Urethral reconstruction using amniotic membrane allograft in hereditary androgen insensitivity syndrome: a case series.

Partial androgen insensitivity syndrome is a rare X-linked disorder. While most cases are sporadic, familial cases are less frequent. The management of this syndrome follows a multidisciplinary approach involving hormone substitution, psychological counseling, and surgical procedures. We present a case series of three young siblings with familial partial androgen insensitivity syndrome who presented with a female phenotype. All of them were managed with hormonal treatment for 6 months followed by surgical reconstruction. The operative procedure involved phalloplasty and urethroplasty using amniotic membrane transplant, which is considered a novel technique in this group of patients. No intraoperative or postoperative complications were observed and good results were achieved within 2 years of follow-up.

Pyogenic Spondylodiscitis Following Nonspinal Cesarean Section.

Pyogenic spondylodiscitis is an uncommon bacterial infection of the intervertebral disc and the vertebral endplates. It usually affects elderly patients with comorbidities but may be also seen after surgical procedures in young patients, mostly after spinal interventions and genitourinary procedures. This article describes a rare case of pyogenic spondylodiscitis in a young female patient after a cesarean section without spinal anesthesia. The patient presented with a three-month history of lower back pain, and the inflammatory markers were elevated. The magnetic resonance imaging showed the involvement of the L5-S1 disc space and the adjacent vertebral bodies. The diagnosis was confirmed with needle aspiration of purulent material. The patient was treated with antibiotics for a total of six weeks. After a follow-up of about one year, the patient showed slight degenerative vertebral changes with no signs of residual infection. This case highlights the importance of the early recognition of pyogenic spondylodiscitis as one cause of postoperative back pain after urogenital procedures, even without spinal anesthesia. Only a few similar cases were reported in the literature.

Pilonidal sinus disease carcinoma: Survival and recurrence analysis.

BACKGROUND: The study aims to determine the survival and recurrence rates of pilonidal sinus disease (PSD) carcinoma. METHODS: The data were collected retrospectively by searching the worldwide literature for all reports of carcinoma developing on the background of PSD. The results were presented using Kaplan-Meier curves. RESULTS: Between 1900 and 2022, 140 cases of PSD carcinoma were published in 103 papers, with follow-up data available in 111 cases. Squamous cell carcinoma constituted 94.6% of the cases (n = 105). The disease-specific survival rate was 61.7% for 3 years, 59.8% for 5 years, and 53.2% for 10 years. There was a significant survival difference between stages: 80.0% in stages I and II, 70.8% in stage III, and 47.8% in stage IV (p = 0.01). The 5-year survival in G1-tumors was better than G2 and G3-tumors at 70.5% and 32.0%, respectively (p = 0.002). Recurrence occurred in 46.6% of the patients. The time-to-recurrence in patients treated with curative intention averaged 15.1 months (1-132 months). Local, regional, and distant recurrence was observed in 75.6%, 33.3%, and 28.9% of the recurrent tumors, respectively. CONCLUSIONS: Pilonidal sinus carcinoma has a worse prognosis than primary cutaneous squamous cell carcinoma. Poor prognostic factors include advanced-stage disease and poor differentiation.

Symptomatic familial primary iris cysts at the pupillary margin in three consecutive generations: A case series.

Case series purpose: Iris cysts are uncommon lesions, most of them are iris pigment epithelial (IPE) cysts which typically manifest in adults as unilateral single cysts, are typically asymptomatic and rarely require treatment. The most frequent location of IPE cysts is the iris periphery and the iridociliary sulcus, whereas pupillary cysts are rare. This observational case series aims to describe a unique occurrence of bilateral pupillary IPE cysts in three consecutive generations of a single family. Observations: The series describes eight patients of a single family with no consanguineous marriage. All patients have IPE cysts with remarkable abnormally-shaped pupils. The patients were examined at the slit-lamp and imaged with anterior segment optical coherence tomography. Three brothers (14, 19 and 28 years old) were symptomatic and suffered from hemeralopia and reduced visual acuity. ND-YAG laser was successful in relieving the symptoms in the two younger brothers. No recurrence or refill of the cysts occurred after laser application and no intra- or ppostoperative complications were observed during a 9-month follow-up. The older family members showed spontaneously shrunken IPE cysts. Conclusions and Importance: IPE cysts are considered idiopathic with an unclear origin. The rare familial incidence of the cysts suggests an autosomal dominant heredity pattern. Many theories were proposed to explain the origin of cysts and none is conclusive. Their principal clinical significance is their similarity to pigmented iris tumors, but they might also cause visual symptoms. Treatment modalities vary from less invasive chemical compounds and ND: YAG laser application to more invasive surgical procedures with disparate efficacy and safety. In the case of multiple cysts, examination of other family members is worthy even when asymptomatic and cardiac consultation of affected patients is warranted as IPE cysts may proclaim a coexisting cardiovascular abnormality, such as familial aortic dissection.

