November 2022

Abstract
A 75-year-old woman attended a large academic teaching hospital for a computed tomography (CT) of the chest for a T3 N0 M0 epithelioid mesothelioma of the right pleura (to assess treatment response). The malignancy was diagnosed one year previously, and the patient was being treated with second line immunotherapy, Nivolumab (a human immunoglobulin G4 monoclonal antibody) with palliative intent. To date, the patient was showing a partial response to this treatment.
The CT chest incidentally showed locules of gas under the right diaphragm and therefore an urgent CT of the abdomen and pelvis was performed. This scan re-demonstrated a small pneumoperitoneum, but also an incidental finding of pneumatosis involving the hepatic flexure. Prior to Nivolumab treatment, there were no abnormalities noted on the most recent abdominal CT scan.
The patient was admitted to hospital as an emergency under the care of oncology. The patient was entirely asymptomatic with a soft, non-tender abdomen, with both a normal diet and bowel function. Observations including heart rate, temperature, blood pressure and respiratory rate were within normal limits. Blood testing showed a C-reactive protein of 86 mg/L and white cell count of 4.8 10^9. Based on the radiological findings, intravenous fluids and antibiotics were commenced and the patient was restricted to nil intake orally. A surgical review was also requested. Based on surgical advice, the patient was treated conservatively, and was discharged home without complication and no surgical follow up.
709 Two-Layer Biodegradable Temporizing Matrix Reconstruction of Abdominal Wall Dermatofibrosarcoma Protuberans
Authors: Shah R , Kiely A , McKirdy S 
Published: November 2022

Abstract
Dermatofibrosarcoma protuberans (DFSP) is a rare, locally invasive dermal sarcoma. The management is generally surgical, with wide local excision (WLE) forming the mainstay of treatment. Large abdominal wall defects are most aesthetically reconstructed using pedicled or free flaps; however, these require tumour-free surgical margins, and can cause donor site morbidity. We describe an alternative, aesthetic, and low-morbidity technique for abdominal wall reconstruction following WLE of DFSP, using 2 layers of a novel synthetic dermal matrix (NovoSorb® BTM).
25-year-old women presented with a large DFSP involving the right anterior-abdominal wall. After WLE with 3cm margins, BTM was implanted to the large sub-fascial abdominal wall defect. At 6 weeks, after histological confirmation of tumour-free margins, a second layer of BTM was applied to improve the significant contour deformity of the wound bed. After complete integration by 7 weeks, a split-thickness skin graft was harvested from the right thigh and fixed to the new dermis.
At 14-days postoperatively, the skin graft had fully taken, and donor site healed. By 8 weeks, the scar had started to mature with no obvious contour defect or contracture. Overall, the patient was satisfied with the functional and aesthetic outcome.
To our knowledge, a two-layer reconstruction using an artificial dermal matrix has never been described for abdominal wall reconstruction. We found that double-layer BTM is able to restore the inherent thickness and pliability of skin in complex abdominal wall reconstruction following WLE of DFSP and offers improved durability and cosmesis compared to skin grafting or indeed single layer skin substitutes alone.
718 Cryptogenic Stroke in a Patient with Firearm Injury - a Diagnostic Dilemma
Authors: Bhatti HW , Arham M , Shahid R Muhammad N , Zaidi SMJ , Hanif M 
Published: November 2022

Abstract

Introduction
Neurological deficit associated with firearm injury outside the head and neck region is a rare phenomenon. Multiple explanations, including pellet embolization, patent foramen ovale and carotid intimal tear, have been suggested.

Case Report
We present a case of an otherwise healthy 21-year-old male, who was received in the emergency with a firearm injury, unstable vitals, and GCS 14/15. Bullet entry wound was on the back of the chest, 3 cm medial to the spine of left scapula, with no exit wound, but bullet palpable superior to the medial 1/3rd of right clavicle. CT and X-ray imaging confirmed surgical emphysema and left sided haemopneumothorax. Two release incisions were given superior to the medial 1/3rd of both clavicles. Bullet was found below the right release incision and was retrieved. Chest tube was inserted bilaterally, and the patient was placed on mechanical ventilation. On the 5th day, upon resolution of emphysema and haemopneumothorax, the patient was extubated, and the chest tubes were removed. However, examination findings revealed left facial and abducens palsy along with left circumduction gait. MRI brain showed ischaemic changes in the right frontoparietal region. Carotid angiography and echocardiography were normal. Patient was then managed by neurology and neurosurgery.

