Emphysematous gastritis after metastatic malignant melanoma: a radiological surprise

Malignant melanoma is cancer of the skin which commonly metastasises to the stomach. There have been no reported cases of emphysematous gastritis secondary to metastasis of malignant melanomas, to date. However, a 61-year-old woman with metastatic malignant melanoma of the left great toe presented to us with symptoms of severe left hypochondrium pain associated with high-grade fever, gross abdominal distension and recurrent vomiting. Two months earlier, metastasis was observed to have spread to the stomach and inguinal lymph nodes. At this stage, the patient opted for traditional medication instead of definitive surgery and chemotherapy. Radiological imaging revealed an emphysematous change to the stomach which was radiologically consistent with gastric malignant melanoma. Unfortunately, the patient succumbed to this rare condition

Sinonasal undifferentiated carcinoma – a rare cause of proptosis in elderly

Sinonasal undifferentiated carcinoma is a rare and extremely aggressive sinonasal tract malignancy. It is a rapidly enlarging tumour and a highly destructive lesion. We hereby report a 71-year-old Malay male with progressive left proptosis for one month, associated with reduced vision in the left eye, intermittent diplopia and anosmia. He was later diagnosed as having sinonasal undifferentiated carcinoma. The patient subsequently underwent a series of radiotherapy and showed improvement following treatment. This case was reported to highlight the importance identifying this entity and emphasise that sinonasal undifferentiated carcinoma should be considered in an elderly patient with proptosis associated with nasal symptoms

Transarterial Embolization: Alternative Treatment of Early and Late Postpartum Hemorrhage at a Single Tertiary Center

Objective: To evaluate the eicacy of uterine artery embolization (UAE) in the treatment of postpartum hemorrhage (PPH). Methods: All women who underwent UAE for the treatment of PPH between August 2008 and February 2016 were included. he patients were divided into early and late PPH deined by the onset of bleeding. All UAE procedures were performed by experienced interventional radiologists. Electronic medical records and radiological images were reviewed for data collection. Statistically signiicant associations between angiographic indings and the onset of PPH were evaluated. Results: Total twenty-one women were enrolled in the study. he mean age of the patients was 30.1 years (range 16- 42 years).Total 23 UAE procedures were performed in 21 women. Major clinical presentation was vaginal bleeding in 19 patients (90.5%) and hypovolemic shock was found in 10 patients (47.6%). Eight patients (38.1%) were in early PPH group and thirteen patients (61.9%) were in late PPH group. Five women underwent hysterectomy before UAE. Active contrast extravasation was a common inding associated with early PPH (50%) while pseudoaneurysms were commonly found in late PPH (53.8%) (p=0.016). he overall technical and clinical success rate were 100%. However, two women required repeated UAE ater gelatin sponge embolization for active extravasation due to re-bleeding. No immediate complication of UAE was found in our study. Conclusion: UAE is a safe and efective treatment for both early and late PPH. Various embolic materials can be used but permanent embolic material is preferable in patient with extravasation

Numerical approach for the evaluation of hemodynamic behaviour in peripheral arterial disease : A systematic review

Reduced blood flow to the lower extremities causes peripheral arterial disease (PAD), which is caused by atherosclerotic plaque in the arterial wall. If this impairment is not treated, it will result in severe vascular diseases like ulceration and gangrene. Previous research has shown that while evaluating the pathology of the peripheral artery, the assumption of the model geometry significantly impacts the uncertainty of the stenosis area. However, more work needs to be done to understand the interaction between mechanical better and flow conditions in the peripheral artery using a separate computer model of the cardiovascular system. This paper reviews the numerical approach on pre and post-treatment of hemodynamic behavior in peripheral arterial disease (PAD). The goal of this study was to thoroughly examine the most recent developments with the application of computational studies in PAD from 2017 to 2022. While FSI investigation highlights the behavior of both the fluid and structure domains (blood and artery) during the numerical analysis of blood flow, CFD simulations primarily focus on the fluid domain (blood) behavior. Out of 92 research publications, 19 were appropriate for this assignment. This thorough study divides the publications into the categories of CFD, and FSI approaches. The results were then reviewed in accordance with the wall characteristic, analytical method, geometry, viscosity models, and validation. This paper summarizes the parameters of geometrical construction, viscosity models, analysis methods, and wall characteristics taken into consideration by the researchers to identify and simulate the blood flood flow in the stenosis area. These parameters are summarised in this study. Additionally, it could offer systematic data to help future studies produce better computational analyse

Non-invasive ventilation in a pregnancy with severe pneumonia

Introduction: Non-invasive ventilation (NIV) is not proven to be effective in treating respiratory failure in severe pneumonia. However, some clinicians nevertheless attempt NIV to indirectly deliver adequate oxygenation and avoid unnecessary endotracheal intubation. Case presentation: In this article, we report the case of a 24-year-old woman at 32 weeks' gestation who presented with hypoxemic respiratory failure requiring mechanical ventilation. She was successfully managed by NIV. Discussion: However, NIV must be managed by providers who are trained in mechanical ventilation. This is of the utmost importance in avoiding any delay should the patient's condition worsen and require endotracheal intubation. Moreover, in pregnant women, the severity of illness may progress quickly due to the immunosuppression inherent in these patients. Conclusion: Special attention should be given to the choices of invasive ventilation and NIV to manage community acquired pneumonia patients in third trimester

Effects of fluoxetine on functional outcomes after acute stroke (FOCUS): a pragmatic, double-blind, randomised, controlled trial

