https://www.theskygallerypattaya.com/hjcr A Heighpubs Open Access Journal en-us 01/12/2021 https://www.theskygallerypattaya.com/hjcr/pdf/acr-aid1044.pdf &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;The increasing use of highly conformal radiation deliberates a higher accurate targeting. Contouring and clinical judgment are presumably the crucial point, thus positron emission tomography/magnetic resonance imaging PET/MRI with somatostatin analogs appears to be useful in radiotherapy target definition. A case report of a 43-year-old woman presented with a recurrence of a meningioma (World Health Organization group I classification) in skull base, 2 years after resection. Magnetic resonance imaging (MRI) revealed a left sided skull base mass on sphenoid wing, anterior clinoid and with a soft tissue component in the lateral portion of the orbit.&lt;/p&gt; &lt;p&gt;Contrast-enhanced MRI and a computed tomography (CT) dedicated were used to the radiotherapy planning. Aiming an improvement on target volume delineation, 68Ga-DOTATOC-PET/MRI was also performed due the difficult localization of the tumor in skull base. Was treated using intensity-modulated radiotherapy (IMRT) to a total dose of 54 Gy in 28 fractions. It was prescribed to the planning target volume (PTV), defined based of both imaging modalities. In our case PET/MRI helped to define the target, which volume becomes bigger than that based exclusively on MRI and CT.&lt;/p&gt; 11/04/2020 https://www.theskygallerypattaya.com/hjcr/acr-aid1043.php &lt;p&gt;A 27-year-old man presented to our hospital for abdominal pain and a cheesy discharge from the umbilicus which lasted&lt;br /&gt; for a few days.&lt;/p&gt; 09/08/2020 https://www.theskygallerypattaya.com/hjcr/acr-aid1042.php &lt;p&gt;A 73-year-old female patient presented to the emergency department with a 3-day history of acute abdominal pain and diarrhea.&lt;/p&gt; 09/01/2020 https://www.theskygallerypattaya.com/hjcr/acr-aid1041.php &lt;p&gt;Avulsive injuries to the face can be challenging. Soft tissue defects secondary to trauma and bites nessecitate local tissue transfer and the tissue closely resembles the missing skin in color and texture. These flaps can be rotated, advanced or transposed into a tissue defect and include:&lt;/p&gt; 07/15/2020 https://www.theskygallerypattaya.com/hjcr/acr-aid1040.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;We report the radio-clinical observation of a 21-year-old patient, referred for anterior chest parietal discomfort evolving for 3 months ago, with the notion of trauma.&lt;/p&gt; &lt;p&gt;The chest CT (computed tomography) scan detected a costal cartilage fracture without associated traumatic pulmonary or mediastinal changes.&lt;/p&gt; &lt;p&gt;This case illustrates the usefulness of imaging in the diagnosis and management of costal cartilage fractures, and for screening out differential diagnoses.&lt;/p&gt; &lt;p&gt;The aim of this study is to determine the interest of imaging in the study of fractures of the chrondro-costal cartilage.&lt;/p&gt; &lt;p&gt;Is to determine the CT value in chrondro-costal cartilage fracture.&lt;/p&gt; 06/16/2020 https://www.theskygallerypattaya.com/hjcr/acr-aid1039.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;Ependymomas, which account for 10% of pediatric central nervous system (CNS) tumors,&amp;nbsp; arise from the ependymal cells that line the cerebral ventricles and the central canal of the spinal cord. Extraneural metastasis to lung is rare for ependymomas primary tumors. Repeated surgeries that disrupt the blood-brain barrier may contribute to haematogenous spread, but the mechanism remains unclear. We present a case of ependymoma with extraneural metastasis to lung in a child and discuss reported cases of extracranial metastatic ependymoma with this presentation.&lt;/p&gt; 06/15/2020 https://www.theskygallerypattaya.com/hjcr/acr-aid1038.php &lt;p&gt;Sinonasal inverted papilloma (SIP) is a benign tumor which originates from the sinonasal Schneiderian mucosa and accounts for 0.5% to 4% of all nasal and sinus neoplasm [1]. Pathologically, SIP epithelium inverts into submucosal stroma, which is different from other types of nasal papilloma. Unlike other benign tumors, SIP exhibits remarkable aggressive behaviors, including invasiveness, recurrence and malignant transformation [2].&lt;/p&gt; 05/16/2020 https://www.theskygallerypattaya.com/hjcr/acr-aid1037.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;&lt;strong&gt;Introduction:&lt;/strong&gt; Arachnoid cyst (AC) is a congenital, benign, extra-axial lesion often found incidentally on intracranial imaging and makes up almost 1% of all intracranial masses. It arises from the splitting of arachnoid membranes with components similar to the cerebrospinal fluid. It&amp;rsquo;s reported that AC can be complicated by chronic subdural haematoma in athletes with repeated head injuries.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Case report: &lt;/strong&gt;We describe a case of a soccer player with an AC that underwent surgery for a chronic subdural haematoma with full recovery.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Material and method:&lt;/strong&gt; From a PubMed research, we found 14 relevant studies reporting a total of 15 patients who met the inclusion criteria: playing soccer, subdural hematoma and arachnoid cyst.