Search

By combining video laryngoscopy and fiberoptic bronchoscopy, awake intubation can be performed more safely., The simultaneous display of bronchoscope and laryngoscope images on a single screen allows for safer conscious tracheal intubations.

The winking earlobe sign is a sign of tricuspid regurgitation, characterized by the movement of the earlobe coincident with the pulse.

Key message This is a video showing a case of nasal myiasis under direct visualization with flexible bronchoscopy in a patient admitted with septic shock and metastatic prostate cancer. Microbiology revealed Lucilia sericata larvae., This video shows a case of nasal myiasis under fibreoptic bronchoscopic visualization in a patient admitted with septic shock and metastatic prostate cancer.

Congenital dacryocystocele is a rare clinical condition, more commonly unilateral, secondary to the defective canalization of the nasolacrimal duct. In case of failure of conservative treatment, surgical marsupialization is recommended. We describe the case of a 40‐day‐old male newborn treated by means of microdebrider marsupialization., Congenital dacryocystocele is a rare, usually unilateral, clinical condition, secondary to an incomplete canalization of the nasolacrimal duct, which can be treated by means of surgical marsupialization with microdebrider.

Many exaggerated skin reactions after insect bites have been described and due to global warming the incidence of these cases will increase. This clinical video promotes its recognition by showing an unusual cutaneous phenomenon after an insect bite., Many exaggerated skin reactions after insect bites have been described, and due to global warming, the incidence of these cases will increase. This clinical video promotes its recognition by showing an unusual cutaneous phenomenon after an insect bite.

A 75‐year‐old male presented with an immediately threatened grade IIb acute ischemia of the left leg due to thrombosis of a femoro‐infrapopliteal prosthetic bypass graft. After an urgent Computed Tomography Angiography, an urgent graft thrombectomy was performed using a 5 Fr Fogarty catheter, which had a troublesome distal passage, causing a tibial A‐V fistula., A hand‐held doppler device reaveals a continuous machinery bruit due to a tibial A‐V fistula

Broad ligament pregnancy is a very rare life‐threatening form of ectopic pregnancy, in which implantation occurs within the peritoneal cavity. The advantages of a laparoscopic approach over a laparotomy in this setting include a reduced estimated blood loss, a shorter operating time, reduced analgesic requirements, shorter hospital stay, and convalescence., An early broad ligament pregnancy can be safely removed by laparoscopy. Ectopic localization of pregnancy typically has a detrimental effect on future fertility; a minimally invasive approach is advocated whenever feasible.

Because the density of air is lower than the effusion, air bubbles can be passively moved by a head position change, causing a bubbling sound in the affected ear.

Foreign bodies are an unusual indication for endoscopic sinus surgery. If outpatient extraction is not possible and acute sinusitis ensues, thorough exploration and extended surgical dissection should be considered to clear the nasal cavities.

Ataxia as the main complaint in a young patient prompts to diagnose neurodegenerative diseases. Not all ataxias are irreversible. We present a video of a patient in the clinic with ataxia diagnosed as subacute combined degeneration of the cord.

The key clinical message is to know that mechanical complications of myocardial infarction are rare but fatal. A high index of suspicion facilitates diagnosis. The presence of acute heart failure should ring an alarm. Other red flags are cardiogenic shock, new murmur, or evidence of hypoperfusion.

Key message We present a patient with a history of cavitary mycobacterial lung infection and chronic obstructive pulmonary disease (COPD) who developed two connected fistulas post thoracentesis, an alveolo‐pleural and a pleuro‐cutaneous fistula, leading to continuous air leak from a stoma on his back., We present a patient with a history of cavitary mycobacterial lung infection and chronic obstructive pulmonary disease (COPD) who developed two connected fistulas post thoracentesis, an alveolo‐pleural and a pleuro‐cutaneous fistula, leading to continuous air leak from a stoma on his back.

Diagnosis of myocardial abscess without endocarditis is challenging, and a high index of clinical suspicion is fundamental for diagnosis. It should never be ruled out before TEE. And CT could be a helpful modality in case of emphysematous morphology.

Needle knife papillotomy (NKP) is still considered a rescue technique after conventional access failure due to traditional high complication rates, albeit data are maturing for early use of NKP in standard endoscopic retrograde cholangiopancreatography indications. By contrast, in certain settings NKP should be prioritized to a first‐class indication, such as in choledochocele management and/or, more often encountered in clinical practice, true papillary stone impaction with or without gallstone pancreatitis. The latter results in prompt stone release; thus, the procedure might become alternatively designated as “needle knife excision.”

