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Nicole Spitzer, Naazli Shaikh, Leah Strickland, Son Ho
This paper describes two patients with squamous cell carcinoma (SCC) of the periocular and periorbital skin who presented with trigeminal neuralgia. Both patients had previous cutaneous SCC of the scalp treated successfully with surgical resection but later presented with neuro-ophthalmic findings suggesting perineural invasion (PNI) of SCC. PNI of SCC in the periocular skin or orbit can lead to devastating effects if malignant cells seed into the orbit and adjacent cranial nerves as our two patients developed an orbital apex syndrome...
December 16, 2016: Curēus
Tyler Janz, Karen Lu, Michael R Povlow, Brittany Urso
Colorectal cancer (CRC) is the third leading cause of cancer death in the United States. Recently, more focus has been placed on developing effective screening tools to detect the presence of both precancerous and cancerous lesions present in the colon and rectum. Colonoscopy has been well established as the gold standard of the colon and rectal cancer screening. However, not all patients are willing to undergo a colonoscopy due to the procedure's invasive nature. Non-invasive screening methods have been developed to appeal to patients who refuse colonoscopy...
December 16, 2016: Curēus
Ali C Agha, Joseph Limback, Raul Loya, Ashley Ramirez, Michael Valente, Jeremy Burt
Lymphoma can involve any organ or tissue that contains lymphoid tissue and the heart is no exception. A few prior case reports have described lymphoma encasing a coronary artery or involving one or more cardiac valves. We present a rare case of diffuse large B-cell lymphoma (DLBCL) involving the tricuspid valve and right coronary artery diagnosed on coronary CT angiography. The clinical and imaging characteristics of cardiac lymphoma are discussed.
December 16, 2016: Curēus
Zain Ul Abideen, Zoya Sajjad, Asna Haroon Khan, Nadira Mamoon, Muhammad Bilal, Khaja Hameeduddin Mujtaba Quadri
Immunoglobulin M nephropathy (IgMN) is characterized by the deposition of immunoglobulin M in a dominant distribution in the renal glomeruli. Primary immunoglobulin M nephropathy is diagnosed after consistent light microscopy (LM), immunofluorescence (IF), electron microscopy (EM) results, and exclusion of known systemic disorders causing immunoglobulin M deposition in the glomeruli. The secondary disease has been reported with a few conditions though it has never been reported with any primary disease of the liver...
December 13, 2016: Curēus
Vibhu Krishnan Viswanathan, Sakthivel Rajan Rajaram Manoharan, Surabhi Subramanian
Nonspondylolytic lateral clefts of the lumbar neural arch (laminolysis and pediculolysis) are rare pathologies that usually occur consequent to repetitive stress injuries in patients with unilateral spondylolysis. These lesions are different from the usual bilateral spondylolytic defects, and their management depends upon the chronicity and the type of bony defect. We hereby discuss the verdict of current literature on underlying pathomechanics and ideal management guidelines of these rare lesions.
December 12, 2016: Curēus
Erfanul Saker, Brandon M Henry, Krzysztof A Tomaszewski, Marios Loukas, Joe Iwanaga, Rod J Oskouian, R Shane Tubbs
The human central canal of the spinal cord is often overlooked. However, with advancements in imaging quality, this structure can be visualized in more detail than ever before. Therefore, a timely review of this part of the cord seemed warranted. Using standard search engines, a literature review was performed for the development, anatomy, and pathology involving the central canal. Clinicians who treat patients with issues near the spine or interpret imaging of the spinal cord should be familiar with the morphology and variants of the central canal...
December 12, 2016: Curēus
Amanda M Krantz, Atman A Dave, Daniel J Margolin
Umbilical endometriosis is a fairly rare clinical entity with unclear pathogenesis. We report the case of a 27-year-old woman who presented with a painful umbilical mass and discharge. Imaging performed was inconclusive, and surgical excision of the site with margins revealed endometriosis on microscopic examination. The incidence of umbilical endometriosis, its pathogenesis, clinical manifestations, workup, and management are discussed.