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; Patients underwent different surgical treatment. In the case of hygroma with no midline shift, a conservative treatment was performed. In all cases the reported follow up was a full recovery.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Discussion:&lt;/strong&gt; Soccer is not usually considered a contact sport related to a high risk of head trauma or shaking head. From our review we can postulate that a soccer player with AC has an augmented risk to have a subdural haemorrhage, more rarely intracerebral haemorrhage.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;ACs are common meningeal abnormalities. They may bleed after minor head trauma, although it is rare. Asymptomatic patients with known AC should be monitored by a neurosurgeon and decision to engage this patient in soccer sport participation is still controversial.&lt;/p&gt; 05/04/2020 https://www.theskygallerypattaya.com/hjcr/acr-aid1036.php &lt;p&gt;The sequelae of deep and extensive burns to the abdomen can lead to serious complications during pregnancy. Studies and publications covering this subject are scarce and outdated. The complications described arise during the 3rd trimester of pregnancy, and surgical treatments to address these complications can initiate premature labor with a risk of fetal demise. We felt it would be of interest to prevent these complications through surgical treatments performed before the pregnancy. The need to reconstruct large regions of abdominal scar tissue prompted us to turn to the Integra&amp;reg; dermal equivalent for preventative surgical treatments.&lt;/p&gt; 04/17/2020 https://www.theskygallerypattaya.com/hjcr/acr-aid1035.php &lt;p&gt;On January 19, 2020, a 28-year-old male presented to the hospital with a 2-day history of fever, occasional cough and headache. He disclosed that he worked in Wuhan [1], China (the center of novel coronavirus outbreak) and flew to Yinchuan on the day of admission.&lt;/p&gt; 04/09/2020 https://www.theskygallerypattaya.com/hjcr/acr-aid1034.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;&lt;strong&gt;Introduction:&lt;/strong&gt; Diffuse axonal injury (DAI) is a major cause of disability in the pediatric patient. Herein we describe the MRI/DWI findings in a case with DAI. We also discuss the current role of CT and MRI with DWI in the evaluation of DAI.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Aim of the study:&lt;/strong&gt; To stress the role of diffusion-weighted imaging in diffuse axonal injury.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A pediatric patient, who was hospitalized in the ICU, was submitted to MRI with DWI for the evaluation of brain lesions. The patient was scanned with T1-weighted images, T2-weighted images, FLAIR, T2*-weighted images and diffusion weighted images.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Result:&lt;/strong&gt; Brain lesions caused by DAI were more conspicuous on diffusion-weighted images compared to FLAIR images. T2*-weighted images were a helpful adjunct in showing micro-hemorrhages.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; T2*-weighted images and FLAIR images alone underestimate the true extent brain lesions in DAI compared to DWI.&lt;/p&gt; 03/31/2020 https://www.theskygallerypattaya.com/hjcr/acr-aid1033.php &lt;p&gt;Symptomatic vasospasm represents an uncommon complication of perimesencephalic nonaneurysmal subarachnoid hemorrhage (SAH) which is a benign form of SAH without any recognizable source of bleeding accounting for about 15% of non-traumatic SAH [1,2].&lt;/p&gt; 03/18/2020 https://www.theskygallerypattaya.com/hjcr/acr-aid1032.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;Toxic epidermal necrolysis -the most serious variant of Steven Johnson Syndrome -arises as the result of cell-mediated cytotoxic reaction against keratinocytes. Most common inciting factors include drugs, and infections. On the other hand, Hemophagocytic lymphohistiocytosis (HLH), is a syndrome characterized by enormous immune response in the absence of down-regulation of activated immune cells resulting in cytokine storm causing severe tissue damage.&lt;/p&gt; &lt;p&gt;Up to date, several cases of concomitance of Toxic Epidermal Necrolysis (TEN) and Hemophagocytic Lympohystiocytosis (HLH) in pediatric patients have been reported. Both situations can be fatal and pediatricians should be aware that these two clinical entities are not mutually exclusive, to the contrary they may coexist.&lt;/p&gt; &lt;p&gt;We herein describe a case of Toxic Epidermal Necrolysis, complicated with Hemophagocytic Lymphohistiocytosis with Central Nervous System involvement due to EBV infection.&lt;/p&gt; 03/16/2020 https://www.theskygallerypattaya.com/hjcr/acr-aid1031.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;Dopamine agonists should usually be the first treatment for patients with prolactinomas of all sizes, because these drugs decrease serum prolactin concentrations and decrease the size of most lactotroph adenomas. Cabergoline is preferred first. When cabergoline develops side effects bromokriptin is switched. Cabergoline is more efficient than bromocriptine. Its side effect profile more favorable than bromocriptine. Cabergoline is an ergot dopamine agonist that is administered once or twice a week. Cabergoline can have rarely serious psychiatric adverse effects, including psychosis, impulse control disorders, dyskinesia, pulmonery fibrosis and valvular heart disease.