Reports

Myxolipomas are rare variants of lipomas characterized by abundant myxoid changes resulting from an abundant mucoid component. While myxolipomas have been reported in various anatomical locations, their occurrence in the popliteal fossa is exceptionally rare, with the last published case dating back to 1914. We present a case of a 64-year-old male with a large myxolipoma in the popliteal region. The patient underwent successful surgical excision, and a histopathological examination confirmed the diagnosis of myxolipoma. This case report highlights the clinical features, differential diagnosis, and diagnostic challenges associated with myxolipomas in the popliteal fossa. Full article

This study aims to evaluate the preliminary effects of a hybrid tele-supervised airway clearance protocol on secretion clearance, health-related quality of life, and patient satisfaction in bronchiectasis patients. A single-arm experimental pilot case series with three participants was conducted, involving six ACT sessions over three days, including one onsite supervised session and five tele-supervised sessions. Assessment measures comprised sputum expectoration, COPD assessment test (CAT), and participant satisfaction ratings. The results showed increased sputum expectoration rates during each ACT session, alongside notable improvements in CAT scores (reductions of 16, 8, and 8 points for each participant). Participants expressed high satisfaction with tele-supervised sessions and reported increased confidence in independent ACT performance post-program. The findings suggest that the hybrid ACT program may be a promising avenue for enhancing bronchiectasis management. However, further research with larger sample sizes and rigorous control groups is necessary to validate its efficacy and broader applicability. Full article

Schwannomas are benign and slow-growing peripheral nerve sheath neoplasms of Schwann cells. These are generally encountered in the neck, head, and flexor areas of the extremities. Even though many schwannomas are easily diagnosable, their variable morphology can occasionally create difficulty in diagnosis. In this study, we present a rare case of melanotic schwannoma of the sacrum, emphasizing the need for routine biopsy to understand the etiology. A 46-year-old man presented to the Department of Neurosurgery, Taipei Medical University Hospital, with buttock pain in the sacrum area for 1 year, which worsened in the last 1–2 months. The patient had no known history of trauma or malignancy. We evidenced an intradural extramedullary neurogenic tumor at the caudal end from S1 to S3. Histologic analysis revealed melanin deposition in the tumor cells. Round to oval tumor cells were positive for HMB-45 and S-100 proteins, suggestive of melanotic Schwannoma, which were removed by laminectomy. After 1 month, the tumor recurred and was further removed surgically. Conclusively, we observed the sacrum as an unusual anatomic site for the possible occurrence of melanotic schwannoma, especially in patients with no known history of trauma and malignancy. The possibility of melanotic schwannoma is very high. We hypothesize that melanotic schwannoma was possible because it occurred in the intradural and extramedullary regions of the spine. Hence, a routine biopsy should be performed to corroborate the exact cause and prevent incorrect presumptions. Full article

Central retinal vein occlusion typically manifests in older individuals with underlying systemic pathology, leading to a spectrum of symptoms ranging from blurred vision to complete vision loss. While odontogenic infections are recognized for causing complications affecting the eye and vision, their potential role as an etiological factor in cases of sudden vision impairment merits consideration. This article presents a case involving central retinal vein thrombosis, wherein resolution was achieved through a combination of ophthalmic therapy and the surgical removal of a concurrently existing large inflamed odontogenic cyst located in the ipsilateral hemimaxilla. This case underscores the importance of recognizing odontogenic factors in the assessment of sudden vision impairment and the efficacy of a multidisciplinary therapeutic approach. Full article