Conclusion
In cases of firearm injury the physician should always look for neurological deficits, irrespective of the firearm injury pathway through the body. Stroke should be a concern in such cases even if the patient is otherwise healthy and young.
727 Pulmonary Embolism Following Posterior Shoulder Dislocation and Traumatic Brachial Plexus Injury - a Case Report
Authors: Noton T , Khanom S , Abd Wahab EH , Gerakopoulos E , Colegate-Stone T 
Published: November 2022

Abstract
Traumatic brachial plexus injuries are considered to be among the rarest but most debilitating complications of shoulder dislocation. In addition, posterior shoulder dislocations are also rare, accounting for only 2–4% of all shoulder dislocations.
A 40-year-old female patient presented to the emergency department (ED) with a dislocated right shoulder secondary to a mechanical fall. Plain film X-rays demonstrated a posterior dislocation of the humeral head. The shoulder was reduced under procedural sedation. Clinical examination after relocation demonstrated dense flaccid paralysis affecting all dermatomes and myotomes throughout the right upper limb. Urgent magnetic resonance imaging (MRI) of the shoulder showed oedematous thickening and haematoma along the brachial plexus, a large ‘reverse’ Hill-Sachs lesion, greater tuberosity avulsion fracture and glenohumeral capsular tear.
The patient was referred to the specialist peripheral nerve injury unit, who advised nerve conduction studies and a magnetic resonance angiogram (MRA) to rule out expanding haematoma. The MRA scan revealed brachial plexus findings consistent with the MRI scan, no active bleeding, however a thrombus in the brachial vein.
Two days after the MRA scan, the patient presented to ED with ongoing flaccid paralysis, severe neuropathic pain, and right-sided chest pain. Blood tests revealed a d-dimer &gt;1000. CT pulmonary angiography confirmed extensive bilateral pulmonary emboli and she was commenced on appropriate anticoagulation.
Association between brachial plexus injury, flaccid paralysis and venous thromboembolism are rare sequelae resulting from posterior shoulder dislocation. Further studies are required to investigate its incidence and establish whether all patients should receive VTE prophylaxis as standard.
736 Endoscopic-Guided Decompression of an Incidental, Massive, Infected Fronto-Ethmoidal Mucocele: Our Experience
Authors: Muhammad U , DeCarpentier J , Noon E 
Published: November 2022

Abstract
A 55-year-old man was referred to neurology with worsening headaches and right-hand numbness. An MRI brain demonstrated a hemangioblastoma but also a large right sided frontoethmoidal mucocele. The only sino-nasal symptom the patient had was unilateral nasal obstruction but felt this was well-controlled with a steroid nasal spray prescribed in primary care. Nasendoscopy showed pus emanating from a smooth mass anterior in the nasal cavity. A CT scan showed features of a large, expansile mass extending across both frontal and ethmoid sinuses, lateralising the septum, with dehiscence of the lamina papyracea. The patient underwent image-guided endoscopic sinus surgery to drain the mucocele which was filled with a considerable amount of pus and was seen to have eroded all sinus lamellae. Sinonasal mucoceles are expansile collections of mucous, lined with epithelium, and are thought to be more common in the third and fourth decades (1). They are usually caused by sinus surgery as a result of an obstructed sinuses but can follow trauma, inflammation or occur spontaneously (2). Once identified, surgery is the standard of care to prevent complications from expansion or infection. In this case report, along with imaging and intraoperative photographs, we further describe our approach and experience in managing a large mucocele.
739 A Primary Thyroid Squamous Cell Carcinoma Presenting as a Left-Sided Neck Lump
Authors: Akbar S 
Published: November 2022

Abstract
The elderly patient presenting with a neck lump often raises concerns regarding a malignany. Thyroid gland malignancies are well-recognised and sub-type characteristics thoroughly researched, whereas rarer types of thyroid carcinoma are reported infrequently and often behave more aggressively.
An 83-year-old female was referred from the GP to ENT due to a 7-month history of an unexplained enlarging left-sided neck swelling. A fine needle aspiration revealed cytology consistent with squamous cell carcinoma (SCC). Staging imaging failed to reveal evidence of a primary foci elsewhere. The definitive diagnosis was that of a primary thyroid SCC: a rare entity with limited citations in the literature. Surgical resection has been found to comprise the optimal treatment for this disease.
Recognition of the possibility of primary thyroid SCC in elderly patients presenting with a neck lump, with prompt referral to a head and neck specialist permits a timely progression to potentially curative surgical management, a more promising prognosis and reduced mortality rates.
741 Paediatric Pigmented Epithelioid Melanocytoma: A Case Report
Authors: Magill H , AlOmran Y , Abela C 
Published: November 2022

Abstract

Background
Pigmented epithelioid melanocytomas (PEMs) pose a challenge in terms of diagnosis and management, this is due to the wide spectrum of disease severity. Not only is management a grey area, but there is controversy over management and follow up, due to their indeterminate malignant potential.