&lt;br /&gt; Prolactinomas are the most common pituitary tumors, 93%-95% of the cases are microadenomas. Macroprolactinomas larger than 40 mm, known as giant prolactinomas, are exceptionally rare, accounting for 0.5%&amp;ndash;4% of all prolactin-hypersecreting adenomas.&lt;/p&gt; &lt;p&gt;In our case, after the 7 x 6 cm giant macroprolactinoma operated we report the manic episode occuring during the second week of cabergoline treatment. In the treatment of patients with prolactinoma, cabergoline is a first choice drug because it has a better tolerance profile and is more effective, however, bromocriptine can be switched to when drug resistance or side effects develop to cabergoline.&lt;/p&gt; 03/04/2020 https://www.theskygallerypattaya.com/hjcr/acr-aid1030.php &lt;h2&gt;Background&lt;/h2&gt; &lt;p&gt;Zoon&amp;rsquo;s vulvitis or plasma cell vulvitis (PCV) is a rare, benign inflammatory condition of the vulvar mucosa [1].&amp;nbsp; PCV can present with an asymptomatic lesion, or can cause discomfort, dyspareunia and pruritus [2]. In this way, PCV can mimic other lesions of the vulval mucosa, such as lichen planus.&lt;/p&gt; 02/26/2020 https://www.theskygallerypattaya.com/hjcr/acr-aid1029.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;Lung cancer is a major cause of morbidity and mortality worldwide. Metastasis can be seen in many organs in advanced-stage disease. Acral metastasis rate in cancer is quite low. However, because of the direct opening of the arterial circulation, the risk of acral metastasis stem from lung cancer is higher than any other cancers. Although the mechanism is not known exactly, acral metastases occur in dominant extremities. Here, we present a case with lung adenocarcinoma metastasis of the left hand in the second phalanx. We presented this case which is rarely seen in the literature to emphasize acral metastases.&lt;/p&gt; 02/06/2020 https://www.theskygallerypattaya.com/hjcr/acr-aid1028.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;Priapism is currently defined as a prolonged painful erection without sexual stimuli, if priapism persists &amp;gt; 36 hours, conservative treatment does not lead to detumescence.&lt;br /&gt; The most common etiologies are: medications into corpora cavernosa, anti-psychotics, anti-hypertensives, hematological disorders (chronic myeloid leukemia).&lt;/p&gt; &lt;p&gt;The Penile prosthesis is the choice treatment for restoring the erectile function after the failure of the conservative treatment.&lt;/p&gt; &lt;p&gt;But the corporal fibrosis makes it very difficult, with high risk of complications [1].&lt;/p&gt; 01/06/2020 https://www.theskygallerypattaya.com/hjcr/acr-aid1027.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;In this brief essay, Harald Koeck offers an introduction to Professor Jakob Erdheim, an eminent pathologist of Vienna. Koeck is an independent researcher at different Pathology Departments (Department of Pathology St. Poelten with Prof. Hans Bank MD, Department of Pathology MSMC N.Y. with Prof. Alan L. Schiller MD, Department of Pathology Minsik with Prof. Jurij Bandaschewski MD and since 2008 at the Jakob Erdheim Institute Vienna Hospital Hietzing, Chair Univ. Prof. Walter Ulrich MD.&lt;/p&gt; 12/23/2019 https://www.theskygallerypattaya.com/hjcr/acr-aid1026.php &lt;h2&gt;Summary&lt;/h2&gt; &lt;p&gt;Sexual activity during healthy pregnancy is safe. There are little data on how coital activity affects outcome of the high-risk pregnancies. Hereby we report a case demonstrating that orgasmic coitus triggered placental abruption resulting in preterm stillbirth.&lt;/p&gt; &lt;p&gt;A 38-year-old 8-para, 12-gravida woman lived unmarriedly with a constant partner in low socioeconomic conditions. Her previous pregnancies included 7 deliveries without complication, two early miscarriages and two pregnancy terminations. Her present pregnancy was complicated with gestational hypertension successfully treated with nifedipine. She had coitus 2 to 4 times a month, mostly without orgasm. The last coitus which happened in side-by-side position was accompanied by orgasm which continued in uterine hypertonicity and massive vaginal bleeding at 29 weeks gestation. Two hours subsequently, on admission to hospital, placental abruption and fetal demise were diagnosed. At the emergency cesarean section, a dead female infant weighing 1,510 g was born. Fetal pathology was not discovered. Placental histopathology showed retroplacental hematoma, intervillous and decidual hemorrhages, focal distal villous hypoplasia and avascular villuses. Patient&amp;rsquo;s recovery rapidly occurred after intensive care.&lt;/p&gt; &lt;p&gt;Placental abruption complicates 0.4% - 1.0% of deliveries. It is known that most cases of abruption cannot be predicted and prevented. Our report suggests that orgasmic coitus may be a trigger for placental abruption in those women who have gestational hypertension and multiple risks for placental abruption. We infer from the above case that sexual intercourse is advised to avoid during pregnancy of such women in order to prevent placental abruption.