(1) Background: This study aims to analyze the bioelectrical activity of the masticatory and cervical muscles in a subject with anisometropia. (2) Methods: A female patient aged 23 years with a best-corrected visual acuity of 1.0 in the right eye and 0.1 in the left eye, a refractive error of −2.25 Dsph in the right eye and +4.25 Dsph in the left eye, and astigmatism of −1.75 Dcyl axis 24° was examined. A comprehensive ophthalmological examination and the study of the bioelectrical activity of the muscles were carried out. During the ophthalmological examination, best-corrected visual acuity was determined, refractive error (spherical equivalent) was assessed, and additionally, retinal thickness, choroidal thickness, axial length, and intraocular pressure were measured. (3) Results: It was demonstrated that higher tension in the resting mandibular position and pain-free maximum unassisted opening were observed on the right side (myopia). Conversely, higher tension during maximum voluntary clenching in the intercuspal position and maximum voluntary clenching on dental cotton rolls in the intercuspal position was observed on the left side (hyperopia and astigmatism). (4) Conclusions: In the case study, muscle asymmetry was demonstrated, which is likely associated with anisometropia. This phenomenon requires further investigation. Full article

Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disorder of the white matter. The pathophysiology is thought to be immune-mediated as in most cases the condition follows an infection or triggering incident. More recent literature has demonstrated that there may be a link between autoimmune conditions and ADEM. Here we present a case of ADEM in a middle-aged woman with systemic lupus erythematosus that recovered well after treatment with corticosteroids and rituximab. Full article

The aim of this study was to investigate the effect of patient demographic and anatomical characteristics on abdominal compliance (AC), which represents the slope of the pressure–volume (P–V) curve of the abdominal cavity and is a measure of the ease of abdominal dilatation. The study included 90 patients undergoing laparoscopic abdominal surgery. Subcutaneous adipose tissue and abdominal muscle thickness were measured using ultrasonography. The mean AC was calculated during insufflation using the formula (ΔV/ΔP). The relationship between demographic and anatomical variables and AC was investigated. The results demonstrated that AC was higher in men, the elderly, and women with a history of pregnancy, and lower in patients with a history of abdominal surgery. No significant correlation was found between AC and BMI, abdominal muscle thickness, and subcutaneous adipose tissue thickness. These findings suggest that morbid obesity, a common comorbidity in laparoscopic surgery, and well-developed abdominal muscles are not indicators of low AC. However, gender, age, pregnancy history, and previous abdominal surgery affect AC during laparoscopic surgery. By taking these factors into account during preoperative evaluation, it may be possible to predict patients with low AC, which could improve perioperative outcomes through the application of individualized intra-abdominal pressure (IAP) during pneumoperitoneum. Full article

Gingival cysts of the adult are rare and benign odontogenic lesions of the oral cavity, accounting for almost 0.3% of all odontogenic cysts. Their differential diagnosis is still challenging for surgeons as it includes other gingival inflammatory or non-inflammatory lesions and peripheral odontogenic tumors. The aim of this paper is to report a new case occurring in an adult, analyzing the clinical, radiographic, and histopathological features as guidelines for a differential diagnosis. We report a 49-year-old patient complaining of a small, pigmented lesion localized on the attached gingiva with no history of trauma, which was surgically excised and histologically diagnosed as a gingival cyst. A differential diagnosis may be challenging for clinicians it includes a wide spectrum of inflammatory and non-inflammatory lesions, so a correct diagnostical–therapeutical approach is needed to avoid possible overtreatment and minimize the recurrence rate. Full article

A healthy man in his 40s was referred to the Oral Surgery and Implantology Unit of Geneva University Hospital for diagnosis and management of facial swelling affecting the right side of his lower jaw. The patient’s history revealed that the patient had been hit by several punches to the face a few months earlier. To investigate the swelling, an intra-oral radiograph, an orthopantomographic radiograph, and computed tomography were performed, which revealed no fracture of the lower jaw but the presence of a partly impacted fractured wisdom tooth (third molar). This finding, together with the clinical status, indicated cellulitis most likely related to the presence of a fractured wisdom tooth. The decision was made to proceed with tooth extraction, and follow-up at 3 weeks showed good healing and complete resolution of facial swelling. This case highlights that odontogenic infection can also occur as a result of necrosis following the fracture of an impacted wisdom tooth. Full article

