Journal of Clinical Case Reports

The Bertolotti syndrome is a rarely recognized cause of low back pain, attributed to a congenital anomaly in the formation of the transverse processes of L5. This case report details the experience of a 22-year-old professional cyclist who transitioned from persistent low back pain to ultimately undergoing a successful surgical intervention for Type IIa Bertolotti syndrome. The initial conservative approaches, including exercise therapy and infiltrations, yielded temporary relief. Subsequent surgical intervention resulted in significant and sustained pain relief, enabling the cyclist to resume professional cycling. The Bertolotti syndrome, rarely acknowledged as a cause of low back pain, necessitates accurate identification for appropriate management. A step-up conservative therapy plan is strongly favoured before considering surgery. However, this case highlights successful surgical outcome in a professional athlete and underscores the importance of individualized management.

Heart donation rates lag behind a growing number of recipients. Therefore, transplant programs increasingly accept organs from extended criteria donors. Donor age ≥ 47 years and allograft ischaemic time ≥ 2-4 hours are linearly associated with a higher risk of death at 1 year after heart transplantation. Ex vivo Machine Perfusion (MP) of heart allografts offers the opportunity to evaluate and optimize extended criteria donor hearts, while also reducing cold ischemic time, with the aim to maximize eligible allograft pool. We describe a case of cancellation of the ongoing procurement due to acute donor instability and subsequent evaluation and successful reconditioning of the heart with MP.

Hypokalemic Periodic Paralysis (HPP) is a form of periodic paralysis, a rare autosomal dominant channelopathy caused by the skeletal muscle ion channel mutations. This is a heterogeneous group of muscle diseases. It is characterized by episodes of flaccid and sudden muscle weakness by a fall in potassium level in the blood.

Here, a case of 15-year-old male is presented. The patient was referred to our emergency department because of sudden onset of paralysis of his both upper and lower limbs. After comprehensive evaluation, significantly lower potassium content was determined. The patient's symptoms resolved after potassium replacement and he was discharged without deficit.

The right differential diagnosis should rule out other causes of weakness and paralysis and allow timely treatment.

A 65-year-old female patient with a history of rheumatoid arthritis who was recently started on etanercept therapy, presented with abdominal pain. She denied a history of alcohol use, trauma, or gallstones and workup yielded a lipase of 1012U/L with normal remaining lab work. Imaging would not indicate evidence of biliary obstruction. The patient was medically managed for pancreatitis, suspected in the setting of etanercept use. She was managed medically with fluid resuscitation and diet advanced as tolerated. She was advised to refrain from etanercept and is symptom-free at one year follow up. The lack of extensive prior trials and studies has prevented consensus guidelines on drug-induced pancreatitis. It is vital to rule out common etiologies such as obstruction, trauma, alcohol use and lab abnormalities. A high index of suspicion is vital for management and preventing recurrence. Etanercept is being increasingly used for a variety of autoimmune conditions and its association with acute pancreatitis is not well known. Further studies are needed to clarify this adverse effect.

In late December 2020, vaccination for the Coronavirus Disease 2019 (COVID-19) started among the personnel of the United States Forces Korea and related units, including the medical team. Because its usage was approved based on emergency circumstances, sufficient research on the possible side effects has not been conducted yet. We experienced an unusual neurologic side effect after injection of the SARS-CoV-2 mRNA-1273 vaccine. A 32-year-old U.S Army male soldier with headache, blurred vision, and cramping chest pain after second-dose injection visited the emergency room. Subsequently, left-sided weakness developed during the observation. Imaging of the cervical lesion for the diagnosis of acute intracranial disease was performed but revealed no definite disease. While under close observation, the patient’s symptoms progressed to nearly hemiplegic but then improved gradually in an ascending and peripheral-to-center manner with only supportive care. We report this case as the first unilateral neurologic side effect of the SARS-CoV-2 mRNA-1273 vaccine.

Background: Wilson’s disease is an inherited autosomal recessive disorder of copper metabolism. Clinical signs, biochemical parameters, histologic findings and/or ATP7B genetic testing are required to diagnose Wilson’s disease.

