Rejected

Pelvic chondrosarcomas are a major clinical challenge since the only therapeutic approach available is surgical resection. Reconstruction after partial resection of the pelvis including the acetabulum or the hip joint is a laborious and rigorous surgical procedure. Numerous complications are associated with different reparative methods. Moreover, due to the anatomical complexities of the area, adequate surgical margins are difficult to achieve in many cases, which are closely related to the advent of local recurrence of the tumor. Several techniques for hip function restoration and skeletal reconstruction have been reported. The purpose of this report is to describe a novel pelvic reconstruction technique for PI-II resection that required a custom-designed implant. We present the case of a 61-year-old female patient with chronic pain in the gluteal region. The pelvis's magnetic resonance imaging (MRI) showed an osteolytic tumor in the right iliac wing that compromises the acetabular roof. The diagnosis was a grade 2 central chondrosarcoma. Surgery included the reconstruction of the acetabulum by inserting two Schanz pins coated with hydroxyapatite, one in the iliopubic corridor and the other in the ischium. A supporting "pyramid" was built, unitizing both Schanz with cement, onto which an acetabular cage was inserted. The procedure was completed with a conventional total hip prosthesis. The patient presented an acute prosthesis infection, which positively responded to prompt surgical lavage and antibiotic treatment. After 10 months of follow-up, the patient remains free of infection, with weight-bearing as tolerated, without pain, and with excellent hip motion. No tumor recurrence has occurred. Medialization of the construct has occurred as expected, with no evidence of implant loosening. The technique used in this patient is novel, could be considered cost-effective, and has allowed the reconstruction of a functional hip. For resections of the acetabular area and preservation of the ischium and pelvic zones, this technique may be an acceptable option.

This case report presents a 63-year-old male patient with chronic left foot drop. The etiology for his condition most likely involved lateral lumbar stenosis and/or sacroiliac joint dysfunction resulting in radiculopathy and subsequent symptoms. The patient was previously recommended a surgical approach for his condition. After an extensive osteopathic examination and application of a high-amplitude low-velocity technique, the patient reported a significant improvement in his pain and resolution of his foot drop. To the best of the author's knowledge, this is the first reported case of the use of osteopathic medicine in the successful treatment and management of left foot drop most likely secondary lumbar stenosis and/or sacroiliac joint dysfunction. The aim of this case report is to discuss the possible mechanisms by which the condition may have been resolved and the role that osteopathic treatment played in it.

Bronchobiliary fistula (BBF) is a rare complication encountered by surgeons, most commonly during the follow-up of surgically managed patients with inflammatory, traumatic, or neoplastic pathologies involving the hepatobiliary tree. We present an operated case of liver hydatidosis with biliary stent obstruction with complaints of bitter green colored sputum and upper abdominal pain. The patient underwent an ERCP-guided stent extraction with reinsertion of a common bile duct stent with complete removal after six weeks. Post operatively, the patient is doing well on follow-up. This complication could be prevented by regular follow-up and timely removal of the placed stents, as a prolonged stay of stent insitu could lead to blockage, leading to complications such as bronchobiliary fistula. Thus, it is concluded that judicious follow-up plays a pivotal role, and timely removal of the stents could prevent such avoidable delayed complications.

Alcoholic ketoacidosis (AKA) is a common reversible biochemical pathology arising from hyperketonaemia in patients with a history of chronic alcohol consumption. It is typically fatal when there is a delay in early recognition and management. A further complicating factor is that this condition is frequently confused with diabetic ketoacidosis (DKA).

Allogeneic stem cell transplantation can cause chronic graft versus host disease (cGVHD). A number of patients manifest cGVHD in and around the mouth. It can present itself as clinically as mucosal lesions and/or salivary gland dysfunction and/or sclerotic changes. Cheeks and tongue are most commonly affected, but the palate, gingiva and lips can also be impacted. Oral cGVHD is associated with mucosal sensitivity, pain, (severe) oral dryness, altered taste, restricted mouth opening and difficulty swallowing, all of which may contribute to a significant decrease of the patient's quality of life. Patients also run an increased risk of developing squamous cell carcinoma of the oral mucosa. The diagnosis of cGVHD is almost always based on the patient's medical history and clinical picture. Treatment of symptoms is based on the patient's problem(s). Dental professionals can provide patients with supportive preventive care aimed at reducing symptoms and preventing further deterioration of oral health.

