Vertebral Artery Dissection in a Bouncy Castle Injury: Case Report and Literature Review.

There is an increased rate of injuries associated with activities on bouncy castles. The purpose of this article was to describe the case of a 6-year-old boy who sustained a brain infarct as a consequence of a left posterior inferior cerebellar artery dissection due to improper landing in a bouncy castle and who required a suboccipital craniotomy. The second goal was to outline the literature review regarding cervical trauma related to trampoline or bouncy castle accidents in pediatric populations. Based on the described case and reviewed studies, bouncy castle or any other activity resulting in hyperflexion or hyperextension of the neck should be carefully evaluated for cervical spine fractures and vascular injuries.

Case of metastatic epithelioid haemangioendothelioma from an unknown primary site associated with membranous nephropathy and hypercoagulable state.

We report a rare case of metastatic epithelioid haemangioendothelioma from an unknown primary site presenting with axillary lymph node metastases. The patient also had a new-onset membranous glomerulonephritis and thromboembolism, which we postulate were paraneoplastic. The pathogenesis of this rare cancer, the risk of misdiagnosis and membranous glomerulonephritis as a paraneoplastic syndrome are discussed.

Intussusception after injury to the small intestine during emergent cesarean delivery of a premature triplet pregnancy: A case report.

Intussusception is a rare cause of intestinal obstruction in the postoperative setting. This report describes a rare case of intussusception in the early postoperative period following an emergent cesarean delivery of a premature triplet pregnancy, where the small intestine was fully transected. The intestine was repaired with a stapled primary side-to-side functional end-to-end anastomosis. Five days after being discharged, the patient was readmitted due to a small bowel obstruction due to intussusception. The anastomotic site was acting as the lead point, and it required resection. Bowel continuity was reestablished with a hand-sewn anastomosis in end-to-end fashion. The patient had an uneventful recovery and was discharged home. All three neonates were eventually discharged home and the patient was able to start breast feeding. This is believed to be the first case in the obstetric literature where intussusception occurred after intestinal repair of transected bowel during an obstetric emergency.

The Case of the Vanishing Vessel Loop: Unrecognized Removal Via Laparoscopic Suction Device.

Although the incidence rate of retained surgical items is low, it remains an important cause of patient injury and can lead to harm, death, and waste of time and resources when looking for the missing item. Perioperative counting of equipment is a common method to identify missing surgical items. We present a rare case report of a missing vessel loop that was suctioned by a suction irrigator device. The diagnosis of a retained surgical item is extremely important; special attention should be paid when suctioning body liquids with small surgical items nearby, to prevent incidences of missing items after the surgery.

Treatment of Epstein-Barr Virus-Related Post-Renal Transplantation Development of Diffuse Large B Cell Lymphoma of the Distal Ureter: A Case Report.

Posttransplant lymphoproliferative disorder with involvement of the donor urogenital tissue is a rare and serious complication of solid organ transplant. We report an adult kidney transplant recipient who developed the diffuse large B cell lymphoma of the distal ureter in the setting of new allograft nephropathy. Early intervention, reduction of immunosuppression, surgical reconstruction and chemotherapy salvaged the allograft kidney and averted a fatal outcome. The renal function recovered to the baseline with creatinine ranging between 1.3 and 1.5. The patient did not require dialysis at any point after ureteral stent placement and reconstructive surgery. In addition, the case highlights the importance of multidisciplinary management involving transplant nephrology, oncology, transplant surgery, and urology in such a complicated disease process.

Progression of the atypical fibroxanthoma to pleomorphic dermal sarcoma in a heart transplant patient.

An 82-year-old man presented with a right scalp lesion which had been increasing in size. The patient's medical history was significant for a heart transplant 25 years before, and he was on chronic immunosuppression. Biopsy of the lesion showed atypical fibroxanthoma. The patient underwent an excision of the lesion with split thickness skin graft. Pathology showed fibroxanthoma with negative margins. Over the next 9 months, the patient developed new lesions, which were also excised to negative margins. However, with each new lesion, the histology demonstrated increasing dysplasia and ultimately pleomorphic sarcoma. The patient had a metastatic workup with CT of the chest, which was negative, and he underwent a radical scalpectomy, split thickness skin graft placement and adjuvant radiation therapy. The patient has not developed any new scalp lesions and no evidence of metastasis.

Neuro-Behcet Disease Mimicking Lymphoma of the Brain and Coexisting with A Dural Arteriovenous Fistula: A Case Report.

BACKGROUND: Diverse clinical manifestations have characterized reports of central nervous system involvement in Behcet disease. There is a limited number of published case reports of neuro-Behcet disease mimicking brain tumor. CASE DESCRIPTION: We present a rare case of neuro-Behcet disease exhibiting mixed systemic and neurological symptoms mimicking malignant lymphoma. Delayed presentation of oral aphthae and rapid improvement of symptoms with steroid treatment led to a diagnosis of neuro-Behcet disease without brain biopsy. The patient also underwent surgery for the resection of an arterio-venous fistula. CONCLUSIONS: We recommend management of neuro-Behcet disease based on perceived natural history risks, with the understanding that no data exist on this within patients population. A multidisciplinary team approach is always recommended because neuro-Behcet disease is an uncommon condition, especially in neurosurgical practice.

Basal cell carcinoma of the scalp with destruction and invasion into the calvarium and dura mater: Report of 7 cases and review of literature.

Basal cell carcinoma (BCC) is the most common skin malignancy in humans. Giant BCC is a rarer entity that is characterised by aggressive biological behaviour. Intracranial invasion by a BCC on the scalp is extremely rare. The gold standard treatment of BCCs is represented by surgical excision with a wide variety of reconstructive techniques. In this paper, we describe the largest series to date of recurrent BCCs with intracranial extension involving the dura mater. We report recurrent giant BCC of the scalp with dura mater invasion in 7 patients. All patients in this series previously had more than 2 operations. Gadolinium-enhanced MRI revealed neoplastic invasion of the meninges and brain tissues. All patients had a multi-disciplinary team approach with the surgical margins ranging between 1 and 2 cm depending on the location and the size of the tumour. 5 of the patients underwent reconstruction of the skin defect by antero-lateral thigh flap, 1 patient underwent reconstruction with pedicled myocutaneous (trapezius) flap, and 1 with a pedicled myocutaneous latissimus dorsi flap. There was a mean follow-up of 5.3 years. 2 patients died due to cardio-pulmonary complications in the neuro-intensive care unit. A multi-disciplinary team approach and early aggressive tumour resection followed by sophisticated reconstructive and aesthetic procedures appears to be a reliable and realistic treatment modality for invasive BCC.

Epilepsy and Neuromodulation-Randomized Controlled Trials.

Neuromodulation is a treatment strategy that is increasingly being utilized in those suffering from drug-resistant epilepsy who are not appropriate for resective surgery. The number of double-blinded RCTs demonstrating the efficacy of neurostimulation in persons with epilepsy is increasing. Although reductions in seizure frequency is common in these trials, obtaining seizure freedom is rare. Invasive neuromodulation procedures (DBS, VNS, and RNS) have been approved as therapeutic measures. However, further investigations are necessary to delineate effective targeting, minimize side effects that are related to chronic implantation and to improve the cost effectiveness of these devices. The RCTs of non-invasive modes of neuromodulation whilst showing much promise (tDCS, eTNS, rTMS), require larger powered studies as well as studies that focus at better targeting techniques. We provide a review of double-blinded randomized clinical trials that have been conducted for neuromodulation in epilepsy.