Case presentation: 25-year-old and 22-year-old young women (siblings) presented to University of Gondar hospital, Northwest Ethiopia, with difficulty of keeping balance of 3 years duration and progressive extremity weakness of 5 years duration respectively. Both siblings had visible ocular Kayser-Fleischer rings, low serum ceruloplasmin level and increased urinary copper content, ultrasoundevidenced cirrhotic liver disease and axial T2- weighted MRI hyperintensities in both basal ganglia and brainstem (mid brain and pons). Diagnosis of Wilson’s disease was established in both patients using diagnostic scoring system proposed by ‘8th International Meeting on Wilson disease and Menkes disease, Leipzig (2001)’. Treatment with D-Penicillamine as chelator and Zinc sulphate as metalothionein-inductor was started. Screening of their family members was recommended.

Conclusion: Wilson’s disease, declared to be an orphan disease, requires clinical acumen of physicians and expensive investigation modalities for prompt recognition and inaccessible as required, lifelong drugs for treatment.

Extraskeletal Myxoid Chondrosarcoma (EMC) is a rare Soft Tissue Sarcoma (STS) highly correlated with the NR4A3 gene rearrangement. This gene rearrangement has not been found in other tumors. However, its function is not yet fully known in cancer biology. Multiple prospective cohort studies show the population frequency of EMC as approximately 0.0001%. Cases of primary skeletal EMC’s have been reported, but the NR4A3 gene rearrangement is less correlated with it as compared to the soft tissue variant. EMC's tend to arise in the soft tissue of the proximal lower extremities and limb girdle in the fifth to sixth decade of life with a male predominance. Cases of EMC arising in the peripheral extremities are rarer still. And pathologic fractures secondary to chondrosarcoma’s are also highly unusual. The following patient presents with a primary tumour showing bland histology, arising in an infrequent location and in an atypical age group, primary to an unlikely tissue and associated with a rare presentation. Its only defining characteristic is the NR4A3 gene rearrangement. When does a rare gene rearrangement retain its specificity and serve as sufficient evidence to be diagnostic?

During routine dissection for gross anatomy practical teaching by unknown age of adult male cadaver for the undergraduate medical students at department of human anatomy, college of medicine and health sciences, university of Gondar, Ethiopia we had encountered anatomical variation in branching pattern of right axillary artery. The third part of right axillary artery gave rise to a common trunk that divides into anterior and posterior circumflex humeral arteries. This anatomical variation in the branching pattern of axillary artery is very crucial for surgical procedures that surgeons perform an intervention or a diagnostic procedure in cardiovascular diseases.

Background: Splenectomy and hydatid cyst resection using either laparoscopy or laparotomy methods are frequently performed procedures. However, cases of patients sufering from both massive splenomegaly and hydatid cyst are rare.

Case Presentation: Patient was a 62-year-old man who complained of upper abdominal pain and was diagnosed with massive splenomegaly. In a Computed Tomography (CT) scan performed prior to surgery, a hypodense lesion with the measurements of 45 × 43 mm was found in the sixth segment of the liver. Therefor we performed an open splenectomy and hydatid cyst resection through one incision.

Discussion: Splenomegaly is a rare condition with the prevalence rate of around 2% in the US. However, tropical splenomegaly is common in Asia and Africa. Splenomegaly may occur due to various reasons, including ET Symptomatic splenomegaly is the most common cause of splenectomy. In myeloproliferative complications, splenectomy is performed to relieve the patient’s pain, early satiety and other splenomegaly related symptoms.

Conclusion: Simultaneous surgical procedures on both massive splenomegaly and hydatid cysts are rare. We suggest a CT scan be performed and the best type of incision be chosen based on the pathology and site of lesion, before performing a midline incision.

Polycystic ovarian syndrome is the disorder of female reproductive system. Obesity, hyperandrogenism and inflammation are known to play a role in its pathophysiology. It can cause menstural irregularities, insulin resistance, infertility, dyslipidemia, acne, hairsuitism and glucose intolerance. Unhealthy lifestyles like high intake of fatty and sugary foods, decrease in physical activity also play a role in causing obesity and metabolic dysfunction. Chromium is an important element in carbohydrate and lipid metabolism. In this review we will find out how chromium improves metabolic dysfunction, lipid and carbohydrate metabolism, menstural irregularities and ovarian problems. We will also find out how chromium can be used as a treatment strategy for polycystic ovaries.