RESUMEN
The diagnosis of a new onset movement disorder after a stroke has important clinical implications. The early assessment and timely diagnosis of post-stroke disorders is essential for influencing long-term outcomes. Localizing lesions and determining the underlying etiology is vital in targeting appropriate therapy. New and sudden onset of hemiparkinsonism with hemiparesis, rigidity, and tremor following an acute ischemic stroke is described here. This presentation was clinically diagnosed as acute post-stroke parkinsonism (APSP). The patient's level of impairment was significant enough to compromise his activities of daily living (ADL), physical therapy (PT), and occupational therapy (OT) in an inpatient rehabilitation center. In the inpatient rehabilitation center, the patient received a trial of levodopa for suspected APSP. After levodopa therapy was initiated, we observed an improvement of his parkinsonian features with a sustained response and reached the conclusion that the clinical recognition of post-stroke parkinsonism treated with a targeted trial with levodopa may improve the quality of life. Proper treatment of APSP has the potential to provide the best opportunity for recovery and positively influence the long-term outcomes in similar patients.
RESUMEN
A rare case of a jejunal mesenteric pseudocyst treated by robotic resection is reported. A 25-year-old woman was admitted to our hospital with intermittent abdominal discomfort which was exacerbated by strenuous physical activities. Physical examination revealed a fluctuant mass without tenderness. Contrast-enhanced computed tomography revealed a 4 cm-sized non-enhancing heterogeneous mass on a proximal small bowel loop mesentery. Based on the findings, a differential diagnosis of a gastrointestinal stromal tumor, hematoma, desmoid tumor, and mesenteric cyst was made. Robotic diagnostic laparoscopy was performed to obtain an accurate diagnosis and treatment. Exploration of the cavity revealed a 4 cm fairly mobile mass originating from the mesentery of the jejunum. Segmental resection of the jejunum and its mesentery, including the mass and extracorporeal anastomosis, was performed without any complications. Macroscopically, the mass was cystic and the lumen had grumous material. The final pathological diagnosis was a mesenteric pseudocyst. The patient had an uneventful postoperative course.
RESUMEN
Primary appendicular adenocarcinoma is a rare tumor, mucinous variety, being most common. The case presentation highlights the unusual appearance and diagnostic dilemma of an appendicular adenocarcinoma. Our elderly patient presented with an ill-defined tender lump which later was diagnosed as a perforated appendicular adenocarcinoma, responsive to single-staged surgery and adjunct chemotherapy. We considered the single-staged surgery since the appendix was perforated and right colectomy would not aid the prognosis. High index of clinical suspicion for malignancy should be kept in mind for elderly patients presenting with an appendicular lump. Every effort should be made during the elective surgery to remove the mass during the single-staged surgery.
RESUMEN
An unusual finding in an adult patient with an infected urachal cyst, was treated surgically using the Da Vinci robot. A 26-year-old woman was admitted to our hospital with complaints of lower abdominal pain and burning sensation with urination. She was diagnosed with lower urinary tract infection, treatment did not help her symptoms and further evaluation of CT revealed complex enhancing mass superior to the urinary bladder. The differentials included inflammatory cause such as an abscess, neoplastic mass, urachal cyst, vitello intestinal fistula and urachal sinus. Da Vinchi robotic diagnostic laparoscopy was performed to obtain an accurate assessment and treatment. After cystoscopy followed by laparoscopic exploration of the abdominal and pelvic cavity further helped to narrow down a diagnosis of remnants of urachus. Pathology of the excised specimen showed inflammation without evidence of malignancy and confirmed Urachal cyst. The patient had an uneventful post-operative course.