Pineal-region tumors are a histologically heterogeneous group of tumors and represent a rare occurrence, accounting for less than 1% of all adult intracranial tumors. Among these, primary pineal malignant melanomas (PPM) represent an even rarer entity, with only twenty-five cases being reported in the literature to date. We present the case of a 65-year-old patient who presented in our department for progressive headache, gait disturbance and memory impairment. Magnetic resonance imaging (MRI) of the brain revealed a solid mass in pineal region, measuring 2.2 × 1.2 × 2.0 cm and causing obstructive hydrocephalus. He underwent a third ventriculostomy, but we failed to obtain a sample for diagnostic purposes. The intraoperative surprise was the presence, at the level of the third ventricle, of multiple melanin deposits, which were not picked up by the MRI. Although the biopsy could not be performed and had to be obtained by stereotactic biopsy in a second intervention, the endoscopy findings allowed for the correct staging of the intracranial disease and appropriate treatment management. Full article

Background: Congenital absence of pericardium is a rare cardiac disorder with a reported incidence of less than 1 in 10,000. Although most of the cases are of little clinical significance, some of them are associated with serious complications, including risk of herniation and strangulation or coronary artery compression. Detailed Case Description: We report a case of a 36-year-old male referred for routine cardiovascular examination. He had a medical history of a heart murmur since childhood. Electrocardiogram (ECG) revealed sinus rhythm, normal axis, poor R-wave progression in the precordial leads and repolarization abnormalities with negative T waves in leads V1–V4. On 2D transthoracic echocardiography (TTE), an unusual heart position was noted with poor image quality from the standard acoustic windows. The parasternal long axis view gave the impression of right ventricular dilatation. The findings raised the suspicion of left to right shunt and possible atrial septal defect. For further evaluation, the patient was referred for cardiac magnetic resonance which demonstrated complete left-sided absence of the pericardium. Discussion: Due to indistinct and atypical symptoms and lack of clinical awareness, pericardial congenital absence is frequently misdiagnosed. Patients may complain of atypical chest pain. Patient’s history and physical examination are often nonspecific. In cases with complete pericardial absence, ECG findings may include right axis deviation, right bundle block and sinus bradycardia. Echocardiography findings are also not characteristic, but some may raise the clinical suspicion of this diagnosis. The imaging modalities of choice are computed tomography and cardiac magnetic resonance. Treatment depends on the type of defect and clinical symptoms. Full article

Background: Airway management in Duchenne patients can be challenging. We present a case of an anticipated difficult airway in a 24-year-old Duchenne patient that was managed by planning different suitable strategies based on the unanticipated difficult airway algorithm of the Difficult Airway Society (DAS). Case presentation: The patient initially presented with appendicitis, requiring a laparoscopic appendectomy within 6 h. Due to the underlying condition and a known difficult airway, we anticipated potential airway problems and successfully managed the “can ventilate but cannot intubate” situation using the algorithm. The difficult airway was attributed to reduced mandibular mobility, limited inclination or reclination, a large tongue, prominent incisors, and a posteriorly positioned epiglottis. Despite thorough preparation and team briefing, we experienced three failed intubation attempts. Considering limited nighttime resources, the urgency of the surgery, the need for a tube for laparoscopy, and the risk of exacerbating airway issues, we made the decision to awaken the patient and wait for a second attempt after the epiglottis swelling had subsided. We used reversible, short-acting agents for induction, enabling us to continue with the algorithm within the allotted timeframe. In a second stage, we successfully performed fiberoptic-guided intubation via a supraglottic airway device using the Aintree intubation catheter, utilizing more favorable resources. Conclusions: For a patient with Duchenne muscular dystrophy and a difficult airway, advanced expertise is critical. Detailed anesthesia planning, clear team communication, and the use of reversible, short-acting agents are crucial. Adherence to the Difficult Airway Society guidelines is essential for safe airway management. Full article

