Orbital neuromuscular choristoma of the ophthalmic nerve.

INTRODUCTION: Neuromuscular choristoma (NC) is a rare tumor composed of striated muscle fibers admixed with nerve fibers that often affects large peripheral nerve trunks in children. To the best of our knowledge, this is the first reported case in the literature of a NC of the ophthalmic nerve in an adult. CASE DESCRIPTION: A 27-year-old woman presented with a 20-day history of left periorbital headache radiating to the frontotemporal region, with associated tearing, nausea, and vomiting. The examination was normal, except for hypoesthesia in the distribution of the first trigeminal nerve branch (V1). Cranial computerized tomography showed a lesion in the left orbit and cavernous sinus with widening of the superior orbital fissure. On magnetic resonance imaging, the lesion was well-defined with fusiform morphology and showed a central cystic component and peripheral enhancement. An extradural approach was performed with subtotal tumor resection. Biopsy showed proliferation of striated muscle cells admixed with nerve fascicles and Schwann cells. A pathological diagnosis of NC of V1 was determined. Six months after surgery, left hypotropia with limitation of supraduction was observed, as well as hypoesthesia and paralysis of the left forehead with ipsilateral eyebrow ptosis. The rest of the examination remained within normal limits. CONCLUSION: NC should be considered in the differential diagnosis of a young patient with periorbital headache and hypoesthesia in the V1 region.

Encefalopatía inducida por metronidazol: descripción de un caso con hallazgos radiológicos y anatomopatológicos / Metronidazole-induced encephalopathy: description of a case with radiological and anatomopathological Findings

Introducción. El metronidazol es un antibiótico ampliamente conocido y utilizado. En casos excepcionales puede producir como efecto adverso un cuadro de encefalopatía con unas lesiones características en la resonancia magnética, localizadas generalmente en el cerebelo y el esplenio del cuerpo calloso. La incidencia y la patogenia se desconocen. La suspensión del tratamiento habitualmente resuelve los síntomas y normaliza la resonancia magnética en pocas semanas. Debido al habitual buen pronóstico, los hallazgos anatomopatológicos son excepcionales. Se presenta un caso clínico con los hallazgos radiológicos sugestivos de la encefalopatía inducida por metronidazol y, de forma excepcional, se aportan los hallazgos anatomopatológicos. Caso clínico. Mujer de 72 años, con enfermedad de Crohn grave, que meses más tarde de iniciar tratamiento con metronidazol presentó de forma lentamente progresiva bradipsiquia y dificultad para caminar hasta llegar al coma. En la resonancia magnética mostraba características imágenes hiperintensas en T2 en el cuerpo calloso, y los núcleos rojos y dentados. Mejoró al suspender el metronidazol, pero posteriormente desarrolló una sepsis y falleció. En la autopsia se observó reblandecimiento del núcleo rojo y, microscópicamente, necrosis celular y desmielinización. Conclusión. Con la publicación de la información clínica, radiológica y anatomopatológica de este caso se pretende fomentar el conocimiento de esta infrecuente causa tratable de encefalopatía subaguda y aportar datos que ayuden a aclarar su patogenia

Introduction. Metronidazole is a widely known and used antibiotic. In exceptional cases, an encephalopathy with characteristic lesions on magnetic resonance imaging (MRI), usually located in the cerebellum and splenium of the corpus callosum, may be an adverse effect. The incidence and pathogenesis are unknown. The suspension of the treatment usually resolves the symptoms and normalizes the MRI in a few weeks. Due to the usual good prognosis, the anatomopathological findings are exceptional. We present a clinical case with the radiological findings suggestive of metronidazole-induced encephalopathy and, exceptionally, we provide the anatomopathological findings. Case report. A 72 years-old woman with severe Crohn’s disease who, months after starting treatment with metronidazole, presented a slowly progressing bradypsychia and difficulty walking until she came to coma. In MRI it showed hyperintense images in T2 in the corpus callosum, red and dentate nuclei. He improved by stopping metronidazole but later developed sepsis and died. At autopsy, softening of the red nucleus was observed and, microscopically, cell necrosis and demyelination. Conclusion. With the publication of the clinical, radiological and anatomopathological information of our case we intend to promote the knowledge of this infrequent treatable cause of subacute encephalopathy and provide data that help to clarify its pathogenesis

Primary squamous cell carcinoma of the stomach: a rare case report

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Primary squamous cell carcinoma of the stomach: a rare case report.