Key message It is unusual to be able to visualize an entire cavity with such clarity., It is unusual to be able to visualize an entire cavity with such clarity.

In specific situations such as patient with severely dilated left ventricle (LV) and spontaneous echo contrast (SEC) who suffered an ischemic stroke previously may be an acceptable indication for oral anticoagulation to prevent further TE events.

Retrieval of central venous catheters fragments often puts us in front of different situations. Having more techniques available for strategic planning of the procedure is important. The authors propose the simultaneous use of two different approaches for the recovery of a CVC fragment from the pulmonary artery., Fragmented PICC migrated into lower branch of right pulmonary artery (arrow) and medially positioned loop (star).

Laparoscopic surgery can be performed safely for the removal of a foreign body embedded in the pancreas and should be preferred instead of open surgery, whenever possible.

Subtle signs of an abnormal communication from the esophagus to the respiratory tract space via the fistula may be missed and can result in delayed diagnosis. Our case shows an atypical presentation of a fistula during barium swallowing test.

Facial myokymia is a clinical sign that can occur as a manifestation of demyelinating lesions. As seen in our patient with multiple sclerosis, acute‐onset continuous facial myokymia can be indicative of an active lesion and can have localizing value., Facial myokymia is a clinical sign that can occur as a manifestation of demyelinating lesions. As seen in our patient with multiple sclerosis, acute‐onset continuous facial myokymia can be indicative of an active lesion and of localizing value.

Functional fat injection under local anesthesia could be useful in the treatment of chronic dysphagia in selected patients with tissue loss secondary to laryngeal surgery.

Palatal myoclonus can be primary or secondary. In primary palatal myoclonus, no obvious structural brain lesions can be found within the triangle of Guillain and Mollaret. Common causes of secondary myoclonus include stroke, demyelination, infections, trauma, and neurodegeneration.

Stair‐specific FTSD in the lower limb is very rare. Most patients show dystonic posture when walking downstairs rather than upstairs.

The pathophysiological mechanism of resting tremor in Parkinson's disease remains obscure. Spinal/peripheral mechanisms may modulate oscillatory activity from central origin, thereby changing amplitude and frequency of tremor in Parkinson's disease.

International audience; Hydrophobia is a clinical sign characteristic of human rabies. This sign occurs following paroxysmal contractions of pharynx responsible for hydrophobic spasms.

Key Clinical Message Movement disorders are uncommon manifestations of neurocysticercosis. When present, most are secondary to parenchymal lesions in the basal ganglia. Rarely, movement disorders can occur in racemose/extraparenchymal neurocysticercosis, an aggressive variant frequently associated with cerebrospinal fluid outflow obstruction and hydrocephalus. Appropriate treatment can reverse neurological manifestations.

Key Clinical Message Noncompaction cardiomyopathy (NCCM) is a rare but important cause of heart failure. The reported prevalence of left ventricle NCCM based on echocardiographic criteria varies between 0.014% and 1.3%, while the biventricular involvement is extremely rare with only few cases reported.

The key clinical message of this case is that it is critical to differentiate between arachnoid cysts and spinal cord herniation. This is performed by evaluating the ventral dura to assure that it remains intact.

Tube removal by endoscopic submucosal dissection using needle and insulation‐tipped diathermic knives against buried bumper syndrome is a reliable, noninvasive and safe procedure.

We present a patient with end‐stage hypertrophic cardiomyopathy who was suffering from ocular and generalized forms of myasthenia gravis as an uncommon neurological complication of sotalol. This case report warns clinicians to maintain caution over rare side effects of medication, which could be confused with the clinical symptoms of the underlying disease.

A 70‐year‐old woman developed acute cerebral infarction. Transthoracic echocardiography showed a large mobile mass in the left atrium, suggesting cardiac myxoma as the most likely diagnosis. Surgical exploration revealed a papillary fibroelastoma originating from the coumadin ridge, which is fairly rare but important as a source of cerebral embolization.