The nasal cavity is a sporadic site for mesiodens, and if it is impacted in the lower nasal floor or localized in the nasal septum, it may cause various nasal symptoms such as nasal obstruction, recurrent rhinitis, and epistaxis. Early diagnosis is made through clinical findings and a cone-beam computed tomography (CBCT) scan, but a definite treatment plan has not yet been developed. This study aims to present a case of a mesiodens in a 27-year-old male, located in the nasal septum, an unusual and rare site, and its surgical removal using an endoscopic nasal approach with subperiosteal intranasal dissection. The result of the study appears significant because this technique led to fewer postoperative complications, and it appears to be safer and more effective than the traditional palatal or transoral approach. Moreover, the nasal endoscopic approach is more natural to the ear, nose, and throat (ENT) surgeons than the transoral approach. Full article

The eruption of a rash along with spiking fever in travelers returning from the tropics may be suspicious of arboviral diseases, and isolation prevent further transmission in non-endemic countries. The case presented here was seen at the Fever Clinic at the Hospital for Tropical Diseases in Bangkok, Thailand. The presenting complaints were fever, headache, myalgia, and a distinctive erythematous blanching rash. Despite a negative dengue NS1 test on the initial day, anti-dengue IgM and IgG were detectable on day five of illness. Dengue, a leading cause of traveler’s fever with rash, is of particular concern, especially during outbreaks like the one in Thailand in 2023, when the number of cases exceeded one hundred thousand over a nine-month period. The influx of 28 million travelers in 2023, many with naive immunity to many arboviruses, raises fear of transmission to temperate regions, including to countries like France, where Aedes albopictus establishment can lead to autochthonous dengue cases and clusters. Enhanced surveillance is crucial, urging the consideration of dengue as a potential diagnosis in travelers with febrile rash, even prior to lab confirmation. Immediate isolation of patients is essential to prevent autochthonous transmission, reduce outbreak risks, and avert public health crises. Full article

Tibial Periprosthetic fractures (PPF) after primary total knee arthroplasty (TKA) are uncommon and mainly occur after trauma. Various management options have been proposed; however, the decision mainly relies on the location of the fracture and the tibial baseplate stability and ranges between conservative (non-operative), fracture fixation, and revision TKA. We report a case of a 79-year-old female patient who presented with atraumatic lateral tibial plateau PPF (Felix type ⅠB) with a loose tibial implant after three weeks of having left primary TKA. The patient was treated successfully by revising the tibial component using a stemmed tibial baseplate and reconstructing the tibial bone defect using two metal wedges. The radiological, functional, and PROM outcomes were satisfactory and accepted both early on (eight weeks) and at the last follow-up (six months). Atraumatic insufficiency Felix type ⅠB PPF of the lateral tibial plateau after primary TKA is uncommon. Reconstructing the tibial bone defect, revising the tibial component, and adding a stem to offload the tibial plateau are the treatments of choice that lead to acceptable outcomes. Full article

While insertion of a central venous catheter (CVC) for intravascular access, diagnosis, and intensive care medical treatment is frequently needed in critically ill patients, retention of the guidewire used for CVC placement with Seldinger’s technique is a very rare complication. In patients treated with extracorporeal membrane oxygenation (ECMO), significant negative pressures in the thoracal and abdominal venous system are generated by the venous ECMO drainage cannula. Therefore, during CVC placement in patients treated with ECMO, special vigilance is required because the significant negative pressures generated by the venous ECMO drainage cannula facilitate venous suction of an unsecured guidewire. Full article