Primary squamous cell carcinoma (SCC) of stomach is a rare disease. There are fewer than 100 cases published in the literatura. The pathogenesis remains to be elucidated and the prognosis is poor. In the case presented here, clínical, endosopy, histopathological examination and staging are described; However, the outcome was bad and the patient died 6 months later.

Periocular inverted follicular keratosis: a retrospective series over 17 years.

PURPOSE: To evaluate the demographic, clinical, and histopathologic characteristics of periocular inverted follicular keratosis (IFK), a very rare lesion with poorly defined characteristics. STUDY DESIGN: Retrospective case series. METHODS: We evaluated 11 patients with clinically diagnosed IFK confirmed by histologic analysis. Data were collected on the patients' demographics, clinical presentation and course of the disease, signs and symptoms, location of the lesion, and outcomes of treatment. RESULTS: The patients' mean age was 71 years (range, 32-91 years). Seven (64%) of the patients were female. Eight of the patients (72.7%) had no symptoms, two (18.2%) reported itching, and one (9.1%) had edema and bleeding of the lesion. The lesion affected the upper eyelid in 4 of the patients (36%), the lower lid in 3 of the patients (27%), and the inner canthus in 4 of the patients (36%). CONCLUSIONS: IFK has no specific clinical characteristic and thus requires histologic confirmation for its diagnosis and appropriate management.

Secuencia TRAP: serie de casos en el Hospital Regional de Alta Especialidad de la Mujer de Tabasco / TRAP sequence: Series of cases in Hospital Regional de Alta Especialidad de la Mujer de Tabasco

Resumen OBJETIVO: Reportar, comparar y analizar el estado posnatal de pacientes con embarazo gemelar monocorial y determinar la incidencia de secuencia TRAP. MATERIALES Y MÉTODOS: Estudio retrospectivo y descriptivo de una serie de casos de pacientes con diagnóstico de embarazo múltiple monocorial atendidas entre 2014 y 2018 en el Hospital Regional de Alta Especialidad de la Mujer de Tabasco. Se incluyeron todas las pacientes con diagnóstico de secuencia de perfusión arterial reversa gemelar con finalización del embarazo y reporte del estado posnatal. Se determinó la incidencia y se excluyeron las pacientes con expedientes incompletos y embarazos no concluidos en el Hospital Regional. RESULTADOS: Se encontraron 6 casos de embarazo gemelar monocorial con secuencia TRAP. De los casos reportados, 5 fueron gemelar doble y 1 de alto orden fetal. Solo 1 de los 6 casos recibió tratamiento intraútero. En 4 casos el gemelo bomba supervivió sin complicaciones reportadas. La incidencia de secuencia TRAP de embarazos monocoriales de la muestra de estudio fue de 5.2%. CONCLUSIÓN: Se expusieron 6 casos tratados de diferentes maneras y con mejores resultados con la conducta conservadora porque en los 4 casos que no recibieron tratamiento los gemelos bomba no sufrieron descompensaciones cardiacas y supervivieron, a diferencia del único caso con tratamiento intra-útero en el que hubo complicaciones que llevaron a la terminación del embarazo en el segundo trimestre.

Abstract OBJECTIVE: Report, compare and analyze the postnatal status of patients with monochorionic twin pregnancy and determine the incidence of TRAP sequence. MATERIALS AND METHODS: A descriptive, retrospective, case series study of patients diagnosed with monochorionic multiple pregnancy attended at the High Specialty Regional Women's Hospital of Tabasco between 2014 and 2018 was carried out. The study included all patients with the diagnosis of TRAP sequence, reported postnatal outcomes and the incidence was determined. Patients with incomplete records and unfinished pregnancies were excluded. RESULTS: Six cases of twin reversed arterial perfusion were diagnosed, five of which were twin pregnancies and one was a higher order multiple pregnancy. Only one of the patients received intra-uterine treatment. The pump twin survived without complications in four of the six cases. CONCLUSION: Six treated cases were exposed in different ways and with better results with the conservative behavior because in the 4 cases that did not receive treatment, the twin pump did not suffer cardiac decompensation and survived, unlike the only case with intra-uterine treatment in which there were complications that led to termination of pregnancy in the second trimester.