Journal of the College of Physicians and Surgeons--Pakistan : JCPSP
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J Coll Physicians Surg Pak · Sep 2021
Case ReportsScapular Winging Secondary to Iatrogenic Spinal Accessory Nerve Lesions.
Motor innervation of trapezius and sternocleidomastoid (SCM) muscles is provided solely by the spinal accessory nerve (SAN). SAN palsy most often occurs as a result of iatrogenic injury to the nerve. A patient, who had undergone neck dissection for thyroid cancer, presented with pain and reduced range of motion of the shoulders. ⋯ However, evidence to support the use of PT in the treatment of shoulder dysfunction secondary to SAN injury is insufficient; the optimum type and timing of PT requires further investigation. Development of best-practice guidelines in terms of management is necessary. Key Words: Spinal accessory nerve, Electroneuromyography, Scapular winging.
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J Coll Physicians Surg Pak · Sep 2021
Diagnosis of Levothyroxine Pseudo-malabsorption: The Results of Standardised Testing Protocol.
The levothyroxine absorption test for the assessment of pseudo-malabsorption in patients with refractory hypothyroidism has not been standardised. The aim of this observational study was to describe a protocol for levothyroxine (LT-4) absorption test in patients with refractory hypothyroidism, to report possible side effects and to emphasise the importance of pseudo-malabsorption in the differential diagnosis. The results of 10 patients, who underwent LT-4 absorption tests because thyroid stimulating hormone suppression could not be achieved despite the need for LT-4 >3 mcg/kg/day, were retrospectively analysed. ⋯ The fT4 peak level increased 3.25 times compared to baseline. The shorter LT-4 absorption test with low doses may provide an alternative method to the commonly used longer protocols with higher doses to rule out malabsorption. Key Words: Levothyroxine absorption test, Pseudo-malabsorption, Resistant hypothyroidism.
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J Coll Physicians Surg Pak · Sep 2021
Observational StudyCBX2 Expression in Colorectal Mucosa-adenoma-adenocarcinoma Sequence.
To investigate the expression of chromobox 2 (CBX2) in colorectal adenoma (CRA) and colorectal cancer (CRC), and analyse its correlation with various clinicopathological parameters. ⋯ CBX2 expression progressively increased in the sequence of mucosa-adenoma-carcinoma, which may be used as a diagnostic biomarker and therapeutic target for CRA and CRC. Key Words: CBX2, Colorectal adenoma, Colorectal cancer, Biomarker.
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J Coll Physicians Surg Pak · Sep 2021
The Relationship between PI-RADS Categories and Incidental Findings in Multiparametric Prostate MRI.
To find the frequency and significance of extraprostatic incidental findings (ep-IFs) during multiparametric-magnetic prostate resonance imaging (mp-MRI), and compare them with prostate imaging reporting and data system (PI-RADS) outcomes. ⋯ Extra prostatic incitental findings are frequently encountered during mp-MRI, benign ep-IFs are quite frequent; although rare malignant ep-IFs may be subject to being missed due to focused analysis and interpretation of prostate. PI-RADS scoring system does not contribute to the diagnosis of incidental mp-MRI. Key Words: Incidental findings, Multiparametric prostate MRI, Prostate cancer, MP-MRI.
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J Coll Physicians Surg Pak · Sep 2021
Case ReportsCladophialophora Bantiana as a Cause of Rare Fungal Brain Abscess.
Cerebral phaeohyphomycosis refers to central nervous system infection caused by dematiaceous molds, which have many genuses. Cladophialophora bantiana is a member of the phylum ascomycota, which is found in soil samples from all over the world. This organism typically infects immunocompromised patients and associated with 70% mortality rate even after weeks of antifungal agent administration and surgical debridement. ⋯ Both patients presented with complaints of headache, vomiting, drowsiness and impaired cognition. A brain biopsy together with microbiological culture and VITEK 2 helped in reaching to a final diagnosis. Key Words: Cladophialophora bantiana, Dematiaceous, Intracerebral, Phaeohyphomycosis.