Rejected

The purpose of this study was to evaluate the incidence of primary headache and potential biomarkers in patients diagnosed with Hashimoto thyroiditis.

Radiofrequency thermocoagulation (RFT) of the trigeminal ganglion is an excellent treatment option for medically intractable trigeminal neuralgia. However, this procedure can manifest abrupt changes in cardiovascular responses. With abrupt cardiovascular changes, a sudden trigeminocardiac reflex can occur during RFT of the trigeminal ganglion.

Malignant tumours of the small bowel are uncommon in clinical practice. Adenocarcinoma is the most common of these tumours, accounting for approximately 35-45% of all tumours. It may occur sporadically, in association with familial adenomatous polyposis coli or Peutz-Jeghers syndrome or hereditary non-polyposis colorectal cancer, or in association with chronic inflammatory bowel changes (such as Crohn's disease or celiac disease).

Pituitary apoplexy is a very rare cause of sudden and severe headache with a neuro-ophthalmic deficit during pregnancy due to hemorrhage or infarction in the pituitary gland. Delayed identification can be life-threatening to both mother and baby.

The management of frozen shoulder (FS) differs depending on experience level and variation between scientific guidelines and actual practice.

A 44-year-old woman was transferred to the ED from an outside hospital because of hemoptysis and concern for left-sided pulmonary infiltrate with associated pleural effusion. The patient presented to this outside hospital multiple times over the past 3 months because of left-sided shoulder pain, diffuse myalgias, and supraventricular tachycardia. On her third visit, she was found to have a left-sided pleural effusion and underwent diagnostic and therapeutic thoracentesis; 1.5 L of fluid was removed. Fluid studies reportedly demonstrated an exudative pleural effusion with negative bacterial cultures and no evidence of neoplastic process. The patient was referred to the Rheumatology Department by the outside hospital for suspected underlying autoimmune process. In the months leading up to her current presentation, the patient had been prescribed one prednisone burst and two prednisone tapers. She was then placed on a regimen of 10 mg prednisone daily and 200 mg hydroxychloroquine bid by her primary care doctor. This was tapered by the Rheumatology Department such that the patient was on 7.5 mg of prednisone daily on arrival to this ED. Rheumatologic workup until this point revealed only low titer (1:80) positive antinuclear antibody. Prior to these ED visits, the patient had been otherwise healthy with only a history of a Roux-en-Y gastric bypass 17 years earlier. Aside from recent daily low-dose prednisone use, the patient did not have other preexisting immune compromise or risk factors for aspiration such as seizure disorder, chronic alcohol use, or cognitive impairment. Before her transfer, the patient experienced foul-smelling, maroon-colored hemoptysis as well as anemia that required a higher level of care. On arrival to the ED, she was in acute hypoxic respiratory failure. The patient was intubated emergently and was admitted to the medical critical care unit for further treatment.

Neuroendocrine tumor of the gallbladder is a rare gallbladder tumor with aggressive behavior and poor prognosis. Cholelithiasis is the most important risk factor for it. The clinical presentations of most patients are non-specific and vague abdominal pain is the most common initial symptom followed by cholecystitis, with obstructive jaundice, weight loss, ascites, pruritus or palpable mass and occasional associated endocrine manifestations. Surgery remains the main cornerstone for it. In January 2019, in the department of Hepatobiliary, Pancreatic and Liver transplant surgery in Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, a 30-year-old female presented with incidental finding of gallbladder mass. Extended cholecystectomy was performed. Histopathology examination revealed small cell neuroectodermal tumor of the gallbladder.

Use of opioids for chronic intractable pain is increasing globally, and their proper use can improve patients' quality of life. In contrast, opioid use disorders, such as abuse or addiction, caused by prescribing opioids, are a worldwide issue. This study aimed to understand current opioid prescribing patterns and pain physicians' experiences with opioid use in South Korea.

Spinal anesthesia is a safe and effective alternative to general anesthesia for patients undergoing lumbar spine surgery, and numerous reports have demonstrated its advantages. To the best of our knowledge, no group has specifically reported on the use of spinal anesthesia in thoracic-level spine surgeries because there is a hypothetical risk of injuring the conus medullaris at these levels. With the advantages of spinal anesthesia and the desire for many elderly patients to avoid general anesthesia, our group has uniquely explored the use of this modality on select patients with thoracic pathology requiring surgical intervention.

Giant cell tumors (GCTs) are locally aggressive but rarely malignant bone neoplasms that uncommonly involve the skull. In this report, we describe a tumor of the sphenoid sinus. A 51-year-old female was presented with headache, and bilateral decreased visual acuity, CT scan, and brain MRI revealed an infra-sellar enhancing tumor expanding to the sellar and supra-sellar region which proved to be a GCT. the patient had received 03 months of preoperative denosumab-based treatment and imaging follow-up showed regression in size and morphology modifications of tumor tissue. : This is one of few reports to describe the appearance of sphenoid bone GCT, and the first report to highlight the effects of short-term denosumab treatment in GCTb in such a location.