Case
An 11-year-old boy presented with a six-month history of a rapidly changing pigmented naevus on his upper back. He had Fitzpatrick type 1 with no history of significant sun damage or familial history of skin cancer, and no relevant past medical history. Differential diagnoses included spitz naevus, malignant melanoma, or MelTUMP (melanocytic tumour of unknown malignant potential). An excision biopsy showed a benign pigmented epithelioid melanocytoma with local lymphatic involvement. The child was seen two months following the original surgery and no signs of local or regional recurrence was present.

Discussion
This is one of few cases of paediatric PEM reported in literature. This lesion has potential to metastasise through the lymphatics and mortality is very low. The management of PEMs is complicated due to their unknown malignant potential and should be decided by an MDT. Based on the limited literature on PEMs and our knowledge of ‘thin’ melanomas wide local excision is sensible, however a larger cohort if needed to fully understand prognosis. SNB should be considered on a case-by-case basis by an MDT, and regular ultrasound surveillance with clinical examination offers a safe alternative to SNB in some patients.
743 Dermal Fillers and Fibromyalgia Flares: A Case Report
Authors: Magill H , Totty J 
Published: November 2022

Abstract

Background
Minimally invasive treatment with dermal fillers is increasing in popularity in facial plastic surgery. These fillers can be used in the midface to address volume loss associated with ageing, such as loss of malar projection, or deep nasolabial folds. The use of medicinal products has the potential to cause complications, and dermal fillers are no exception, however, reports of these in the literature are uncommon. Selection of a suitable product, patient, and accurate placement of product may avoid some of these complications.
Case: 56-year-old female underwent cheek augmentation with hyaluronic acid filler. The procedure was uncomplicated, and there were no concerns immediately afterwards. Over the following months however the patient reported flares that occurred when she had a fibromyalgia flare. She had no signs of infection and there was no evidence of a reaction to the filler itself.
This is the first case of its type to be described to our knowledge; literature searching does not retrieve any reports to date of adverse events related to fibromyalgia following the use of cosmetic dermal fillers. Careful consideration of patient suitability, and clear and detailed informed consent is vital in providing cosmetic treatments safely.
749 Bouveret Syndrome: A Challenging Case of Impacted Gallstone Within the Fourth Part of the Duodenum
Authors: Smith E , Zhao S , El-Boghdady M , Sabato-Ceraldi S 
Published: November 2022

Abstract

Aim
Bouveret syndrome is a rare condition characterised by gastric outlet obstruction secondary to a gallstone fistulating into the proximal duodenum or pylorus. In this report, we present a case of Bouveret syndrome in a 68-year-old requiring an atypical approach to surgical retrieval.

Method
The patient presented acutely with abdominal pain and vomiting. This was on a background of recent admission for gallstone ileus managed conservatively. Initially, due to high anaesthetic risk (P POSSUM score = 14% mortality, 60% morbidity), the patient was managed conservatively with nasogastric drainage and total parenteral nutrition. On day 6 of admission, emergency laparotomy was performed after identifying radiological signs of impending perforation related to a large gallstone impacted in the fourth part of the duodenum and a cholecysto-duodenal fistula. Endoscopic management was not available locally.
Unsuccessful attempt was made to milk the stone proximally for retrieval via pyloroplasty. Subsequently, high pressure water flushes were delivered via the gastrostomy which expelled the stone distally. The stone was then retrieved via jejunotomy at the DJ flexure.

Results
The patient required a 2-day high dependency unit admission, and she was discharged 3 weeks post-operatively at her functional baseline. She was clinically well and asymptomatic when reviewed at the four-month post-operative surgical follow up appointment.

Conclusions
This is the first report to our knowledge to describe successful surgical management of a gallstone impacted in the fourth part of the duodenum. Enterolithotomy can be considered in case of large, impacted stone and can be a safe option in patients with multiple co-morbidities.