Postpartum unscarred uterine ruptures are exceedingly rare. A 29-year-old multipara with a retained placenta presented hypovolemic shock. An emergency laparotomy revealed that her uterus was ruptured where the placenta adhered to. Pathological examination confirmed the placental accreta that could be a risk factor for postpartum unscarred uterine rupture.

We can safely treat mitral valve disease with mitral annular calcification using Sapien 3 valve through the incision of the right side of the left atrium under direct visualization preventing atrio-ventricular disruption and left ventricular outflow tract obstruction.

A giant granuloma obstructing the upper airway in a 21-year-old male is described. It arose after an extreme psychological stress. The patient underwent microlaryngoscopic removal of the granuloma, with no recurrence. This case confirms the role of psychological stress in the pathogenesis of laryngeal granulomas, that can reach huge dimensions.

Thyrotoxic periodic paralysis is rare in pediatric population. An adolescent male presented to the emergency department with a syncopal episode, muscle weakness, and shortness of breath. We present the clinical characteristics and laboratory evaluation and summarize the treatment and outcome of an adolescent with Thyrotoxic periodic paralysis.

Nontuberculous mycobacteria are rare causes of cardiac implantable electronic device (CIED) pocket infections and may lead to device-related endocarditis, so preventing them is key. Diagnosis is by presence of acid-fast bacilli on smears and culture takes around 3-7 days on grow on standard agar media.

Regular treatment of DKA patients includes rapid and large amount of fluids supply, which is not feasible in DKA patients associated with Uremia because of being urineless and prone to heart failure of these patinets. Our results indicated that continuous renal replacement therapy (CRRT) is a better alternative.

Intestinal pseudo-obstruction (IPO) is defined as an intestinal obstruction without mechanical obstructive lesion. It’s a rare complication of systemic lupus erythematosus (SLE). We report a case of SLE inaugurated by IPO to emphasize the importance of early recognition of the diagnosis especially that SLE-related IPO responds well to corticosteroid therapy.

A 70-year old patient with chronic atrial fibrillation, a large atrial septal defect (ASD) and severe tricuspid regurgitation of rheumatic aetiology was admitted to our unit for elective surgery, through a mini right thoracotomy (RT).

A 26-year-old female developed bilateral blindness after a complete remission for ALK-positive ALCL. Initial workup showed neurolymphomatosis involving the bilateral optic nerves. She underwent hematopoietic cell transplantation and she remained in complete remission after 1 year; however her vision never improved. ALCL likely led to destruction of the optic pathway.

Total anomalous pulmonary venous connection is an anomaly where the pulmonary veins are directly connected to one of the systemic veins or to the right atrium. The most common classification of this condition is by Craig, Darling and Rothney, which is based on the anatomic site of abnormal connection

Rhombencephalitis refers to inflammatory diseases of the rhombencephalon. The encephalitic processes located to the rhombencephalon are frequently associated with Listeria monocytogenes and enterovirus infections. We report a case of community-acquired Klebsiella Pneumoniae systemic infection with CNS involvement in an adult patient without significant comorbidities.

A patient with Birt-Hogg-Dubé Syndrome (BHDS) developed metastatic follicular thyroid cancer, which until now has never been described in someone with BHDS. Thyroid cancer is not currently recommended for screening with BHDS. This case presents implications for future guidelines and planning for renal transplant in patients with this condition.

Through this case, we present the thought process, team-based strategy and sequel of managing a complex, critically ill pregnant with ARDS and COVID-19 pneumonia. This case also confirms the feasibility of using convalescent plasma and ECMO during early postnatal period in acutely ill parturient with respiratory failure.

A 70-year-old diabetic woman was admitted to our hospital with a complaint of high fever accompanying shaking chills for three days. The patient had no abdominal symptoms and no history of eating raw food. The patient’s body temperature was increased to 39 oC, and blood analysis showed elevations of leukocytes (17,400 /µL) and C-reactive protein (16.5 mg/dL). Computed tomography revealed air density spots in the aortic wall (Fig A ), and Salmonella enteritidis serotype O9 was detected by blood culture. Under a tentative diagnosis of Salmonella-induced infective aortic aneurysm, the patient underwent antibiotic treatment with ampicillin/sulbactam. On day 11, the air had disappeared and the aortic wall showed a varicose deformity, leading to a differential diagnosis of infective aortic aneurysm (Fig B ). The patient recovered completely with 8-week antibiotic therapy without any operation.Cases of infective aortic aneurysms account for only about 1% to 3% of total cases of aortic aneurysm. However, the case fatality has been reported to be as high as 18 percent in two years1, and an early diagnosis is essential. Salmonella species are known as a common pathogen of the crucial infection2, and so clinicians should pay attention to the development of the disease.

Patients who undergo hematopoietic stem cell transplantation may present with a variety of dermatologic complications. Clinicians must be careful to maintain a broad differential and seek a biopsy proven diagnosis as soon as possible when there is ambiguity as to cause.

The case of a 71 year-old woman with rapid atrial fibrillation who underwent electrical cardioversion and amiodarone therapy. QT interval prolongation was observed with the development of torsades de pointes that required recurrent electrical cardioversion and temporal pacemaker implantation.

The tumor of a patient with Bowen’s disease exhibited expression of the tumor suppressors p53 and p16INK4a(p16), which correlated with cytoplasmic expression of the histone deacetylase sirtuin 1(SIRT1). Epigenetic regulation of p53 and p16 by SIRT1 may play a role in the carcinogenesis of Bowen’s disease.

This chext x-ray (CXR) shows a large right sided pneumothorax with a degree mediastinal shift suggesting tensioning (The CXR you should never see!). Furthermore, features of pneumomediastinum are present including the continuous diaphragm sign, and subcutaneous emphysema around the neck and right side of the thorax