December 12, 2016: Curēus
Venkataramana Kandi, Ritu Vaish, Padmavali Palange, Mohan Rao Bhoomagiri
[This corrects the article DOI: 10.7759/cureus.751.].
December 12, 2016: Curēus
Erfanul Saker, Gabrielle G Tardieu, Fernando Alonso, Beom Sun Chung, Christian Fisahn, Marios Loukas, Rod J Oskouian, R Shane Tubbs
INTRODUCTION: Most ligaments of the human body have been well studied. However, the lumbocostal ligament has received little attention in the extant medical literature and, to our knowledge, has not undergone anatomical study. Therefore, the present study was performed to better characterize this structure's anatomy and relationships. METHODS: In the prone position, 10 adult cadavers underwent dissection of their lumbocostal ligaments. All specimens were unembalmed and had no history of surgery to the spine...
December 11, 2016: Curēus
Xingrao Wu, Ayesha Baig, Goulnar Kasymjanova, Kamran Kafi, Christina Holcroft, Hind Mekouar, Annie Carbonneau, Boris Bahoric, Khalil Sultanem, Thierry Muanza
BACKGROUND AND PURPOSE:  No longer considered a single disease entity, breast cancer is being classified into several distinct molecular subtypes based on gene expression profiling. These subtypes appear to carry prognostic implications and have the potential to be incorporated into treatment decisions. In this study, we evaluated patterns of local recurrence (LR), distant metastasis (DM), and association of survival with molecular subtype in breast cancer patients in the post-adjuvant radiotherapy setting...
December 9, 2016: Curēus
Chirag Kapoor, Amit Patel, Maulik Jhaveri, Paresh Golwala
Tarsometatarsal (TMT) arthritis is characterized by instability and pain in the foot. The commonest cause is post-traumatic arthritis. A Lisfranc injury involves the articulation between the medial cuneiform and the base of the second metatarsal, which is considered a keystone to midfoot integrity. Neglected or undertreated injury to the Lisfranc joint complex leads to secondary arthritis and significant disability. We present a case of a young male patient with a two-year-old neglected Lisfranc joint injury and secondary osteoarthritis of the first, second, and fourth TMT joints, which we treated surgically with arthrodesis using screws, with a good functional outcome on final follow-up...
December 9, 2016: Curēus
Nicole C DeMartinis, Philip R Cohen
Subungual melanoma with pigmentation beneath the nail that extends to involve the proximal nail fold is referred to as Hutchinson's sign. Black or brown subungual discoloration involving the proximal nail fold secondary to other etiologies has been referred to as pseudo-Hutchinson's sign. Three patients with nail discoloration and concurrent dyschromia of the proximal nail fold are described: a female with a chronic subungual hematoma and pseudo-Hutchinson's sign, a male with culture-confirmed Pseudomonas aeruginosa (P...
December 9, 2016: Curēus
Son Nguyen, Mila Pak, Daniel Paoli, Donna F Neff
The clinical characteristics of emergence delirium (ED) associated with post-traumatic stress disorder (PTSD) among military veterans encompass transient agitation, restlessness, disorientation, and violent verbal and physical behaviors due to re-experiencing of PTSD-related incidents. Two cases of ED after general anesthesia associated with PTSD are presented. Different anesthesia methods were applied for the two cases. A traditional medical approach appeared not to prevent the incidence of ED. In the second case, dexmedetomidine infusion along with verbal coaching was effective in preventing ED for a veteran known to have "wild wake-ups" with prior anesthetics...
December 8, 2016: Curēus
Paula Rupert, Robert A Ochoa, Laurie Punch, Jeffrey Van Epps, Sherilyn Gordon-Burroughs, Sylvia Martinez
Advanced wound management of complex surgical wounds remains a significant challenge as more patients are being hospitalized with infected wounds. Reducing recurrent infections and promoting granulation tissue formation is essential to overall wound healing. Wounds with acute infection and critical colonization require advanced multimodal approaches including systemic antibiotics, surgical debridement, and primary wound care. The goal in surgical wound management is to optimize clinical outcomes such as time to wound closure and functional recovery...
