Nicolau dermatitis (ND) is a well-known but rare adverse drug reaction involving the skin and the subcutaneous and even muscle tissues at the site of intramuscular injection (IMI). Benzathine penicillin (BP) is the most frequent medication causing serious and acute complications such as limb ischemia, compartment syndrome (CS), and nerve paralysis. The subsequent damage to the lower limb (LL) might be due to microemboli, leading to progressive deterioration of the downstream tissue bed. We describe a 7-year-old boy with a diagnosis of ND after IMI of BP and diclofenac sodium to the medial mid-right thigh. Two days earlier, the patient seemed to experience an acute suppurative complication of circumcision and underwent the aforementioned treatment (September 15, 2018). The circumcision and injection of drugs were illicitly carried out by a nonmedical practitioner. The child complained of severe pain and disability of his right LL. On admission (September 16, 2018), he was found to have acute LL ischemia and CS with cyanosis, hypoesthesia and paresis. Fasciotomy was achieved and medical therapy with heparin, corticoid, and an antibiotic was made for 7 days. Postoperative periods were uneventful. Livedoid violaceous patch and erythematous plaque and ecchymosis have evolved progressively during 10th day, with formation of a diffuse necrotic spot before healing up within 2 months. The length of hospital stay was 10 days. The rehabilitation for walking was started 2 weeks after the operation. Between 6 and 12 months of follow-up, the motor deficit involved the entire LL and persisted despite the tremendous achievement of regular neuromuscular physiotherapy. The paralysis was considered permanent.

Since recurrence rates have been considerably reduced with mesh repairs, chronic pain has recently become the main concern after inguinal hernia repair (IHR), with significant impact on patient satisfaction, societal cost, and quality of life. Some 31% of all patients with persistent postsurgical pain develop neuropathic pain (NP) after IHR seeing that the inguinal nerves that cross the surgical field can directly or indirectly be damaged. Because of the multiplicity of the risk factors and the complexity of the pathophysiological mechanisms, substantial attention has been devoted to the multidisciplinary approaches and to the preventive measures. More clinical trials are needed to improve the level of evidence of the use of pharmacological, surgical, and interventional procedures in both prevention and treatment of chronic NP following IHR. In this article, the current objectives are to review the incidence, risk factors, pathogenesis, diagnosis, prevention, and treatment of chronic NP after IHR.

Background: For vertebroplasty, newly synthesized bone cements are proposed to replace traditional polymethylmethacrylate (PMMA). Most inventors initially evaluated these newly developed cements in animal spine models. However, even these time- and work-consuming histological inspections performed meticulously by experienced hands, there are still lots of specimen lost during the processing procedures. Although the histological sections can reveal new bone formations and surrounding tissue reactions to implanted materials, it is difficult to identify the degradation processes of the injected cement. In fact, there is no standard method to quantify the volume changes of injected substitutes postoperation. Methods: Previously, we developed two new biodegradable cements and evaluated performances in fixed-volume and fixed-shaped holes in vertebral bodies of porcine lumbar spine. The animals were sacrificed and the retrieved spines were analyzed after 3 and 6 months. Herein, we further used computed tomography (CT) and three-dimensional CT (3D-CT) to quantitate volumes and biodegradation of cements inside vertebral bodies after previous attestation of CT findings. Exteriors of controls and injected materials were reconstructed with different Hounsfield units (HU); changes of HU as well as cement volumes were later calculated. Results: The results revealed that the volumes and shapes of these biodegradable cements can be determined by 3D-CT. After meticulous comparisons among gross specimens, histologies, and CT images, the different patterns observed in CT implied consistency among all three observations. Gradual reductions of HU and volumes of newly synthesized cements showed the degradability. Meanwhile, consistent HU and volumes of PMMA meant its inertness. Conclusion: CT imaging may be a preliminary, quantitative, and liable way for evaluating injectable bone cements in the vertebral bodies.

VACTERL association is sporadic and nonrandom, with co-occurrence of various congenital malformations in a single patient due to defect in structures derived from embryonic mesoderm. The VACTERL association with pulmonary agenesis is very rare; few cases have been reported only in neonates till now in the past, as most babies could not survive longer. However, we present a rare case of VACTERL association with left pulmonary agenesis in a 9-month-old infant.