&lt;/p&gt; 12/06/2019 https://www.theskygallerypattaya.com/hjcr/acr-aid1025.php &lt;h2&gt;Letter to Editor&lt;/h2&gt; &lt;p&gt;Experience with allogeneic hematopoietic&amp;nbsp;stem cell transplantation&amp;nbsp;(HSCT) in mycosis fungoides/Sezary syndrome (MF/SS) is limited to a small number of case reports and case series [1,2]. The advantage of allogeneic HSCT has been indicated in progressive disease in the review of CIBMTR study groups [3]. A consensus is still not available about the intensity and the content of the conditioning regimen due to the rarity of the disease and heterogeneous patient groups.&lt;/p&gt; 12/06/2019 https://www.theskygallerypattaya.com/hjcr/acr-aid1024.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;&lt;strong&gt;Purpose:&lt;/strong&gt; This work is aimed at demonstrating that scraping cytology and scanning electron microscopy can successfully assist in the diagnosis of nontuberculous mycobacteria infection. For this purpose, we report the use of both these techniques in the diagnosis of cornel ulcer in a previously healthy young man.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Cytological samples were achieved by scraping technique on the mucosa, both sub palpebral and temporal area of the eye tarsal conjunctiva. The obtained sample was affixed to a sanded rectangular slide, stained with the Pappenheim method, washed in bidistilled water, treated in Giemsa solution, washed again and subsequently dried on a hot plate and observed with a microscope at various magnifications.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; After a therapy based on a 500 mg clarithromycin tablet administered every 12 hours for 30 days as systemic therapy, a complete recovery of the patient from left eye inflammation was observed and SEM cytology showed that NTM colonies had disappeared.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; Conjunctival cytology scraping and SEM technologies can be therefore exploited as new tools in diagnosis and fast identification of these newly discovered mycobacteria. In fact, they have a new way for studying ocular pathology, because of the simple execution and remarkable accuracy in the diagnosis. In fact, this technique allows to gather valuable information about all pathogens expression and the cellular action involved in pathology. As a further plus, this technique provides clinicians with the opportunity to repeat the SEM cytology for monitoring patients during therapy, hence leading to evaluate the efficacy of the pharmaceutical regimen in real time.&lt;/p&gt; 11/20/2019 https://www.theskygallerypattaya.com/hjcr/acr-aid1023.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Pulmonary artery bleeding secondary to iatrogenic injury is a troublesome intraoperative complication. The likelihood of encountering this complication is significantly higher in redo surgery for a number of reasons, including distortion of anatomical structures, adhesions and loss of tissue planes. Significant blood loss, although rare, remains a concern, and can occasionally be life-threatening. When significant bleeding from the pulmonary artery occurs, it can be a challenging situation to manage.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Case Report:&lt;/strong&gt; A 65 year old female was undergoing redo thoracic surgery in the setting of a completion lobectomy for biopsy-proven primary adenocarcinoma of the lung. Iatrogenic injury to the pulmonary artery resulted in significant bleeding that could not be managed by gaining proximal control due to dense adhesions. The novel decision to utilize a Foley catheter for balloon tamponade was taken, in order to provide sufficient haemostasis for definitive surgical repair of the defect to be undertaken.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; The increased technical difficulties of redo thoracic surgery are well recognised. We describe the first case of Foley catheter balloon tamponade being utilized in the context of iatrogenic pulmonary artery bleeding during thoracic surgery.&lt;/p&gt; 11/20/2019 https://www.theskygallerypattaya.com/hjcr/acr-aid1022.php In this article, we describe the case of a fifty-year-old patient with autoimmune hemolytic anemia (AIHA) with constitutional symptoms, jaundice, unquantified fever and progressive dyspnea. The patient had history of smoking and Hepatitis A and following a physical exam she was found in a regular condition, icteric but with no other further signs. Her laboratory tests revealed hemolytic anemia with a hemoglobin of 8.5 g/dL, an increase of total and indirect bilirubin, an elevated ferritin, a decreased transferrin and haptoglobin and a positive result for direct Coomb&rsquo;s test. Considering this, an immune profile was ordered finding a negative result of ANAs and ENAs and a decrease of complement C3 and C4. The patient was diagnosed with AIHA and as an initial step a corticosteroid treatment was administrated however the patient showed no clinical nor chemical improvement. At her third day of hospitalization, she was unstable hemodynamically requiring transfer to Intensive Care Unit (ICU) to optimize management. After 24 hours on ICU, due to persistence of deterioration of the patient, it was decided to manage with erythropoietin (EPO). In the following days, the patient showed a rise in her hemoglobin and an overall improvement made possible the transfer to hospitalization service. The AIHA is an uncommon disease and is not the first option that comes to mind with these symptoms, currently there are not controlled studies to the treatment due to its complexity and the heterogeneity of the results. We strongly support the use of EPO in refractory cases of this pathology. 