December 8, 2016: Curēus
Aditya Iyer, Casey H Halpern, Gerald A Grant, Sayantan Deb, Gordon H Li
The authors report a challenging case of a brain metastasis located in the motor cortex, which was not responsive to radiosurgery. Use of a novel technique, magnetic resonance-guided laser-induced thermotherapy (MRgLITT), resulted in the complete obliteration of the lesion without adverse effects or evidence of tumor recurrence at follow-up. This case illustrates that MRgLITT may provide a viable alternative for patients with brain metastases refractory to radiosurgery or in deep locations, where both stereotactic radiosurgery (SRS) and surgical resection may be ineffective...
December 7, 2016: Curēus
Eric Ladd, Katherine M Shea, Patrick Bagley, Paul S Auerbach, Elizabeth A Pirrotta, Ewen Wang, Grant S Lipman
BACKGROUND: Hydration status is a controversial determinant of athletic performance. This relationship has not been examined with mountaineering performance. METHODS: This was a prospective observational study of mountaineers who attempted to climb Denali in Alaska. Participants' urine specific gravity (SG), and ultrasound measurements of the inferior vena cava size and collapsibility index (IVC-CI) were measured at rest prior to ascent. Upon descent, climbers reported maximum elevation gained for determination of summit success...
December 7, 2016: Curēus
Douglas F Blazek, Emily Lockridge
A 57-year-old obese female with uncontrolled diabetes mellitus type I presented to the emergency department (ED) with the main complaint of worsening pain and redness in her right groin and inguinal regions. In the ED, a CT scan confirmed the likely presence of necrotizing fasciitis in the right groin and thigh. She was also found to be febrile and septic on admission. She was urgently taken to the OR for extensive debridement then admitted to the ICU for medical stabilization. She was subsequently taken back for serial debridements, and a negative pressure wound therapy with instillation (NPWTi-d) Veraflo device was placed once the wound was successfully debrided down to viable tissue...
December 7, 2016: Curēus
Waqas Ullah, Hafez Mohammad A Abdullah, Muhammad A Shahzad, Muhammad Aslam Sadiq, Ejaz Ahmad, Sana Khan
Epidermal nevus syndrome (ENS) is a term used to describe the occurrence of an epidermal nevus in association with other extra-cutaneous developmental anomalies, most commonly involving the nervous and musculoskeletal systems. The nevus is classified on the basis of the main component which may be keratinocytic, sebaceous, follicular, apocrine, or eccrine. Most patients who present with ENS is at the time of birth, though some become apparent later in life. This case describes a young female who presented with seizures and cognitive impairment along with a linear epidermal nevus on the midline of her face...
December 6, 2016: Curēus
Paresh Golwala, Chirag Kapoor, Malkesh Shah, Aditya Merh, Ankur Kansagra
Tuberculosis (TB) is a chronic granulomatous infection caused by acid-fast mycobacterium tuberculosis bacilli. Spinal involvement occurs in less than one percent of TB. Spinal TB (Pott's disease) accounts for 50% of skeletal TB. Though it most commonly affects the thoracolumbar junction, it can occur at any level of the spine. Early diagnosis and treatment is mandatory in order to avoid neurological complications and spinal deformity. We report a case of a young female with tuberculosis of D12-L1 who was treated with posterior decompression using a modified transpedicular approach and posterior instrumentation with a successful outcome...
December 6, 2016: Curēus
Sitaraman Balaji Subramanian, Karunakaran Balaji, Moorthi Thirunavukarasu, Sumana Premkumar
The purpose of this planning case report is to share the perceived dosimetric benefits of innovative hybrid volumetric modulated arc therapy (h-VMAT) for bilateral breast cancer radiotherapy in two patients with synchronous bilateral breast cancer. Two patients with early bilateral breast cancer after breast conservation surgery and adjuvant chemotherapy were planned for bilateral breast radiotherapy. On the planning computed tomography (CT) dataset, bilateral breast planning treatment volume (PTV) and organs at risk (OARs) were delineated using standard guidelines...
December 5, 2016: Curēus
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