Background: This study aimed to profile the clinical pictures and identify the risk factors of mortality among terminally ill patients who visited the emergency department (ED) and had signed do-not-resuscitate (DNR) consents. Methods: This prospective study employed purposeful sampling of 200 adult, nontrauma, terminally ill patients who visited the ED and signed a DNR consent between July 1, 2011, and March 31, 2012. Physiological variables were compared between fatal and survival patients using Student's t-tests after assessing the normality of the data distribution. Results: The Cox proportional regression analysis revealed that patients taking antiarrhythmic drugs and vasopressor had a 47.6-fold and 2.8-fold higher mortality, respectively, compared to nonusers and those who had a respiratory rate ≥28 breaths/min showed a 2.8-fold increase in their risk of death compared to those with a respiratory rate Conclusions: Among terminally ill patients who had signed a DNR consent at the ED, significantly higher hazard ratios of mortality were observed in patients who were on antiarrhythmic drugs or vasopressor, had respiratory rates ≥28 breaths/min, had been intubated, and had serum potassium levels ≥ 4.5 mEq/L.

Emphysematous gastritis is a rare but severe disease characterized by air within the gastric wall. It is commonly caused by a bacterial infection and carries a remarkably high mortality rate (50%–60%). The most common predisposing factors include ingestion of corrosive substances, alcohol abuse, and recent abdominal surgery. Diagnosis of emphysematous gastritis is difficult and relies on computed tomography (CT) scan because of the nonspecific clinical presentation of abdominal pain with systemic toxicity. In this report, we present a case of a 78-year-old male with gastric adenocarcinoma who underwent laparoscopic radical subtotal gastrectomy. After the operation, he complained of severe abdominal pain and fever. Subsequently, the patient developed acute respiratory distress syndrome and septic shock. A CT scan performed on postoperative day 17 revealed extensive intramural gas in the stomach. The patient was diagnosed with emphysematous gastritis and received conservative treatment.

Colorectal cancers commonly metastasize to the liver and the lung; it is distinctly unusual for these cancers to metastasize to the skeletal system. The typical locations of skeletal metastases from colorectal cancer are the vertebrae and pelvis. Sternal metastasis from a rectal cancer primary is exceedingly rare, and to the best of our knowledge, there are only two prior case reports in literature. The presence of distant metastases usually portends a poor prognosis, however with continuous improvements in multimodality management, the survival rates of metastatic colorectal cancers has considerably improved. We present an interesting case of a 71-year-old man who underwent a complete metastatectomy for a metachronous sternal metastasis from a locally advanced rectal cancer and discuss its clinical presentation and management implications with a brief review of literature.

Kimura's disease (KD) is a benign chronic inflammatory disorder attributed to an immune-mediated hypersensitivity which often presents as a tumor-like swelling in the head and neck region with or without lymphadenopathy, associated with hypereosinophilia and elevated serum immunoglobulin E. Most cases have been described predominantly in Chinese and Japanese people. KD has been confused with angiolymphoid hyperplasia with eosinophilia, from which it probably should be distinguished as a separate entity. The course is usually benign except for the potential cosmetic disfigurement. The diagnosis may be suggested by a fine-needle aspirate but is established by a biopsy. A case of KD in a 42-year-old male with recurrent left submandibular swelling is presented together with a brief review of the literature.

Often presented with an insidious onset, intramural esophageal dissection (IED) is a rare disease which has been mostly treated conservatively, though the treatment for infectious cases is still controversial. Two cases are reported here as follows: one was approached surgically by thoracoscopic mediastinotomy and neck debridement and the other was treated conservatively. The latter subsequently developed septic shock and was readmitted with intensive care. Both patients eventually recovered and resumed oral intake without requiring esophagectomy. Comparing these two cases of IED, one with a mucosal perforation and the other without, surgical intervention revealed the advantages of definitive isolation of pathogen and rapid mechanical removal of pus. Surgical risks should be evaluated against the severity, such as the presence of a mucosal perforation and the risk of a protracted clinical course for IED.

Background: The aim of the present study is to evaluate our initial experiences of thoracoscopic repair (TR) for esophageal atresia with/without trachoesophageal fistula (EA/TEF) and also to compare the results with open repair (OR). Subjects and Methods: Patients with EA/TEF who received surgeries in our institution between July 2009 and June 2015 were included in the study. The medical records were retrospectively reviewed. Patients are divided into two groups as follows: TR and OR. Parameters collected includes demographics, operation time, conversion, time to oral feeding, length of hospital stay, complications, and growth status. Statistical Analysis Used: Wilcoxon rank sum test, Chi-square, and Fisher's exact test. Results: A total of 21 patients with EA/TEF, 19 with type C and 2 with type A, were enrolled. There were 9 and 12 patients in TR and OR groups, respectively. There was no significant difference in demographics between both groups. Median operation time was significantly longer in TR (197.5 vs. 115 min, P Conclusions: TR for EA/TEF is feasible. The initial experiences revealed longer operation time and higher complication rate compared to OR.