Demographic overview of pilonidal sinus carcinoma: updated insights into the incidence.

PURPOSE: There are only rough estimates of the worldwide incidence of pilonidal sinus carcinoma. The purpose of the study is to explore the demographic characteristics of this disease and to provide more precise information about its incidence. METHODS: The study included questioning the surgeons and pathologists in Germany in addition to a literature research. The literature investigation included all published articles about pilonidal carcinoma in all languages. The questionnaire included 1050 pathologists and all 834 hospitals with a surgical division in Germany. The outcome measures included the total number of cases, the language of publication, gender, age, country of origin, interval until the diagnosis of carcinoma, and reported incidence based on local studies. RESULTS: From 1900 to 2022, we found 140 cases of pilonidal sinus carcinoma in 103 articles. The investigation revealed two additional unpublished cases from Germany. The male-to-female ratio was 7.75:1. The countries with the most cases were the USA (35 cases, 25.0%), Spain (13 cases, 9.3%), and Turkey (11 cases, 7.6%). The average age was 54.0 ± 11.8 years and the interval between the diagnosis of the disease and the development of carcinoma was 20.1 ± 14.1 years. There was a parallel increase in reported cases of pilonidal sinus disease and pilonidal carcinoma over the last century. The reported incidence varied from 0.03% to 5.56%. The worldwide calculated incidence equaled 0.17%. CONCLUSION: Due to underreporting and other causes, the incidence of carcinoma emerging on the background of pilonidal sinus disease is higher than reported.

Aldosterone-Secreting Large Oncocytic Neoplasm of the Adrenal Gland with Borderline Potential.

Adrenal oncocytomas are rare tumors that are mostly benign and non-functional although they may be hormonally active and can exhibit a borderline or malignant potential. We present a case of a 40-year-old female patient with known hypertension who presented with abdominal discomfort. Radiologic investigations showed a large mass on the left adrenal gland. In the hormonal study, an aldosterone-secreting tumor was identified. After laparoscopic resection, the histological assessment of the 12-cm mass showed an oncocytic neoplasm with borderline characteristics. The laboratory results returned to normal and the hypertensive disease improved. The patient was doing well after 14 months of follow-up. This is the seventh documented case of aldosterone-secreting oncocytoma, the first borderline tumor of this type, and the largest reported tumor so far.

A Rare Case of a Prostatic Abscess Secondary to a Mycoplasma hominis Infection.

Mycoplasma hominis is one of the pathogenic organisms that may cause prostatitis with the development of a prostatic abscess in very rare cases. A 57-year-old man presented with lower urinary tract symptoms and low-grade fever. The transabdominal ultrasonography showed prostate enlargement suggesting acute prostatitis. The patient was started on empiric antibacterial therapy with fluoroquinolones. The urine and semen cultures showed no bacterial growth. A few days later, the patient presented again with symptoms progression and acute urinary retention. The transrectal ultrasound revealed diffuse calcifications and intraprostatic fluids. The computed tomography of the abdomen and pelvis showed a large abscess in the prostate with a periprostatic inflammatory reaction. While all bacterial cultures were negative, the multiplex polymerase chain reaction (PCR) test revealed a Mycoplasma hominis infection. The patient was managed with transurethral drainage. After six months of follow-up, the patient was free of symptoms and the repeat PCR study confirmed clearance of the Mycoplasma infection.

Ectopic abdominal pregnancy on the ascending colon.