11/19/2019 https://www.theskygallerypattaya.com/hjcr/acr-aid1021.php We describe a rare case of patellar fracture in a seven year old girl. The case was reviewed for various aspects such as clinical diagnosis, imaging tests and most suitable treatment. 10/16/2019 https://www.theskygallerypattaya.com/hjcr/acr-aid1020.php A 36-year-old man without previous medical history presented to the emergency department with abdominal pain and vomiting of acute onset. His vital signs were stable and he had no fever. Abdominal exploration revealed distention with pain at palpation. Laboratory tests were normal. Abdominal X-Ray showed gastric and small intestine distention.A nasogastric tube was placed and fluid therapy started. Computed tomography showed an intestinal malrotation, without the duodenum crossing the midline and with the colic frame arranged in the left hemiabdomen (Figure 1), complicated with a midgut volvulus as demonstrated by the whirlpool sign (Figure 2, arrow). Ladd&rsquo;s procedure was performed using a midline open approach. Mesenteric lymphadenopathy and chylous ascites was found (Figure 3). The volvulus was reduced by counter-clockwise detorsion without need of intestinal resection and Ladd&rsquo;s bands division along with an extended Kocher manoeuvre (Figure 4) allowed a good position of the mesentery. Appendectomy was also conducted. Postoperative course was uneventful with the patient being discharged the fifth day, after resumption of bowel function. No alterations were detected at follow up one month later. 10/02/2019 https://www.theskygallerypattaya.com/hjcr/acr-aid1019.php Agranulocytosis is one of the common reasons of consultation in hematology. It&rsquo;s life-threatening because of an infection risk. The metamizole is a drug, known for its potential rare danger of inducing a severe agranulocytosis. However, it remains widely used because of its beneficial effect analgesic and antipyretic. We report in this study, a case of a girl who was 16 years old, referred for severe agranulocytosis, and appeared two weeks after treatment with Novalgin. The clinico-biological symptoms were dominated by Streptococcal septicemia with an infectious pulmonary and digestive focus. The blood cell count confirmed a severe agranulocytosis with total disappearance of neutrophils. Despite broad-spectrum antibiotic therapy and stimulation with hematopoietic growth factor, the clinical evolution was fatal in the short term. What motivates us to add this case to those of the literature in order to remind practitioners about the danger of this drug, and to promote has doubled of vigilance during use. 09/30/2019 https://www.theskygallerypattaya.com/hjcr/acr-aid1018.php The proliferation and popularity of open source hardware and software, such as Arduino and Raspberry PI, together with IoT and Embedded System, has brought the health industry to rapid evolution, creating portable and low-cost medical devices for monitoring vital signals. Electrocardiographic (ECG) equipment plays a vital role for diagnosis of cardiac disease. However, the cost of this equipment is huge and the operation is too much complex which cannot offer better services to a large population in developing countries. In this paper, I have designed and implemented a low cost fully portable ECG monitoring system using android smartphone and Arduino. The results obtained by the device were tested comparing them with those obtained from a traditional ECG used in clinical practice on 70 people, in resting and under-activity conditions. The values of beats per minute (BPM), ECG waveform and ECG parameters were identical, and presented a sensitivity of 97.8% and a specificity of 78.52%. 09/24/2019 https://www.theskygallerypattaya.com/hjcr/acr-aid1017.php <em>Trichosporonosis</em> is a disease caused by <em>Trichosporon</em> spp. which are ubiquitous anamorphic yeast that commonly inhabit the soil. In human they are found in the skin, gastrointestinal tract and respiratory tract. Globally, <em>Trichosporon</em> spp. infection is rare and remains scantily reported in urinary tract infections and disseminated invasive infection amongst immunocompromised and cancer patients with neutropenia. <em>Trichosporon asahii</em> is the most commonly reported species. Virulence factors like proteinases, lipases, and phospholipases may be responsible for disease manifestation. We report a case of recurrent urinary tract infection due to <em>Trichosporon</em> spp. in a 62-year-old immunocompetent diabetic female which remained misdiagnosed for a long period of time. The patient was subsequently treated successfully by oral fluconazole drug. 08/05/2019 https://www.theskygallerypattaya.com/hjcr/acr-aid1016.php A male, 4 days old and 20 kg Simmental calf was evaluated for regurgitation and hyper salivation since birth. The mother became pregnant by artificial insemination and the pregnancy was the second of the mother. A membrane closed the pharynx and a diverticulum on dorsal of this membrane was seen during oropharyngeal examination through inspection. Membrane was also viewed by endoscopy under general anaesthesia. Larynx and oesophagus were imaged by bronchoscopy through the back side of the membrane. After these applications, it was decided that soft palate adhered firmly to the root of tongue causing congenital atresia. Surgical treatment of oropharyngeal membrane was carried out under general anaesthesia. Firstly, tracheotomy was performed for to ease breathing and membrane removed by electrocautery application. Intensive fluid accumulation and oedema formation at the incision area were detected by endoscopic examination following operation and the calf had severe dyspnoea two days after operation and died due to respiratory insufficiency. At necropsy, severe inflammatory reaction, laryngeal oedema and intensive salivation at the surgical side was determined. Direct imaging techniques should be used to determine in the closed oropharyngeal lumen. Moreover, nasopharyngoscopy should be considered to image larynx and oesophageal way. Present case is the first report with concern to pharyngeal membrane formation together with direct imaging and surgical procedures. Therefore, it was considered that this case report could be useful for colleagues and literatures. 08/02/2019 https://www.theskygallerypattaya.com/hjcr/acr-aid1015.php Left ventricular outflow tract obstruction is a well-recognized feature in hypertrophic cardiomyopathy but can occur in other clinical scenarios when anatomically susceptible heart is subjected to permissive physiological conditions that provoke systolic anterior motion of the mitral valve (SAM): ie, reduced preload, increased inotropic state, and decreased afterload. This report describes a case of hemodynamically significant latent LVOTO that was associated with hypotension, syncope, acute myocardial ischemic ECG changes, and an increase in cardiac enzymes. (Type II myocardial infarction) in a non HCM patient with excessive anterior mitral valve tissue. 07/17/2019 https://www.theskygallerypattaya.com/hjcr/acr-aid1014.php Anasarca is generalized swelling of the body following accumulation of fluid in the extracellular compartments. It may result from multiple aetiology mainly of renal, hepatic or cardiovascular origin.&nbsp; The aim of this case report is to highlight the challenges encountered in making diagnosis in a patient with anarsaca. We report a case of a 34 year old transporter who presented with anasarca. He had clinical features and risk factors suggestive of renal, hepatic and cardiovascular disease. However investigations ruled out renal, hepatic or cardiovascular diseases as the aetiology of the anarsaca. The anarsarca was also noted to be unresponsive to diuretics. The diagnosis of the disease causing the anarsaca was therefore a dilemma. 06/04/2019 https://www.theskygallerypattaya.com/hjcr/acr-aid1013.php <strong>Introduction:</strong> Peripherally inserted central venous catheters (PICCs) have been increasingly used as an alternative to conventional central venous catheters for long-term administration of chemotherapy, antibiotics, parenteral nutrition, and hydration in patients with difficult venous access. Traumatic complications to arteries and nerves adjacent to veins selected for PICC placement have been rarely described. <strong>Case presentation:</strong> We report the case of a PICC placement in the brachial vein of the right upper limb of a 78-year-old woman that resulted in brachial artery pseudoaneurysm and median nerve lesion. <strong>Discussion:</strong> The pseudoaneurysm was successfully repaired with thrombin injection, but neurological deficits to the hand resulting from nerve injury persisted even four months after the procedure. 04/05/2019 https://www.theskygallerypattaya.com/hjcr/acr-aid1012.php Local isolated recurrence of kidney cancer in the renal lodge after radical nephrectomy is rare and has a poor prognosis. Surgical excision, sometimes even extended to neighboring organs, is currently the only effective treatment for local recurrence of kidney cancer. The interest of new medical therapies remains to be defined. We report a case of local recurrence in a patient with radical nephrectomy. 03/08/2019 https://www.theskygallerypattaya.com/hjcr/acr-aid1011.php Acute dizziness/vertigo is among the most common causes for visiting the emergency department or primary care physician. Although the majority of these presentations represent an acute peripheral vestibulopathy (APV), lateral medullary, lateral pontine, and inferior cerebellar infarctions can mimic APV very closely. We present an atypical presentation of an aggressive APV and outline how a well-constructed bedside neurotologic evaluation can distinguish central from peripheral vertigo in the acute setting. 12/31/2018 https://www.theskygallerypattaya.com/hjcr/acr-aid1010.php &lt;h2&gt;Resume&lt;/h2&gt; &lt;p&gt;McArdle&amp;rsquo;s Disease, or Glycogen Storage Disease Type V, is the result of a deficiency in one of the enzymes responsible for the metabolism of glycogen in the body. Individuals with this disease, lack or produce very small concentrations of the myophosphorylase or glycogen phosphorylase enzyme.&lt;/p&gt; &lt;p&gt;McArdle&amp;rsquo;s disease is a metabolic and recessive genetic disease caused by a mutation on the PYGM gene located on chromosome 11q13. This gene is responsible for the synthesis of the myophosphorylase (or glycogen phosphorylase) enzyme. It is the most common form of muscular glycogenesis. We present here the clinical case of a 35 years old woman diagnosed with McArdle&amp;rsquo;s disease at the age of 21 after a visit to a Neurologist. It was confirmed that the patient had shown symptoms of this disease at least 10 years before definitive diagnosis: intolerance to exercise, asthenia and muscular weakness. In this report we describe the different signs and symptoms of the disease, as well as the tests performed to confirm the diagnosis by muscle biopsy and genetic analysis. McArdle&amp;rsquo;s disease is classified as a rare disease and often its diagnosis is delayed due to a lack of knowledge about its symptoms and signs. Our intention is to make, with the description of our clinical case, the information about this disease more available to physicians to prevent future misinterpretations and delayed diagnosis. A medical documentary we have created on &amp;ldquo;McArdle&amp;rsquo;s Disease&amp;rdquo; can be seen in YouTube using the following links: https://youtu.be/HAhoZ7jxz7Q (English version) and https://youtu.be/uZopzSHOl20 (Spanish version).&lt;/p&gt; 11/01/2018 https://www.theskygallerypattaya.com/hjcr/acr-aid1009.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;A 51-year-old women presented with asymptomatic multiple polypoidal nodules over scalp with simultaneous papularnodular skin eruptions involving nose, nasolabial folds and forehead for 40 years duration. Her daughter also noted to be having multiple papularnodular skin eruptions involving nose, nasolabial folds and forehead which raised curiosity of possible familial condition. The punch biopsy of polypoidal nodule indicating histological evidence of spiradenoma was favour in diagnosis of Brook Spienger Syndrome. We report this case as this is a rare clinical entity.&lt;/p&gt; 10/13/2018 https://www.theskygallerypattaya.com/hjcr/acr-aid1008.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;A rare case of Diabetic Foot in male of middle age has been shown.&lt;/p&gt; 04/24/2018 https://www.theskygallerypattaya.com/hjcr/acr-aid1007.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;The lymphatic system consists of small non-contractile lymph vessels which collect fluid from the interstitial space and carry it to the major contractile lymphatic vessels with valves that maintain a unidirectional flow to the lymph nodes and is responsible for returning proteins, lipids and water from the interstitium to the venous system near the junction of the subclavian vein and internal jugular vein on both sides. Lymphedema would be the result of the failure of transport with the further accumulation of fluid rich in protein at the interstitium, especially in limbs.&lt;/p&gt; &lt;p&gt;Primary lymphedema, which affects 1.15 / 100000 children (especially pre-pubescent girls), not always clinically evident at birth, is a genetic disorder that represents many different subsets of phenotypes: congenital or congenital lymphangiectasia, congenital trofoedema family or Meige, congenital amniotic band and essence or idiopathic.&lt;/p&gt; &lt;p&gt;The most common form of presentation is due to congenital absence or abnormality of the lymphatic tissue caused by a genetic mutation of the genes responsible for the development of lymphatic vessels that is characterized by the difficulty of draining lymph vessels. This genetic alteration may be sporadic or inherited.&lt;/p&gt; 02/06/2018 https://www.theskygallerypattaya.com/hjcr/acr-aid1006.php &lt;h2&gt;Summary&lt;/h2&gt; &lt;p&gt;A 53-year-old male presented to the Emergency Department (ED) with multisystem trauma and respiratory distress following a blunt-force injury to his anterior left neck. CT imaging showed extensive subcutaneous emphysema and pneumomediastinum. A chest X-ray showed elevation of the left hemidiaphragm suggesting phrenic nerve injury which was confirmed by bedside ultrasonographic examination of the left hemidiaphragm. Flexible bronchoscopy demonstrated tracheal rupture. The patient was treated supportively and recovered without surgical treatment. Trauma-induced hemidiaphragmatic paralysis is rarely reported. This case represents a clinical scenario with demonstrable anatomic correlations, and a clinical reminder that phrenic nerve injury should be included in the differential diagnosis of respiratory distress in a trauma patient.&lt;/p&gt; 01/30/2018 https://www.theskygallerypattaya.com/hjcr/acr-aid1005.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;&lt;strong&gt;Introduction:&lt;/strong&gt; Prune Belly syndrome is a disease characterized by abdominal muscle defect, bilateral cryptorchidsim and urinary system anomalies (reflux megaureter, hydronephrosis, etc.). Pulmonary, cardiac, and gastrointestinal anomalies may also be present. Management of these rare cases is very important. In this case, the clinical course of a patient with Prune Belly syndrome with megaurethra is presented.