A 23-year-old gentleman came to Emergency Department with first episode of sudden collapse. He had a right pelvic Ewing's sarcoma surgically resected 6 years ago. MRI of the head demonstrated a lesion in right temporal lobe, extending into infratemporal fossa. He was referred to oncology for further management with chemotherapy.

Α 59-year-old female presented to our hospital with epigastric pain. A computed tomography scan of the abdomen revealed a foreign body in the head of pancreas. A laparoscopic surgery was performed and the foreign body was safely removed. The foreign body was identified as a 3-cm-long fish bone.

Multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominant disorder with tumor predisposition in the parathyroid gland, anterior hypophysis and pancreatic islet cells. Here we describe the first Costa Rican MEN1 case with a novel MEN1 mutation in a 37-year-old male with history of nephrolithiasis and recurrent hypoglycemia

We present the case of a patient with patch-stage mycosis fungoides who developed ulcerative tumors compatible with large cell transformation. Tumor cells were positive for CD30 and CXCR3 and negative for CCR3, and subsequently exhibited spontaneous regression. Thus, large cell transformation in early mycosis fungoides may not indicate poor prognosis.

Focused Intensive Care Echo (FICE) is recommended in critically unwell patients to assess haemodynamic status. In certain circumstances, FICE can also be used as a diagnostic tool. We present a case where FICE identified a large left atrial mass in an intensive care patient with acute hypoxia and thromboembolic sequelae.

We present the case of an adult patient with acute dyspnoea and stridor following thyroidectomy. After excluding other causes of postoperative stridor, we concluded the patient was suffering from laryngospasm due to hypocalcaemia secondary to postoperative hypoparathyroidism. It is important to consider hypocalcaemia as a differential diagnosis in stridor.

The biological father of an 11-year-old girl infects his daughter, who returns to her biological mother's family before the father's diagnosis. The daughter endures a 1-day, mild illness. However, despite close physical contact prior to and during the girl's illness, her mother, stepfather and 1-year-old half-brother were not infected.

This case showed that anticancer drug administration induces unhealthy subcutaneous tissue (thrombus or edema) without subjective symptoms, abnormal sign by palpation or inspection, which have an extravasation risk. Especially, short-term interval therapy such as a weekly chemotherapy have high risk for anticancer drug infusion to the risky site.

Neoplastic meningitis remains a diagnostic challenge due to its varied clinical manifestations. We discuss a presentation with dizziness with an initial diagnosis of Benign Paroxysmal Positional Vertigo. We highlight the hallmark findings and reflect on how clinicians may miss evolving features in recurrent attenders due to ‘anchoring’ to previous diagnoses.

Binswanger's disease is a type of vascular leukoencephalopathy that can lead to cognitive impairment and neurological deficits and is sometimes difficult to diagnose. We present a case of Binswanger's disease with an interesting differential diagnosis based on clinical aspects, laboratory findings and imaging studies.

A 73-year-old woman with occult hepatitis B virus (HBV) infection was diagnosed with hepatocellular carcinoma (HCC). Serum HBV core-related antigen (HBcrAg) was elevated and HBV covalently closed circular DNA (cccDNA) was presented in the liver tissue. This report shows HBcrAg might be a predictive factor for development of HCC.

A young man presented with sudden onset chest and neck pain, dyspnoea and dysphonia, following vigorous coughing. Examination identified surgical emphysema and subsequent CT scan revealed a spontaneous pneumomediastinum. The patient remained well despite the remarkable radiological findings. He was managed conservatively but his travel plans were interrupted.

Cracked tooth syndrome is a common well documented condition that many occur due to morphologic, physical and iatrogenic factors. Epidemiologic data revealed that splits or fractures are the third most common cause of tooth loss. Simvastatin allowed a good management for a case suffered from cracked tooth.

We experienced refeeding syndrome (RFS) with an eating disorder and distal renal tubular acidosis (dRTA). A low body mass is high-risk factors for RFS development. Therefore, frequently measurement of serum phosphorus levels at the initiation of nutrition and rapid administration of phosphate preparations are required to prevent RFS-related organ failure.

Bilateral concomitant inguinal and femoral hernias are very rare. Preoperative examinations may not be able to detect coexisting inguinal hernias. However, laparoscopic surgery can identify these subclinical hernias and repair them appropriately. We report about the use of laparoscopic surgery to repair coexisting bilateral inguinal and femoral hernias.

A 14-year-old girl presented with the rapid growth of bilateral breasts within a year, causing her chest discomfort, and pressure sores in the inframammary fold. Bilateral reduction mammoplasty with free nipple-areola graft was performed. Nine kilograms of breast tissue, accounting for 15% of her total body weight, were excised.

Systemic mastocytosis (SM) can be extremely heterogeneous and its treatment should be highly individualized. We reported a description of clinical management of an aggressive SM characterized at diagnosis by multiple organ involvement. The patient underwent to different lines of treatment, from standard chemotherapy to the novel tyrosine kinase inhibitor midostaurin.

We present a 30-year-old male with end-stage renal disease (ESRD) secondary to anti-glomerular basement membrane (anti-GBM) disease who presented to the emergency room with hypertensive emergency and seizures. He was treated with antihypertensives and lorazepam. His seizure etiology was attributed to hypertensive emergency due to ESRD from anti-GBM disease.