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1/6. