The current understanding is that small intracranial aneurysms (<7 mm) are not at a significant risk for rupture. However, there have been several published series of rupture and subarachnoid hemorrhage from aneurysms <5 mm. Three cases of intracranial aneurysms rupturing at <3 mm are presented in this paper. Patient age ranged between 38 and 57 years. The aneurysms were located in different parts of the circulation in the brain. This case series highlights that the size criterion alone is not adequate when evaluating patients with unruptured brain aneurysms for observational follow-up or treatment.
Nutcracker syndrome (NCS) is caused by compression of left renal vein (LRV), usually between the aorta and the superior mesenteric artery (SMA). This can lead to obstruction of flow into the inferior vena cava and secondary left renal venous hypertension. Despite potential serious consequences, diagnosing NCS is often challenging, circuitous and commonly delayed. We report an extremely unique case of NCS. A 34-year-old woman presented with left flank pain and discomfort. On investigation, it was found that high pressure in the LRV, due to compression by the SMA, had led to a large venous aneurysm that had caused pelviureteric junction obstruction and hydronephrosis. Management was with stenting of the LRV and coil embolisation of the venous aneurysm with excellent clinical outcome.
Simultaneousinvolvement of the supraclavicular and axillary lymphatic basins is known to occur in metastatic skin cancers. We present the case of a 35-year-old male with metastatic melanoma present in the right neck and axillary lymph nodes. He underwent a combined, in-continuity dissection of both basins using intraoperative ultrasound to ensure full clearance of lymph nodes from the cervicoaxillary canal, which otherwise would have been impossible to achieve without clavicle osteotomy. This allowed us to avoid a division of the clavicle and related morbidity. Postoperative imaging confirmed no residual disease, and no local recurrence subsequently. We conclude that intraoperative use of ultrasound can help guide surgeons trying to achieve clearance of metastatic disease in anatomically complex regions, avoiding unnecessary morbidity. Melanoma Res 33: 149-151
Introduction: To explore the causes and management of renal infarction from pathologies such as renal artery fibromuscular dysplasia and spontaneous dissection. It is a rare occurrence and often misdiagnosed in clinical practice. Methods: We present four patients, between 30-50 years of age, who have no underlying cardiac conditions, hypertension or diabetes mellitus. They presented with abdominal/loin/flank pain due to spontaneous renal artery dissection and were treated with endovascular stents. Two patients had renal artery fibromuscular dysplasia, confirmed by CT angiogram. Results: All four patients recovered fully from the operation, with no post-operative complications noted. These patients were post-operatively managed medically with anti- platelet therapy for two years and have not experience any post-procedural complications at their 24-month follow up
Spontaneous renal artery dissection and acute renal infarcts are rare occurrences and often misdiagnosed in clinical practice. We present four male patients, between 30-50 years of age, who have no underlying cardiac conditions, hypertension, or diabetes mellitus. They presented with abdominal/loin/flank pain due to spontaneous renal artery dissection and were all treated with endovascular stenting. Two patients had renal artery fibromuscular dysplasia, confirmed by CT angiogram, a rare pathology which is reported in literature to mostly affect women. All four patients recovered fully from the operation, with no post-operative complications noted. These patients were post-operatively managed medically with anti-platelet therapy for two years and did not experience any post-procedural complications at their 24-month follow up. Classically visceral artery dissection can be managed by anti-platelet therapy alone, however fibromuscular dysplasia can cause spontaneous dissection with renal infarcts and this requires urgent treatment with endovascular stents. Further research is needed on the post-procedural medical management guidelines.
The current literature regarding the morphology and presentations of strokes due to basilar artery stenosis/occlusion is limited. This pathology is a rare cause of stroke and its management is not clearly decided in guidelines or published literature. Moreover, posterior circulation strokes are reported to be more devastating than anterior circulation. We present a case of a 68-year-old male who presented in an acute setting with reduced consciousness, myoclonic jerks, weakness and nausea due to a stroke from an occluded mid-segment basilar artery. MRI showed evidence of left cerebellar and right occipital infarcts. Emergent cerebral angiography was performed, and he was immediately treated by thrombectomy and stenting (Stryker Wingspan stent). The patient made a full recovery within one week and remained well at follow-up 3 months post-procedure. Emergency recanalization of basilar artery strokes, by clot retrieval and stenting, should be considered as a treatment option.
Introduction: Up to half of the population may have benign thyroid nodules, and currently surgery is still the mainstay for treatment. However, minimally invasive approaches such as radiofrequency ablation (RFA) have been emerging in clinical practice in recent years. The purpose of this study is to investigate the safety and efficacy of RFA in treating benign thyroid nodules in our local population in Singapore. Methods: This retrospective study included a cohort of 22 patients (17 female, 5 male), who underwent RFA for benign thyroid nodules at our institute in Singapore, between March 2016 and May 2018. Initial assessment was carried out by ultrasound scanning, to measure pre-RFA nodule diameters, and fineneedle aspiration cytology, to confirm the nodules are histologically benign. Final nodule diameters and post-procedural complications were recorded at 12-months follow-up for all patients. The primary outcome was to investigate a reduction in nodule size, post RFA. The secondary outcome was to investigate any complications/adverse effects up to 12 months post-RFA.
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