Background: Secondary prevention of cerebrovascular disease through dedicated stroke clinics has been shown to decrease recurrent vascular events in patients. However, there is limited literature describing such stroke clinic experiences from low and middle income countries. This study describes patient characteristics and observations made at the first systematized stroke clinic in Pakistan. Methods: A retrospective audit of medical records of all patients presenting between September 2006 and August 2008 with a cerebrovascular event was conducted. Information about clinical presentation, modifiable risk factors and laboratory and radiological investigations was collected. Burden of disability was assessed using Modified Rankin score. Data was entered and analyzed using SPSS 14.0. Results: 159 patients with a mean age of 57.0 ± 13.9 years were included in this study and 34.6% of all patients were women. 108 patients were diagnosed with ischemic stroke (67.9%) while 34 patients presented with hemorrhagic stroke (21.4%) and 17 patients presented with transient ischemic attacks (10.7%). Hypertension was the most common modifiable risk factor seen in 78.0%, followed by diabetes in 40.3% and dyslipidemia in 31.5%. At presentation to clinic, only 26.0% patients with dyslipidemia and 64.5% patients with hypertension were on appropriate medications. Conclusion: A high prevalence of modifiable risk factors such as hypertension in stroke patients was observed and it presents an opportunity for conventional interventions in Pakistan. Systematized clinics for stroke and an algorithmic approach in primary care towards stroke may improve the implementation of evidence based secondary prevention strategies in developing countries.RÉSUMÉ: Facteurs de risque de l'accident vasculaire cérébral au Pakistan : l'expérience d'une clinique spécialisée. Contexte : Il est bien établi que la prévention secondaire de la maladie cérébrovasculaire dans des cliniques spécialisées en AVC diminue le taux de récidive chez ces patients. Cependant, il y a peu de publications sur ce type de cliniques établies dans des pays à moyen ou à faible revenu. Cette étude décrit les caractéristiques et les observations de patients de la première clinique spécialisée en AVC au Pakistan. Méthodes : Nous avons effectué une revue rétrospective des dossiers médicaux de tous les patients qui ont consulté à la clinique entre septembre 2006 et août 2008 pour un événement cérébrovasculaire. L'information au sujet du tableau clinique, des facteurs de risque modifiables et des examens de laboratoire et de radiologie a été colligée. Le niveau d'invalidité a été évalué au moyen du score à l'échelle de Rankin modifiée. Les données ont été analysées au moyen de SPSS 14.0. Résultats : Cent cinquante-neuf patients, dont l'âge moyen était de 57,0 ± 13,9 ans et dont 34,6% étaient des femmes, ont été inclus dans cette étude. Cent huit patients étaient porteurs d'un AVC ischémique (67,9%), 34 patients étaient porteurs d'un AVC hémorragique (21,4%) et 17 patients avaie...

Key Clinical MessagePrimary apocrine sweat gland carcinoma is a rare neoplasm. It is usually slow growing and is often suspected to be a benign disease at initial assessment. A thorough clinical and histological workup is required for diagnosis. Treatment of choice is wide local excision with clear margins.

Patient: Female, 63 Final Diagnosis: Recurrent desmoid tumor Symptoms: Abdominal discomfort • abdominal fullness Medication: — Clinical Procedure: Abdominoplasty Specialty: Plastic Surgery Objective: Rare co-existance of disease or pathology Background: Desmoid tumors are fibrous neoplasms that originate from the musculoaponeurotic structures in the body. Abdominal wall desmoid tumors are rare, but they can be locally aggressive, with high incidence of recurrence. These tumors are more common in young, fertile women. They frequently occur during or after pregnancy. Case Report: We present the case of a 63-year-old post-menopausal woman with a desmoid tumor of the anterior abdominal wall. She had no relevant family history. During abdominoplasty, an incidental mass was excised and biopsied, and was identified as a desmoid tumor with free margins. One year later, the patient presented with vague abdominal discomfort and feeling of heaviness. An incision was made through the previous abdominoplasty scar to maintain the aesthetic outcome. A large mass, arising from the abdominal wall and extending intra-abdominally, was excised and was determined to be a recurrent desmoid tumor. Conclusions: Recurrent anterior abdominal wall desmoid tumors in post-menopausal women are rare and locally aggressive, with a high risk of recurrence. During abdominal wall repair in abdominoplasty, desmoid tumor filaments might seed deep intra-abdominally. Therefore, it is necessary to take adequate safe margins before abdominal wall repair. Post-operatively, surgeons should keep a high index of suspicion for tumor recurrence.

Summary: Cherubism is a rare, autosomal dominant condition characterized by the replacement of medullary bone by fibro-osseous lesions, predominantly in the bilateral maxillae and/or mandibles. The clinical presentation of cherubism can vary widely, from clinically undetectable to severe facial disfigurement. Although there are no established management guidelines for this condition, conservative management with observation is typically favored in most cases due to the possibility of spontaneous regression following puberty. In this article, we present three cases of moderate to severe cherubism managed with early surgical intervention utilizing curettage and osteotomy followed by bony repositioning. We aimed to show the feasibility and safety of this minimally invasive surgical technique in the management of moderate to severe cases of cherubism to provide improvement in patient quality of life, aesthetics, and function while also possibly mitigating the need for later reconstructive surgery.