Journal des rapports de cas cliniques

The regular practice of physical and sporting activities is one of the most important measures in cardiovascular prevention. It is to be recommended at all ages as it improves fitness and significantly reduces cardiovascular morbidity and mortality. However, exercise can become a trigger of Sudden Cardiac Death (SD) in patients with often, underlying cardiovascular disease.

Aim: Postoperative pelvic hematoma is almost a universal consequence of gynaecologic surgery. It occurs especially after vaginal or abdominal hysterectomy. To our knowledge, so far no case of pelvic hematoma after surgical treatment of ectopic pregnancy was described in the literature.

Case report: This case report describes a pelvic hematoma that occurred after surgical treatment of ectopic pregnancy. The hematoma was infected and resolved spontaneously. The patient, a North African woman, was given antibiotic treatment for two weeks. During 4 months of follow-up, the size of the hematoma decreased down to 59.5% of the initial size. Monitoring of the patient is still continuing.

Conclusion: Postoperative pelvic hematoma can be diagnosed in the early postoperative period of gynaecologic surgery. Sometimes it resolves spontaneously.

Cryptococcal meningitis is one of the most common neurologic complications of AIDS. Cerebral venous sinus thrombosis is a rare cerebrovascular complication, usually associatied with HIV-related thrombosis, but infrequently reported on the setting of cryptococcal meningitis. The diagnostic method of choice for cerebral venous sinus thrombosis is magnetic resonance in combination with venography. Anticoagulation is usually not used in the setting of infectious thrombosis, but proved to be useful in this case.

A 21 year-old Mexican man with recently diagnosed and untreated AIDS, presented with involuntary movements, headache, gait disturbances, and dysmetria. Cryptococcal meningitis was diagnosed and treated with amphotericin B and fluconazole, achieving some improvement. A week after diagnosis, the headache worsened and the imaging studies suggested a cerebral venous sinus thrombosis. The patient was started on non-fractionated heparin and he presented gradual recovery. He was followed-up for a year and did not present any recurrence or complication related to the thrombosis.

Although elbow dislocation is the second most frequent type of dislocation in the human body, complications in the brachial artery are rare. In addition, brachial artery injury due to elbow dislocation which is not discernible during the initial examination(occult dislocation) is even more rare.

Aortoenteric Fistula (AEF) is a rare and life threatening condition that has been challenging to diagnose and manage. Early diagnosis and treatment is important to prevent fatal outcomes. While multiple diagnostic modalities have been used to help diagnose AEF, including upper endoscopy, aortogram, and Computed Tomography (CT) angiography; a high clinical suspicion and history remain of utmost importance for the diagnosis. Esophago Gastroduodeno Scopy (EGD) and CT scans are the most helpful diagnostic studies.

Leptospirosis is a zoonotic disease which causes a variable spectrum of illness in humans, ranging from a selflimiting or subclinical illness, to the severe potentially fatal “Weil’s disease,” which can have a mortality of up to 50%. We present the case of a returning traveller presenting with vomiting, diarrhoea, jaundice and acute kidney injury.

We report on a 61-year-old female case of advanced ureter cancer using omental flap transposition (OFT) with tumor reduction surgery before adjuvant pelvic irradiation to prolong survival and to prevent pelvic complication from irradiation, resulting in a stable disease state for one year without serious major morbidity. The patient presented with growing pelvic pain and constipation for three months without gross hematuria or flank pain. She was diagnosed with stage IV (T4N2M0) left distal ureter cancer extending to the left iliac vessels. After three cycles of neoadjuvant combination chemotherapy of gemcitabine-cisplatin, left nephroureterectomy with a resection of the bladder cuff and ipsilateral salphingo-oophorectomy with lymph node dissection, and segmental colon resection with OFT were performed. Then, 30 adjuvant radiations at a fractionated dose of 6880 cGy on left-sided pelvic areas enabled the patient to remain in a stable disease state without progression or loco-regional recurrence, and no severe complications occurred during follow-up. Therefore, owing to the OFT with surgical reduction of tumor burden, adjuvant high dosing radiotherapy was performed effectively and safely in advanced ureter cancer without occurrence of severe radiation-related complications.

Proper patient positioning is becoming increasingly difficult as the national BMI continues to rise. Gynecologic surgery often requires patients to be in lithotomy position for adequate visualization and access, which can increase the risk of femoral nerve injury. Herein, we describe the first case of using Hoyer Lifts ® intra-operatively for proper leg positioning of a morbidly obese patient. This is the first reported case using Hoyer Lifts ® for positioning the lower extremities of a morbidly obese patient during gynecologic surgery. Using a lift for each leg, we were able to accommodate both lower extremities and prevent neurologic injury. Such lifts provide an additional approach to positioning extreme morbidly obese patients.

Percutaneous vertebroplasty (PVP) is a common procedure for treatment of painful vertebral fractures. Although PVP is considered minimally invasive, complications may occur during the procedure. Bone cement pulmonary embolism (CPE) is a severe and potentially life-threatening complication following vertebroplasty (VP). CPE commonly occurs after performing VP, but hemodynamically it has little clinical impact. Treatment strategies of CPE is still unclear.

Reports have linked thyroid dyscrasias with inflammatory bowel disease and papillary carcinoma of the thyroid with Crohn’s disease. Here is presented a rare case of a patient with co-existing hyperthyroidism, papillary carcinoma of the thyroid and Crohn’s disease. After a 7-year history of Crohn’s disease that was resistant to medical management our patient developed hyperthyroidism and through a thyroidectomy her pathology report relieved papillary carcinoma of the thyroid. To the best of our knowledge these three pathologies have not simultaneously een presented in the current literature. This association is a novel finding and with further advances in research,our approach towards patients with Crohn’s disease might change.

We describe a case of newly diagnosed chronic myelomonocytic leukemia that presented with predominantly rheumatologic symptoms. In addition to the deletion of chromosome 12p, marrow cytogenetics also revealed a unique translocation, t(x:4). This finding was not a constitutive abnormality. We report this unusual chromosomal abnormality and hypothesize about the potential immunogenicity of the gene product and its relation to the patient’s rheumatologic complaints.

A 44 years old woman was referred to the Internal Medicine Department because of left sided cervical lymph node enlargement. She suffered in the last few months from dyspepsia that was responsive to protein pump inhibitors. She knew that her physician suspected that she might have a recurrence of the helicobacter pylori that she suffered from 2 years earlier, but she was afraid to undergo gastroscopy and did not want to perform the breath test for helicobacter pylori detection. She had a left sided parathyroid adenoma that was removed 2 years earlier. It is important to mention that her sister had Hodgkins’ lymphoma and her father suffered from vocal cord cancer. A week before admission she noticed a swelling in the left lower cervix, and she decided eventually to examine it because of esthetic reasons.

The placement of foreign bodies into the rectum is an uncommon medical problem. The first aim of therapy is to extract the foreign body using the simplest method possible without harming the integrity of the intestine. We report a case of 65 year old schizophrenic male patient on antipsychotic therapy who was admitted to the emergency room with abdominal pain and constipation following insertion of a deodorant bottle in the rectum.