A 25-year-old woman presented to the emergency department with acute abdominal pain and amenorrhea. The vaginal ultrasound showed a right para-adnexal mass with a living embryo. An abdominal pregnancy on the ascending colon was found in the laparotomy. The management included removing the gestational sac and treatment with methotrexate.

A 15-cm Adrenal Incidentaloma Suggested on Upper Endoscopy and Resected Laparoscopically.

Incidentalomas are asymptomatic adrenal tumors that are discovered on investigations performed for other reasons. Classically, these tumors are found on computed tomography of the abdomen. This article describes an incidentaloma that was discovered on upper gastrointestinal endoscopy performed before a bariatric operation and caused an extrinsic compression of the first and second parts of the duodenum. Further investigations showed a 15-cm non-functional adrenal tumor. The patient was treated successfully with laparoscopic adrenalectomy. The histological examination showed a benign adrenocortical adenoma with myelolipomatous changes. The article highlights the fact that incidentalomas may not only be discovered on imaging modalities but may also show up in other diagnostic methods such as endoscopy.

MRI-negative myelitis associated with cerebral venous thrombosis after COVID-19 infection.

Transverse myelitis and cerebral venous thrombosis represent some of the described neurological complications of coronavirus disease. A woman in her early 30s presented with headache, left-sided sensory symptoms and voiding difficulty. The patient also reported dry cough, fever, nasal congestion, anosmia and ageusia 2 weeks before presentation. The clinical examination showed sensory disturbances on the left side of the body, starting from the lower abdomen and extending to the left leg, which was consistent with transverse myelitis. The laboratory assessment confirmed a previous infection with coronavirus disease and excluded autoimmune entities. Radiological investigations revealed left transverse sinus thrombosis with no spinal cord abnormalities. The treatment was started with therapeutic anticoagulation and intravenous high-dose steroids. The patient showed significant improvement, and the neurological deficits resolved after 3 months. This is the first documented case of imaging-negative myelitis associated with cerebral venous thrombosis after coronavirus disease.

A Retrospective Comparative Study Assessing Patients With Acute Appendicitis During the Pre and Through Lebanese Financial Crisis.

Introduction In the past three years, Lebanon, a country located in the Middle East, has faced a severe financial crisis. This crisis had many effects on several sectors in Lebanon, including the healthcare sector. The authors expected an increase in the rate of complicated appendicitis after the crisis due to the shortage of medical supplies. The aim of the study was to compare the rate of complicated acute appendicitis before and after the Lebanese crisis. Methods The study included two groups of patients with acute appendicitis. The first group included patients admitted in the period between November 2018 and November 2019 (before the crisis). The second group included patients admitted between November 2020 and November 2021 (during the crisis). The data were collected retrospectively and analyzed using SPSS software (version 25.00) (SPSS Inc., Chicago, IL). Ethical approval was obtained and the study was registered at Al Zahraa hospital, University Medical Center in Beirut, Lebanon. Results The study included 49 patients in the first group (before the crisis) and 46 patients in the second group (after the crisis). The percentage of complicated appendicitis has increased from 22.4% before the crisis to 28.3% during the crisis. The study showed a statistically significant difference between the two groups in the white blood cell count (10,831 versus 7180 cu.mm, respectively, p=0.006), the operating time (59.9 versus 79.0 minutes, respectively; p=0.004), the need to obtain an intra-peritoneal swab for bacterial culture (83.7% versus 58.7%, respectively; p=0.007), and the need for intra-abdominal abscess drainage (6.1% versus 28.3%, respectively; p=0.004). There were no significant differences in the demographics, the duration of postoperative antibiotic use, the duration of stay in the hospital, and the postoperative complications in the first month following surgery. Conclusion Due to the decreased financial income, the high cost of medical care during the Lebanese crisis, and the delay of patients' presentation to the hospital, the rate of complicated appendicitis increased during the crisis.

Hyperreactio luteinalis associated with fetal hyperandrogenism and cystic hygroma.

A 23-year-old woman with a gestational age of 17 weeks presented with abdominal pain. The ultrasound showed maternal hyperreactio luteinalis with fetal cystic hygroma. After termination of pregnancy, the female fetus showed masculinization features with muscular hypertrophy. The hyperreactio luteinalis regressed under hormonal suppression therapy.