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Case: &lt;/strong&gt;The patient from the first gestation and parturition with birth weight of 2500 g and 38 weeks was hospitalized because of the bilateral hydronephrosis. His physical examination revealed undescended testicles and a large penis. The abdominal muscles were not very atrophic. The size of the kidney was small, bilateral hydroureteronephrosis and wide posterior urethra on the ultrasound. Renal function tests were progressively disturbed and the patient underwent cystourethroscopy for diagnostic purposes in terms of posterior urethral valve. A large diverticulum was found in anterior urethra. Prune Belly Syndrome was thought because the orifices were in appearance of reflux. The vesicostomy was applied. After vesicostomy the renal function tests got better but he was hospitalized due to urosepsis two times. In cystoscopic examination, the diverticulum in the urethra was filled with urine and the drainage was very slow. Phimosis was opened with dorsal slit technique. Cutaneous urethrostomy was proximal to the anterior diverticulum.&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; Prune Belly syndrome should be considered in patients with megaurethra and postrenal or renal insufficiency although there are no obvious clinical findings. In Prune Belly cases, via a large penis with obstruction signs, anterior urethral diverticulum should be considered.&lt;/p&gt; 12/20/2017 https://www.theskygallerypattaya.com/hjcr/acr-aid1004.php The catamenial pneumothorax is defined as the accumulation of air in the pleural cavity that appears in women infrequently and spontaneously with various clinical presentations. Actually, it is considered as an extremely rare entity with few cases described in the literature, that is the reason why the etiology is still discussed. However, a strong association with thoracic endometriosis syndrome has been found. We want to emphasize how the importance of conducting a diagnosis and having a timely management would improve the quality of life of the patient and give a better prognosis of the disease. Thus, a case report of a 38-year-old female patient who was receiving hormone therapy as a treatment for abdominal endometriosis and repetitive pneumothorax was presented. In the video-assisted thoracoscopy we saw diaphragmatic lesions and pneumothorax during the perioperative and postoperative period. Emphasize the importance of a detailed inspection of each intrathoracic organ during the surgical procedure, we also showed how the intraoperative pleurodesis, the placement of a mesh on the diaphragm and the continuity of the hormonal treatment, seems to be an effective therapy to prevent recurrences and have a better control of the disease. 12/14/2017 https://www.theskygallerypattaya.com/hjcr/acr-aid1003.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;Lipoma is a benign mesenchymal tumor with a thirteen percent incidence in head and neck region. Posterior triangle is the most common location while anterior neck lipoma is a rare one. Giant lipomas &amp;gt;10cm have been reported in different parts of the body but rarely in the anterior neck. Giant lipomas of the neck can present as a cosmetic disfigurement or can produce pressure symptoms. Most lipomas do not pose any difficulty in diagnosis. Surgical excision remains the treatment of choice. We here present a case of giant anterior neck lipoma.&amp;nbsp;&lt;/p&gt; 09/27/2017 https://www.theskygallerypattaya.com/hjcr/acr-aid1002.php &lt;h2&gt;Abstract&lt;/h2&gt; &lt;p&gt;Gastric mucosal calcinosis is a very rare pathology of the gastric mucosa. It may develop secondary to several diseases but may also be idiopathic in some cases. In this case, gastric mucosal calcinosis was diagnosed with endoscopic biopsy performed for a patient who presented to our clinic with heartburn and abdominal discomfort. This case involves a very rare gastric pathology, and is being studied here with reference to literature data.&lt;/p&gt; 07/21/2017 https://www.theskygallerypattaya.com/hjcr/acr-aid1001.php &lt;h2&gt;Case Report&lt;/h2&gt; &lt;p&gt;A 32-year-old G4P301LC3 woman presents to the office for a visit, with a 6-day history of vaginal discharge with an unpleasant odor. On speculum examination, the discharge was green in color and frothy in appearance. Is noticed vulvar erythema, edema, and pruritus, also is noted the characteristic erythematous, punctate epithelial papillae or &amp;ldquo;strawberry&amp;rdquo; appearance of the cervix.Vaginal pH was 6.2. Diagnosis of Trichomonas vaginalis is made via wet prep microscopic examination of vaginal swabs.But also, for diagnosis help even the exam with the speculum, concretely &amp;ldquo;strawberry&amp;rdquo; appearance of the cervix. The diagnosis is confirmed by culture.Trichomoniasis is a sexually transmitted infection [1,2], that caused by trichomonas vaginalis. Trichomonas vaginalis is a unicellular, anaerobic flagellated protozoan, that inhabits the lower genitourinary tracts of women and men, but that can cause vaginitis. Clinical findings of Trichomonas vaginalis include a profuse discharge with an unpleasant odor. The discharge may be yellow, gray, or green in color and may be frothy in appearance. Vaginal pH is in the 6 to 7.Vulvar erythema, edema, and pruritus can also be noted. The characteristic erythematous, punctate epithelial papillae or &amp;ldquo;strawberry&amp;rdquo; appearance of the cervix is apparent in only 10% of cases. Symptoms are usually worse immediately after menses because of the transient increase in vaginal pH at that time. Diagnosis of Trichomonas vaginalis is made via wet prep microscopic examination of vaginal swabs.&lt;/p&gt;