Transient cortical blindness following peripheral vascular trauma: A case report.

Cortical blindness is characterized by unilateral or bilateral vision loss despite an intact pupillary reflex, full extraocular movements, and normal fundoscopic examination. Common causes include stroke, cardiac emboli, head trauma or rarely, a hypoxic-ischemic event which results to decreased perfusion to the occipital lobes supplied by the posterior cerebral artery. Imaging with computed tomography is usually diagnostic documenting stroke or embolization as well as ensuring an intact cerebral circulation. Prognosis largely depends on the etiology as most reports document an irreversible condition or at least the patient is left with some residual visual symptoms. We present a case of a 25-year-old male who underwent brachial artery repair with reverse saphenous vein graft interposition after sustaining a right upper arm laceration associated with massive hemorrhage and shock due to delayed consult. He presented with profound bilateral loss of vision 12 h after surgery characterized as right homonymous hemianopsia. Computed tomography of the brain demonstrated ischemic infarcts in the occipital lobes. Close observation was instituted, and his symptom resolved spontaneously within a week. This case highlights the importance of considering atypical causes of perioperative vision loss as early recognition and timely diagnosis are essential to improve patient outcomes. To our knowledge, this is the first report of transient cortical blindness after peripheral vascular trauma.

Coconut leaf midrib skewer as a cause for small bowel obstruction and perforation: A case report.

Foreign body ingestion is an infrequent cause of small bowel obstruction and, rarely, perforation. It is a common occurrence among pediatric patients, mentally impaired and the edentulous elderly population majority of which will pass through the gastrointestinal tract uneventfully. The likelihood of complications such as perforation, bleeding or fistula formation increases markedly particularly for sharp, stiff, and elongated objects (i.e. toothpicks, meat bones, pins, and razor blades). Diagnosis can be difficult as frequently patients are incognizant of the nature and time of ingestion. Imaging is commonly non-specific as well. We present an unusual case of a 65-year-old male who had an ileal perforation secondary to a coconut leaf midrib skewer initially presenting as small bowel obstruction. Intraoperatively, adhesions were seen in the ileum with note of the foreign body perforating two bowel loops that was not identified in preoperative imaging. This case highlights the importance of considering atypical causes of small bowel obstruction even in the background of previous surgery. Finally, early recognition, accurate diagnosis, and timely intervention are essential to improve patient outcomes and decrease mortality in such cases.

Metastasizing ameloblastoma of the breast: A case report.

INTRODUCTION: Ameloblastomas are slow growing and locally aggressive odontogenic tumors with a high propensity for recurrence. It frequently arises in the mandible and has been reported to metastasize commonly in the lungs. An updated World Health Organization classification re-categorized metastasizing ameloblastomas under benign tumors. Other rare metastatic sites include the skull, maxilla, kidney, and liver. CASE PRESENTATION: We present a 53-year-old female with a gradually enlarging right breast mass for 2 years. She previously underwent right hemimandibulectomy with clavicular bone grafting 15 years ago for a primary ameloblastoma. Preoperative imaging showed a resectable, heterogenous right breast mass with a biopsy revealing spindle cell neoplasm. She subsequently underwent radical mastectomy with a latissimus dorsi myocutaneous flap as a reconstructive procedure. Histopathologic findings were consistent with a metastasizing ameloblastoma. The patient remains disease-free as of most recent follow-up. DISCUSSION: There are several proposed mechanisms for metastasizing ameloblastomas. Based on the history and location of the tumor, we surmised that tumor seeding from the first surgery done 15 years ago may explain this rare occurrence. Preoperative imaging and biopsy determine resectability and surgical approach. Radical surgery is frequently performed which largely depends on the site of the tumor. Complete primary resection with adequate margins remains to be the treatment of choice to prevent recurrence or metastasis. The role of adjuvant radiotherapy or chemotherapy are still to be established. CONCLUSION: This case highlights the value of history-taking and having a high-index of suspicion for metastasis several years after primary resection of ameloblastomas.

Wide Excision of a Retroperitoneal Liposarcoma with En Bloc Ureterectomy and Renal Salvage by Autotransplantation.

Liposarcoma is a malignant mesenchymal neoplasm composed of adipose tissue with varying degrees of atypia. These tumors grow slowly and may reach an enormous size particularly if located in the retroperitoneum. We report a 40-year-old male with a 6-month history of gradual abdominal enlargement. Computed tomography (CT) of the abdomen showed a huge retroperitoneal mass with characteristic features consistent with liposarcoma. On laparotomy, the mass was noted to be encasing the right ureter for which a wide excision with en bloc ureterectomy and subsequent renal autotransplantation for organ preservation was done. Post-operative course was uneventful with excellent outcome after 6 months of follow-up. Final histopathologic diagnosis was low-grade, well differentiated liposarcoma, which has favorable prognosis following radical surgery. This was the first report of such a case in the Philippines.

Lower lip pits: van der woude or kabuki syndrome?

Kabuki syndrome (KS) is a multiple congenital anomaly/mental retardation syndrome with characteristic facial features. Despite more than 350 documented cases and recent correlation of MLL2 mutations as a genetic cause, its full clinical spectrum is still being defined. This report describes two patients who were initially diagnosed with Van der Woude syndrome (VWS) based on the presence of lower lip pits. However, this finding can occur with KS, albeit infrequently. For patients with lower lip pits, a thorough evaluation should be made to distinguish between VWS and KS, as there are differences in long-term prognosis.