Objective: Chloroquine (CQ) and hydroxychloroquine (HCQ) were used as off-label treatments for SARS-CoV-2 infection during the first pandemic waves. The urgency of combatting COVID-19 led to the dissemination of medical recommendations with a scarce awareness of possible drug–drug interactions. This issue primarily concerned people already taking multiple medications, such as older individuals. We estimated the prevalence of drug interactions with CQ or HCQ in COVID-19 inpatients during the first pandemic waves and their possible association with hospitalization-related outcomes. Methods: This study considers 487 patients aged ≥60, hospitalized for COVID-19 from March to December 2020, and treated with CQ or HCQ. Data on acute and chronic therapies and hospitalization length and outcomes were derived from medical records. The presence of drugs potentially interacting with CQ and HCQ was identified based on published literature and drug databases. Results: In our sample (mean age 77.1 years, 47.8% females), 255 (52.4%) patients presented with one drug interaction with CQ or HCQ, and 114 (23.4%) had more than two interactions. The most frequent drugs potentially interacting with CQ or HCQ were lopinavir/ritonavir (50.4%), azithromycin (47.2%), tocilizumab (15.4%), levofloxacin (8.7%), clarithromycin (6.0%), amlodipine (3.3%), and trazodone (2.4%). No substantial differences in the duration and outcomes of the hospitalization emerged as a function of the presence of drug–drug interactions. Conclusions: Many older patients prescribed with CQ or HCQ, which have lately proved ineffective against COVID-19, were exposed to the risk of drug–drug interaction. This underlines that medical recommendations should undergo careful peer review before being widely disseminated, even in emergencies like a pandemic. Full article

Background: This study aimed to compare the clinical outcomes of using two different devices to treat upper palatal discrepancies evaluated with a digital intraoral scanner. Methods: A total of 64 patients were enrolled and treated with either an elastodontic expansion device (32 patient test group, 16 females and 16 males, mean age 7.08 ± 0.44) or Haas expander (32 patient control group, 16 females and 16 males, mean age 7.32 ± 0.50). The two groups exhibited similar orthodontic features. The orthodontic criteria were: skeletal class I relationship; molar class I relationship; complete eruption of upper sixths; presence of unilateral or bilateral cross bite. All dental casts were examined and subsequently scanned with an intraoral scanner (I-Tero) pre-treatment (T0) and 12 months after the onset of therapy (T1) to assess the distance between the decidous upper canines (ICW, intercanine width) and the distance between the mesiopalatal cusps of the upper first molars (IMW, intermolar width). For statistical analysis, the t-test for continous variables and the chi-square test for categorical variables were used, respectively. Results: There were no statistically significant differences between the mean and SD of the expansions that resulted from the Haas expander and the elastodontic devices (Haas expander vs. Eptamed: ICW_T1 (Haas) = 42.34 (3.09), ICW_T1 (Eptamed) = 42.69 (2.77); p = 0.743; IMW_T1 (Haas) = 34.22 (2.29), IMW_T1 (Eptamed) = 34.00 (2.56); p = 0.800). The two devices were similarly effective. Conclusions: Elastodontic devices and the Haas expander can successfully help the orthodontist to conduct upper arch expansion treatment. However, elastodontic devices are more comfortable during the resolution of palatal discrepancies compared to palatal expander devices. Full article

Introduction: Descending necrotizing mediastinitis is one of the most lethal forms of acute mediastinitis. It originates from an odontogenic or deep neck infection, which descends to the mediastinum through the fascial planes. It is a rare condition, but mortality rates remain high, especially in the presence of comorbidities or predisposing factors. Delay in diagnosis has been shown to be one of the most important factors for the disease outcome. Therefore, early diagnosis and treatment by a multidisciplinary team are of utmost importance. Case series: Four healthy young males with descending necrotizing mediastinitis were treated at our institution. None of them had any comorbidities, but all of them waited between 3 and 4 days before seeking medical help. Upon their arrival at the hospital, in addition to the presence of a severe neck infection, the presence of mediastinitis was also found. Despite the timely surgical treatment of both the source of the infection and the mediastinitis, three of the four cases had a fatal outcome. Conclusion: We believe that the time factor is of greater importance for the outcome of acute descending mediastinitis than the factors of age and presence of accompanying diseases. Proper and rapid treatment by a multidisciplinary team is essential, even for young and healthy people. Full article