Key Clinical Message This case illustrates surgical technique for wide neck aneurysm clipping in a rotated complex and how to manage intraoperative aneurysm rupture while maintaining hemostasis (Cai et al., Anterior communicating artery aneurysm morphology and the risk of rupture. World Neurosurg. 2018;109:119 and Dehdashti et al., The implication of anterior communicating complex rotation and 3‐dimensional computerized tomography angiography findings in surgical approach to anterior communicating artery aneurysms. World Neurosurg. 2016;91:34).

Key Clinical Message The proper performing of the fine‐needle aspiration cytology of head and neck neoplasms leads to an accurate preoperative diagnosis by an inexpensive and relatively simple technique.

Key Clinical Message Patients with nontoxic lithium levels can still develop hand tremors, downbeat nystagmus, and an unsteady gait.

Key Clinical Message Primary cardiac tumors are exceedingly rare. They are usually first identified by transthoracic echocardiography. However, transesophageal echocardiography (TEE), with the aid of real‐time three‐dimensional (3D) imaging, can provide additional important mass characteristics. We present a case that demonstrates the usefulness of 3D TEE in characterizing a papillary fibroelastoma.

Key Clinical Message This teaching case of tongue myokymia offers clear electromyographic findings of myokymic discharges on two different sweeps. Radiation-induced tongue myokymia should be considered in the differential diagnosis for motor neuron disease (MND).

Key Clinical Message The diode laser promotes regression of the small venous lake of the lip by forced dehydration with induced photocoagulation of the lesions, with an uneventful postoperative course and anesthetic sequelae.

Key Clinical Message Diabetic chorea accompanies hyperglycemic states or drastic changes in blood glucose levels and involves the acute onset of unilateral or bilateral choreatic movements. Diabetes is sometimes discovered due to diabetic chorea, and thus, diabetic chorea is considered an important neurological complication.

Key Clinical Message Unilateral hypoglossal nerve stimulation may be associated with myoclonus of the mylohyoid muscle.

Key Clinical Message Windsock diverticulum is a rare anomalous finding of a true intraluminal duodenal diverticulum. While complications of bowel obstruction, bleeding, and pancreatitis may occur, most patients are asymptomatic. Surgical or endoscopic management may be pursued when complications develop.

Key Clinical Message We present the first reported video of milk fistula. Milk fistula is a rare complication secondary to abscess or breast intervention in lactating women. It is a clinical diagnosis and the treatment is usually conservative, which included cessation of breastfeeding, with a good prognosis.

Key Clinical Message Ultrasound‐guided saphenous nerve block above the knee may be a valuable diagnosis tool in patient presenting chronic pain of the calf.

Careful anamnesis can act as gasometry in services with few resources. In this clinical case, a detailed clinical history made it possible to suspect the presence of acute hypocalcemia, a biochemical anomaly after confirmed in gasometry. Acute hypocalcemia can be life threatening, necessitating urgent treatment. Sometimes it can be managed with oral ambulatory treatment.

Key Clinical Message Optical view trocars provide an acceptable level of safety for port entry during minimally invasive surgery. Nevertheless, this technique is not exempt from potential complications. These can range from a minor subcutaneous insufflation that will not require any further treatment to abdominal aorta injuries.

Key Clinical Message In our patient with Steele–Richardson–Olszewski syndrome presenting with apraxia of eyelid opening, there is a possibility to be readily confused with conditions presenting in similar pattern such as blepharospasm and eyelid ptosis. Therefore, it is essential to correlate the clinical findings with electromyographic recordings and dopamine transporter scan (DaT).

Key Clinical Message Urgent anticoagulation, despite the presence of acute cerebral hematoma, improves survival as well as the prognosis. Surgical decompression is a life‐saving procedure and is required in a selected group of patients with considerable mass effect and elevated intracranial pressure (ICP). Endovascular thrombectomy is a novel approach to reduce the clot burden, achieve venous patency, and reduce ICP.

Key Clinical Message Fluoroscopy permits rapid and straightforward assessment of mechanical valve function and allows a distinction between normal and malfunctional prostheses, acting as a complementary diagnostic step.

Key Clinical Message Tumbling motility is one of the useful characteristics of Listeria monocytogenes. This can be helpful to identify the causative pathogen along with Gram staining before the confirmatory microbiological examination.

Key Clinical Message Examination of apical impulse is an important component of nonauscultatory cardiac examination. Seesaw‐like movements of the chest wall during the systolic phase suggest severe tricuspid regurgitation.