Background Results of small trials indicate that fluoxetine might improve functional outcomes after stroke. The FOCUS trial aimed to provide a precise estimate of these effects. Methods FOCUS was a pragmatic, multicentre, parallel group, double-blind, randomised, placebo-controlled trial done at 103 hospitals in the UK. Patients were eligible if they were aged 18 years or older, had a clinical stroke diagnosis, were enrolled and randomly assigned between 2 days and 15 days after onset, and had focal neurological deficits. Patients were randomly allocated fluoxetine 20 mg or matching placebo orally once daily for 6 months via a web-based system by use of a minimisation algorithm. The primary outcome was functional status, measured with the modified Rankin Scale (mRS), at 6 months. Patients, carers, health-care staff, and the trial team were masked to treatment allocation. Functional status was assessed at 6 months and 12 months after randomisation. Patients were analysed according to their treatment allocation. This trial is registered with the ISRCTN registry, number ISRCTN83290762. Findings Between Sept 10, 2012, and March 31, 2017, 3127 patients were recruited. 1564 patients were allocated fluoxetine and 1563 allocated placebo. mRS data at 6 months were available for 1553 (99·3%) patients in each treatment group. The distribution across mRS categories at 6 months was similar in the fluoxetine and placebo groups (common odds ratio adjusted for minimisation variables 0·951 [95% CI 0·839–1·079]; p=0·439). Patients allocated fluoxetine were less likely than those allocated placebo to develop new depression by 6 months (210 [13·43%] patients vs 269 [17·21%]; difference 3·78% [95% CI 1·26–6·30]; p=0·0033), but they had more bone fractures (45 [2·88%] vs 23 [1·47%]; difference 1·41% [95% CI 0·38–2·43]; p=0·0070). There were no significant differences in any other event at 6 or 12 months. Interpretation Fluoxetine 20 mg given daily for 6 months after acute stroke does not seem to improve functional outcomes. Although the treatment reduced the occurrence of depression, it increased the frequency of bone fractures. These results do not support the routine use of fluoxetine either for the prevention of post-stroke depression or to promote recovery of function. Funding UK Stroke Association and NIHR Health Technology Assessment Programme

Essential vascular anatomy and choice of embolic materials in gastrointestinal bleeding

Non-variceal gastrointestinal bleeding is the significant emergency problem to manage in the hospital. Transcatheter arterial embolization is minimally invasive treatment, which becomes an essential role in controlling bleeding, leading to lifesaving. To reach the goal, the interventional radiologist should have fundamental of vascular anatomy and choice of embolic material, which is the key to success

Wilms tumor presenting as small bowel obstruction in a neonate: A diagnostic challenge

Wilms tumor is the most common primary malignant renal tumor of childhood which usually presents between 2 and 6 years of age. Its presentation in the neonatal period is ex- tremely rare and presenting with intestinal obstruction is perhaps unknown. We report a 2- day-old baby girl who manifested features of acute upper gastrointestinal obstruction with frequent post-feeding vomiting and abdominal distension. The initial abdominal radiograph showed abnormally displayed small bowel loops to the right hemiabdomen. Subsequent ultrasound and computed tomography scan of the abdomen detected a massive left renal mass. Left-sided nephrectomy was performed, and histopathology demonstrated left-sided Wilms tumor with favorable histology. Post-treatment yearly follow-up for 5 years recorded a disease-free, normally thriving child

Image-guided system endoscopic drainage of orbital abscess caused by methicillin-resistant Staphylococcus aureus in an infant

Introduction: The management of orbital abscesses in neonates and infants is very challenging. Surgical drainage of the abscess is aimed at removing the pus and preventing blindness. We describe a case of orbital abscess in an infant that was caused by methicillin-resistant Staphylococcus aureus and that was successfully drained with image-guided endoscopic surgery. Presentation of case: A 39-day-old infant presented with progressive right maxillary swelling complicated by methicillin-resistant Staphylococcus aureus orbital abscess. Tooth bud abscess was the most likely primary cause and a combination of intravenous antibiotics was initially prescribed. The collection of intra-orbital pus was removed using image-guided system-aided endoscopic surgical drainage. Discussion: Prompt diagnosis and management are very crucial. Endoscopic drainage of these abscesses in children has been described. Image-guided drainage of the orbital abscess is a newer technique that has been reported in a teenager and in adult patients. This is the first reported case of endoscopic orbital drainage surgery in an infant. The procedure was performed successfully. This approach provides for better identification of the anatomical structures in a very young patient. Injuries to the medial rectus, globe and optic nerve can be avoided with this technique. Conclusion: Aggressive management of orbital abscesses in infants is mandatory. Image-guided endoscopic orbital drainage offers precise visualization and a safer technique in a relatively smaller orbit

Asymptomatic complete distal abdominal aortic occlusion with initial presentation of ruptured intracranial aneurysm

Aortoilliac occlusive disease is occlusive atherosclerosis disease involving the distal aorta and bifurcation of iliac arteries and it is a subtype of peripheral arterial disease. Total occlusion of the abdominal aorta is a rare occurrence with an incidence of 3% -8.5% among the aortoiliac occlusive disease patients. We present a case of a 53 years old patient with a background history of hypertension and ex intravenous drug abuser with negative retroviral screening status, with no previous complaints who was brought to the Emergency Department with sudden onset of altered sensorium and 1 episode of seizure. Computed tomography angiogram of the brain showed a ruptured anterior communicating artery aneurysm. Diagnostic conventional angiogram of the brain was planned; however, difficulty was encountered during bilateral femoral artery cannulation with the abrupt termination of bilateral common iliac arteries. Computed tomography angiogram of the abdomen showed incidental finding of total occlusion of the abdominal aorta. As a conclusion, total occlusion of abdominal aorta secondary to aortoiliac occlusive disease with an associated intracranial aneurysm is never reported in the literature to date. This case highlights the possibility of association in between these two conditions which may benefit from further research