Unilateral Giant Varicocele Mimicking Inguinal Hernia Resulting from Portosystemic Shunt without Evidence of Portal Hypertension: An Unusual Case Report.

Isolated giant varicocele has been reported with portal hypertension that results in abnormal communication between portal venous system and testicular vein venous system resulting in retrograde backflow of blood into the testicular venous system which leads to varicosity of the pampiniform plexuses. 65-year-old male with no past medical or surgical history presented to us with soft inguinoscrotal swelling that disappears on lying down mimicking inguinal hernia. Clinical examination revealed soft inguionoscrotal swelling that disappears on pressure.

Missed torsion in undescended testes detected by scintigraphy: testicular scintigraphy a decisive complementary tool.

Torsion of undescended testis, although not uncommon, causes diagnostic difficulties. We here present testicular scintigraphy images of a typical case of torsion of an undescended inguinal testis with disparity between clinical and ultrasonography (USG) findings in the contralateral retractile testis.

Recurrent neonatal organophoshorus poisoning.

Organophosphorus poisoning in neonates is extremely rare and needs high index of suspicion to diagnose it. The clinical presentation is often confused with the features of sepsis like apnea, copious oral secretions, diarrhea, letharginess, seizures. There may be recurrence of manifestations due to chronic exposure.

Solitary epithelioid histiocytoma (reticulohistiocytoma) of the glans penis.

Solitary epithelioid histiocytoma (previously called reticulohistiocytoma) is a rare benign dermal histiocytic proliferation characterized by the presence of large, eosinophilic histiocytes with 'glassy' cytoplasm. This entity assumes importance because of its close histologic resemblance to several benign as well as malignant cutaneous lesions. Involvement of the penis is extremely rare, and to our knowledge, only one case has been previously described in the literature.

Dexmedetomidine infusion to facilitate opioid detoxification and withdrawal in a patient with chronic opioid abuse.

Many patients are admitted to the intensive care unit (ICU) for acute intoxication, serious complication of overdose, or withdrawal symptoms of illicit drugs. An acute withdrawal of drugs with addiction potential is associated with a sympathetic overactivity leading to marked psychomimetic disturbances. Acute intoxication or withdrawal of such drugs is often associated with life-threatening complications which require ICU admission and necessitate prolonged sedative analgesic medications, weaning from which is often complicated by withdrawal and other psychomimetic symptoms.

Intrathecal drug delivery system (IDDS) for cancer pain management: a review and updates.

Cancer pain remains undertreated and a significant number of patients with cancer pain die from severe untreated pain. With increasing survival rate in cancer, the prevalence of cancer pain is also increasing in number. Though majority of patients with cancer pain can be effectively treated with conventional medical management, still a significant portion of patients required some form of interventional pain management techniques.

Metformin poisoning: A complex presentation.

The objective of this case report is to highlight presentation, complications and treatment of metformin poisoning. Patient after ingestion of 45gms of metformin developed colicky abdominal pain, severe tachypnea and vomiting. He developed severe lactic acidosis, cardiac arrest, pancreatitis and hemolytic anemia which was treated with charcoal, sodium bicarbonate, early initiation of high volume continuous veno-venous hemofiltration and supportive therapy.

Mixed adenocarcinoma-carcinoid (collision tumor) of the appendix.

Objective: To report a case of mixed adenocarcinoma and carcinoid in the gastrointestinal tract.

Clinical Presentation And Intervention: A 52-year-old man presented with a mass at the base of the appendix. On microscopic examination of the tumor, mixed adenocarcinoma and carcinoid was identified.

Malacoplakia of the vallecula masquerading as a malignancy.

Malacoplakia is an unusual chronic granulomatous inflammation that commonly occurs in the urinary tract. It is rarely encountered in the head and neck region, and only a handful of such cases have been described. We report a case of malacoplakia in a 50-year-old woman who presented with a mass in the vallecula that was clinically suspected of being malignant.

Pyomyositis mimicking osteomyelitis detected by SPET/CT.

Pyomyositis is a relatively infrequent, sub-acute primary bacterial muscle infection, which due to its non specific clinical findings is unlikely to be early diagnosed especially in diabetic patients. This diagnostic delay may be fatal. Therefore, early diagnosis and prompt treatment are imperative.

Foreign body reaction to soft tissue filler simulating atypical lipomatous tumor: report of a case.

Injectable silicone or microimplant has been extensively used for the soft tissue augmentation. Here we report a case of cystic granulomatous reaction to injectable tissue filler, possibly liquid silicone, used for tissue augmentation in the buttocks. Patient presented with a progressive painful swelling in the lower back over L4-L5 and S1 lumbosacral region of 4-month duration.

Acute amebic appendicitis: report of a rare case.