Growing evidence shows that nerves play an active role in cancer development and progression by altering crucial molecular pathways and cell functions. Conversely, the use of neurotropic drugs, such as tricyclic antidepressants (TCAs), may modulate these molecular signals with a therapeutic purpose based on a direct antitumoral effect and beyond the TCA use to treat neuropathic pain in oncology patients. In this review, we discuss the TCAs' safety and their central effects against neuropathic pain in cancer, and the antitumoral effects of TCAs in in vitro and preclinical studies, as well as in the clinical setting. The current evidence points out that TCAs are safe and beneficial to treat neuropathic pain associated with cancer and chemotherapy, and they block different molecular pathways used by cancer cells from different locations for tumor growth and promotion. Likewise, ongoing clinical trials evaluating the antineoplastic effects of TCAs are discussed. TCAs are very biologically active compounds, and their repurposing as antitumoral drugs is a promising and straightforward approach to treat specific cancer subtypes and to further define their molecular targets, as well as an interesting starting point to design analogues with increased antitumoral activity.

Intrahepatic cholestasis of pregnancy is a disorder characterized by pruritus and elevated liver function tests and bile acids. Poor vitamin absorption and, as a result, hypovitaminosis K can occur as a result of the pathology. Given the known effects of vitamin K, the authors considered that hypovitaminosis K could increase the risk of coagulopathic hemorrhage in pregnant women. The study revealed that 59.2% of women with intrahepatic cholestasis of pregnancy were diagnosed with hypovitaminosis K; however, 98.6% of women had normal coagulogram indices. Thus, coagulogram markers are more likely to indicate vitamin K activity than its actual level.

BACKGROUND Ankylosing spondylitis (AS) is an immune-mediated chronic inflammatory condition grouped under spondyloarthritis (SpA), which is an umbrella term for a group of interrelated inflammatory rheumatic conditions with characteristic radiographic findings such as erosions and ankylosis of the sacroiliac joint. Unfortunately, there is an average delay of 8-9 years between the onset of the symptoms and diagnosis due to infrequent consideration of this disease in the differential diagnosis of patients with low back pain and unusual or incomplete presenting clinical symptoms. CASE REPORT We describe the case of a 37-year-old male patient with no significant past medical history and surgical history of bilateral hip arthroplasty secondary to idiopathic aseptic necrosis of the bilateral femoral head and bilateral rotator cuff repaired surgery due to multiple motor vehicle accidents (MVA) with a chief concern of chronic low back pain. In this case of ankylosing spondylitis presenting with low back pain and radicular symptoms, his symptoms were resistant to multiple opioid medications, trigger point injections, and epidural steroid injections. Initiation of adalimumab subsequently relieved the patient's symptoms and restored his ability to perform daily activities. CONCLUSIONS This is an unusual presentation of AS with radiographic evidence of bilateral sacroiliitis. The neurological manifestations in AS are not uncommon, and they can occur during the quiescent stage of the disease. It should be emphasized that early diagnosis is essential to prevent progression of the disease and avoid unnecessary treatment for the patient.

We describe a case of 76-year-old woman with glossopharyngeal neuralgia who developed bradycardia and syncope after decreased carbamazepine dosing due to worsening renal function. Telemetry and EKG showed bradycardia and sinus pauses associated with paroxysms of typical glossopharyngeal neuralgia pain. With the addition of gabapentin to carbamazepine, her glossopharyngeal neuralgia pain as well as bradycardia resolved. A pacemaker was placed to prevent bradycardia and syncope. Clinicians should be mindful of the association between glossopharyngeal neuralgia and bradycardia and cardiac syncope so appropriate treatment can be offered in a timely manner to prevent adverse outcomes associated with syncope and cardiac arrest.