RESUMO
Bifid mandibular condyle (BMC) is splitting the mandibular condyle into two separate articular surfaces. The etiology is poorly understood, but trauma and developmental issues are currently the most cited causes. Though most often asymptomatic, occasionally, this condition may cause the development of jaw pain, clicking, and restriction of motion. We present a rare case of a patient who developed unilateral ankylosis of the temporomandibular joint (TMJ) secondary to BMC in the absence of trauma or infection. The ankylosis developed due to abnormal biomechanical forces and degenerative arthritis secondary to the abnormal articulation of the TMJ caused due to BMC. CT imaging is the best modality to evaluate the bony anatomy of the TMJ. It is essential to consider BMC as a cause of TMJ pathology, as management is primarily surgical in nature.
RESUMO
Rhabdomyosarcoma is a highly aggressive cancer that is generally considered a disease of childhood. A vast majority of cases occur in those below the age of 20. Rhabdomyosarcoma can occur in any soft tissue in the body but is primarily found in the head, neck, orbit, genitourinary tract, genitals, and extremities. Prognosis is closely tied to the location of the primary tumor and the extent of metastatic spread. As with most sarcomas, rhabdomyosarcoma has a pattern of hematogenous spread which favors metastasis to the lungs. Other common areas include bone marrows, liver, breasts, and brain. One unusual pattern is the presence of diffuse bone marrow metastases in absence of significant soft tissue disease other than primary (no distant nodal disease, absence of visceral disease in chest and abdomen). Frequently in such cases, patients may have initial presentation similar to hematologic malignancy especially when the primary tumor is not evident. This pattern has been rarely described in the radiology literature. This pattern appears to be well documented in pathology literature. Even more rarely, in some cases, the primary tumor site may not be found after imaging and may remain undetermined even postmortem - only diagnosed by bone marrow aspiration. Awareness of this unique pattern is clearly important for radiologists, especially pediatric radiologists, as misdiagnosis can lead to delay in appropriate treatment that ultimately results in increased mortality. We present a case of rhabdomyosarcoma with this unique pattern of bone marrow metastases in which initial differential diagnosis favored a leukemic picture. This paper will go over the diagnostic techniques utilized throughout our patient's disease course as well as treatment.
RESUMO
Neurodegenerative disorders (NDD) are chronic neurological diseases characterized by loss and/or damage to neurons along with the myelin sheath, and patients are at higher risk of severe infection with the SARSCoV2. A comprehensive literature search was performed using relevant terms and inclusionexclusion criteria. Recent articles, subjects older than 50 years, and articles written in the English language were included, whereas letters to the editor and articles related to pregnant women were excluded from the review study. COVID19 appears to damage angiotensinII receptors which cause natural killer cells to lose the ability to clear virusinfected cells, owing to worse outcomes in patients with NDD. COVID19 can worsen the symptoms of Alzheimer's disease. In addition, COVID19 worsens drugresponsive motor symptoms in Parkinson's disease (PD) and other symptoms like fatigue and urinary complaints. Vitamin D is essential in decreasing proinflammatory and increasing antiinflammatory cytokines in ongoing COVID19 infections and reducing angiotensin receptors and, hence, decreasing COVID19 infection severity. Telemedicine shows promise for patients with NDD but is yet to overcome legal issues and personal barriers. COVID19 has a significant effect on neurodegenerative conditions, which appears partly to the nature of the NDD and the neuroinvasive capabilities of the SARSCoV2. The protective role of vitamin D in patients with NDD further supports this hypothesis. Modifications in current health care, like the telemedicine platform, are required to address the increased risk of serious infection in this population. Further studies will be required to clarify conflicting reports in many fields.
Assuntos
Doença de Alzheimer , COVID-19 , Doenças Neurodegenerativas , Doença de Parkinson , Gravidez , Humanos , Feminino , Doença de Parkinson/complicações , Doença de Parkinson/tratamento farmacológico , Doença de Alzheimer/complicações , SARS-CoV-2 , Vitamina DRESUMO
A school-age boy with a complex medical history underwent a minor elective surgical procedure. Propofol was used for sedation during the procedure. The patient could not be awakened post-operatively. Laboratory findings demonstrated metabolic lactic acidosis, leukocytosis with bandemia, and transaminitis. Neuroimaging demonstrated findings that were consistent with hypoxic-ischemic or toxic-metabolic brain injury involving the bilateral basal ganglia, hippocampi, and cerebellum. The patient's condition progressively worsened over the course of the following few weeks, and brain death was confirmed by scintigraphy seven weeks later. Prompt neuroimaging in unresponsive patients with suspected propofol infusion syndrome (PRIS) is of critical importance in detecting neurologic injuries, excluding alternative diagnoses, and determining prognostication.