Acute appendicitis of amebic origin is considered a rare cause of acute appendicitis. We report a case of amebic appendicitis presenting with fever, severe pain in the right lower quadrant of the abdomen and rebound tenderness. Lab investigations revealed neutrophilic leukocytosis.

Jejunal perforation caused by schistosomiasis.

We report an extremely unusual case of jejunal perforation caused by adult schistosoma worm in a 49-year-old South Korean man who presented with acute abdomen. To our knowledge, this is the first case of jejunal perforation associated with adult worm of schistosoma.

Phyllodes tumor of the vulva: Report of a rare case and review of the literature.

Phyllodes tumor occurring in the vulva is extremely rare; only 6 cases have been previously reported in the literature. The histogenetic origin of this tumor is controversial as it is being debated whether such lesions evolve from ectopic breast tissue, cutaneous apocrine glands, and most recently, anogenital mammary-like gland. We report an 18-year-old Kuwaiti girl who presented with a painless mass in the left labium majus, which was subsequently excised.

Transmission of a Klebsiella pneumoniae clone harbouring genes for CTX-M-15-like and SHV-112 enzymes in a neonatal intensive care unit of a Kuwaiti hospital.

The spread of antibiotic-resistant bacteria has become a large problem in most countries including Kuwait. This antibiotic resistance is usually due to the production of extended-spectrum beta-lactamase (ESBL) enzymes such as SHV, TEM and CTX-M. This study reports the emergence and spread of an ESBL-producing Klebsiella pneumoniae clone in a neonatal intensive care unit (NICU) in a Kuwaiti hospital.

Ibn Sina : a tribute.

Idiopathic Ibn Sina, popularly known in the west as Avicenna;(980-1037 A.D.) was one of the foremost physicians and Islamic philosophers of his time.

An unusual case of extensive epididymotesticular malakoplakia in a diabetic patient.

A 67-year-old Saudi man with poorly controlled diabetes-mellitus underwent orchiectomy for a painful left testicular swelling that did not respond to antibiotics. Clinical diagnosis was testicular malignancy. Histologic workup demonstrated extensive involvement of the testis and epididymis by diffuse infiltrate of large histiocytes with eosinophilic granular cytoplasm and numerous Michaelis-Gutmann bodies, which were diagnostic of malakoplakia.

Lymphoepithelioma-like carcinoma of the urinary bladder: report of a rare case.

Lymphoepithelioma-like carcinoma (LELC) is a rare malignant neoplasm in the urinary bladder, which can histologically mimic lymphoma, poorly differentiated invasive transitional cell carcinoma or poorly differentiated squamous cell carcinoma with a lymphoplasmacytic background. A urinary bladder tumor was identified in a 65-year-old man suffering from hematuria for several weeks. Transurethral biopsy revealed an undifferentiated tumor with prominent lymphocytes and plasma cell infiltration.

Proximal-type epithelioid sarcoma in the groin presenting as a diagnostic dilemma.

Epithelioid sarcoma is an uncommon soft-tissue sarcoma typically presenting as a subcutaneous or deep dermal mass in the distal extremities of young adults. Lately, a 'proximal' subtype has been described, which occurs in the pelvic and genital areas of somewhat older individuals and tends to behave more aggressively than the conventional subtype. The correct diagnosis of this subtype is essential, since this tumor can be easily mistaken for other malignant tumors that exhibit epithelioid morphology.

An unusual case of extensive xanthogranulomatous orchitis in a diabetic patient.

Objective: We report an unusual case of extensive xanthogranulomatous orchitis (XGO) in association with poorly controlled diabetes mellitus.

Clinical Presentation And Intervention: A 65-year-old Kuwaiti man with poorly controlled diabetes mellitus presented with a painful left testicular swelling of 1 year duration. Testicular tumor markers were normal.

Gastric heterotopia of the anus: report of two rare cases and review of the literature.

Heterotopic gastric mucosa is an extremely rare occurrence in the anorectal region, with 41 reported cases till date. Of these, in only nine cases the heterotopic tissue has been found to be located within 2 cm of the dentate line. We report two cases of gastric heterotopia in the anus - one, in a 55-year-old man; and the other, in a 35-year-old woman.

Proliferating trichilemmal tumor in the chest wall: report of a rare case.

Proliferating trichilemmal tumor (PTT) is an uncommon, usually benign lesion that usually arises on the scalp of elderly women. The lesion bears close morphologic resemblance to squamous cell carcinoma at the microscopic level, making correct histologic diagnosis extremely important. We present a case of PTT occurring on the chest wall of a 75-years-old man to highlight the significance of recognizing this unusual tumor at an uncommon location and discuss points of differentiation from squamous cell carcinoma.