Thyrotoxic periodic paralysis: a case report and review of the literature

Thyrotoxic periodic paralysis (TPP) is an uncommon disorder characterized by simultaneous thyrotoxicosis, hypokalaemia, and paralysis and is the most common acquired form of periodic paralysis. It is usually associated with low plasma potassium levels and is often precipitated by physical activity or ingestion of carbohydrates. We presented a 35-year-old man with hyperthyroidism who admitted applied to the emergency department with an episode of flaccid quadriparalysis following oral diclophenac sodium usage for lumbar disk hernia and the review of the literature on this subject. Physical and laboratory examination revealed sinus tachycardia, diffuse toxic goiter, flaccid quadriparalysis, a low serum potassium level (1.51 mmol/L), ST segment depression, coincidental horseshoe kidney. Potassium chloride was admitted via both parenteral and orally. Meanwhile antithyroid treatment (propylthiouracil and propranolol) was also given. Early diagnosis is important for planning antithyroid treatment, protecting the patient from further episodes of paralysis and avoidance of precipitating factors. In our patient, electrolyte imbalance appeared secondary to polyuria and vomiting, serious pain and physical stress may have triggered TTP

Spontaneous rupture of the spleen in a hemodialysis patient

Hypovolemic shock and spontaneous splenic rupture (SSR) are unusual fatal complications in the uraemic patients. We described a case of SSR in a 29-year-old hemodialysis (HD) patient. The diagnosis was confirmed with the acute abdomen picture included the left upper abdominal and left shoulder pain together with shock and ultrasound findings. The splenectomy was performed. The postoperative course was uneventful and the patient was discharged from hospital on the 5th day. The mechanism of the rupture is still unknown, but the rupture and subcapsular haematomas of spleen may be induced by the uraemic coagulopathy, the use of anticoagulants during HD, malignant hypertension and unrecognised microtrauma. Splenic rupture should be considered in any patient with abdominal pain and shock, regardless of a history of trauma or previously known risk factors for spontaneous rupture. An aggressive multidisciplinary approach to the management of these patients may decrease the mortality rate

An extraneural primary anaplastic ependymoma at the subcutaneous inguinal region: Report of a rare case

Ependymomas commonly arise in the central nervous system. Extraneural presentation is quite rare. Herein, we describe a primary extraneural ependymoma in a young female. The mass was located in the right inguinal area. The cut surface of the 7.5 mm × 6.5 mm × 4.5 mm sized tumor was brownish-yellow in color. Histologically, it was hypercellular exhibiting pseudorosette or rosette formations and some papillary structures. Mitosis was counted as high as 10 per 10 high power fields. Neither necrosis nor vascular endothelial proliferation within the tumor was observed. Tumor cells showed strong glial fibrillary acidic protein immunoreactivity. On epithelial membrane antigen, intracytoplasmic dot-like immunostaining was observed. This is the first report presenting a primary extraneural anaplastic ependymoma arising in the inguinal subcutaneous region

An extraneural primary anaplastic ependymoma at the subcutaneous inguinal region: Report of a rare case

Ependymomas commonly arise in the central nervous system. Extraneural presentation is quite rare. Herein, we describe a primary extraneural ependymoma in a young female. The mass was located in the right inguinal area. The cut surface of the 7.5 mm × 6.5 mm × 4.5 mm sized tumor was brownish-yellow in color. Histologically, it was hypercellular exhibiting pseudorosette or rosette formations and some papillary structures. Mitosis was counted as high as 10 per 10 high power fields. Neither necrosis nor vascular endothelial proliferation within the tumor was observed. Tumor cells showed strong glial fibrillary acidic protein immunoreactivity. On epithelial membrane antigen, intracytoplasmic dot-like immunostaining was observed. This is the first report presenting a primary extraneural anaplastic ependymoma arising in the inguinal subcutaneous region

The effects of viral cirrhosis on cardiac ventricular function

Liver cirrhosis is a severe disease with complications and viruses take the first place in the etiology of cirrhosis. In this study, the effects of liver cirrhosis due to viral hepatitis cardiac ventricular functions were analyzed. Thirty patients (mean age 43.6±12, 20 male) with liver cirrhosis underwent echocardiographic studies and were compared with 30 healthy controls (mean age 37.3±2, 22 male). Right and left atrium and right ventricle dimensions, interventricular septum, right ventricle free wall thickness, pulmonary artery diameter and assumed mean pulmonary artery pressure measured with 2-dimensional echocardiography were significantly increased in the patient group. In Doppler echocardiographic studies, right ventricle diastolic functions were significantly impaired in the patient group. There were no significant differences in left ventricle systolic and diastolic functions between the groups. In conclusion, liver cirrhosis causes dilatation in right heart spaces and diastolic dysfunction

Importance of HER2 Work-Up and Treatment Even in Patients with Poor Performance Status: A Case Report

Gastric cancer is one of most common types of cancers. Metastatic gastric cancer has a poor prognosis and is accepted as incurable at this stage. Treatment of metastatic gastric cancer did not progress substantially until new targeted agents have come out. Recently published ToGA trial showed promising results in HER2 overexpressing metastatic gastric cancer. In this case we present a case with an excellent complete response with anti-HER2 treatment. Most importantly, we wanted to emphasize (1) the importance of early determination of HER2 overexpression, and (2) to draw attention of anti-HER2 agents in the first line treatment even in patients with a poor performance status

The relationship between prognostic parameters and tumor associated tissue eosinophilia in supraglottic laryngeal tumors

Objective: Tumor-associated tissue eosinophilia (TATE)has been noted in human cancers, sometimes with differentresults regarding their association with clinical outcome.In this study, the association between TATE andprognostic parameters of supraglottic laryngeal cancerwas analyzed.Materials and methods: Sixty-two patients with diagnosisof supraglottic laryngeal squamous cell carcinoma andwho treated surgically in our center were evaluated. Thecases were divided into 3 categories according to the averagenumber of eosinophils per high-power field (400x):0 (negative), 1-5 (grade 1+), more than 5 (grade 2+).Results: We found 24 TATE-negative (38.7%) and 38TATE-positive (61.3%) cases. There was not any statisticallysignificant correlation between TATE and tumor differentiation,vascular invasion, perineural invasion, lymphnode metastasis, patients’ ages, T stages (p>0.05). Asexpected, vascular invasion correlated with lymph nodemetastasis (p=0.001).Conclusion: The results of this study showed that TATEhas no correlation with prognostic parameters such ashistologic differentiation, vascular invasion, perineuralinvasion, lymph node metastasis, patients’ ages and Tstages in supraglottic laryngeal squamous cell carcinoma.The data suggest that stromal eosinophilic infiltrationis not useful for determining biological aggressiveness insupraglottic laryngeal cancer.Key words: laryngeal carcinoma, supraglottic, eosinophilia,prognostic parameter