Late Manifestation of Subependymal Giant Cell Astrocytoma With Hydrocephalus in an Adult Patient With Tuberous Sclerosis Complex.

Subependymal giant cell astrocytoma (SEGA) is a unique brain tumor that constitutes one of the major diagnostic criteria of tuberous sclerosis complex (TSC). It rarely occurs de novo after adolescence. SEGA tends to originate from the ventricular walls, provoking obstructive hydrocephalus, raised intracranial pressure, and papilledema with plausible visual problems. We present a case of large SEGA in a 33-year-old-TSC patient with a higher-than-expected age for the first presentation. His chief complaint was visual acuity deterioration combined with headaches. Microsurgical removal of the tumor was carried out. Obstructive hydrocephalus and papilledema resolved after treatment. Although SEGA-TSC is considered a tumor of children and adolescents, it can present for the first time in adulthood. In TSC patients, periodic imaging follow-up is recommended and any visual symptoms should prompt exclusion of intracranial tumors.

Malignant mixed tumour of the parotid gland in a preterm neonate with cytomegalovirus infection.

A young pregnant woman presented to the emergency department with acute lower abdominal pain. The ultrasound examination showed not only a viable fetus with a gestational age of 24 weeks but also a heteroechoic mass of about 7×7 cm involving parts of the face. The patient was found to be in active labour with rapid progression, and she gave birth to a dead female neonate. The autopsy showed a large malignant mixed tumour of the left parotid gland and revealed infection with cytomegalovirus. To our knowledge, this is the first reported case of a malignant mixed tumour of salivary glands in fetuses.

Perianal abscess as a manifestation of vaginocutaneous fistula after pelvic floor reconstruction.

We present a case of vaginocutaneous fistula 10 years after pelvic floor reconstruction using transvaginal mesh implantation. The female patient in her mid-60s presented with typical symptoms of perianal abscess. After undergoing three surgical operations, the perianal infection was shown to be due to the implanted mesh as a late complication of the reconstruction. The patient was successfully managed with limited removal of the mesh tails. The case highlights one of the late complications of pelvic floor reconstruction using synthetic meshes.

Qat-induced intestinal obstruction: A case series of a new entity.

BACKGROUND: Qat-induced intestinal obstruction is an acute manifestation of qat chewing which was not described previously in the literature. The aim of this case series is to describe the clinical presentation, the diagnostic and therapeutic measures, and the course of the disease. METHODS: This retrospective case series included all patients who presented with qat-induced intestinal obstruction between July 1, 2013, and December 31, 2015. RESULTS: The study included seven patients (five males and two females). The mean age was 41.4 years (22-60 years). All patients presented after 8-12 h of prolonged qat chewing with abdominal pain, severe abdominal distension, and inability to pass stool. Laboratory results were normal apart from slight leukocytosis (<15 × 109/L) in three patients. All patients showed air-fluid levels on the erect abdominal X-ray. The management included intravenous fluids and symptomatic therapy. The symptoms resolved in 1-2 days and the follow-up after 1 week showed no residual complaints. CONCLUSIONS: Qat-induced intestinal obstruction is associated with the heavy and prolonged consumption of qat. The presentation mimics acute intestinal obstruction, but the course is benign. Spontaneous resolution with supportive inpatient treatment is the rule.

Duplication Cyst in the Third Part of the Duodenum Presenting with Gastric Outlet Obstruction and Severe Weight Loss.

Duodenal duplication is a rare developmental abnormality which is usually diagnosed in infancy and childhood, but less frequently in adulthood. We report a case of a 16-year-old female with a duplication cyst in the third part of the duodenum. The patient presented with symptoms of gastric outlet obstruction, including severe anorexia and weight loss. The diagnosis was made preoperatively by CT scan and upper endoscopy. The cyst was successfully treated by marsupialization on the duodenum using a GIA stapler. Duodenal duplication presents with a wide variety of symptoms. Although illusive, many cases can be properly diagnosed preoperatively by using the appropriate imaging modalities. Treatment choices are tailored according to the size and location of the cyst, in addition to its relation to adjacent structures. The outcomes are favorable in the majority of patients.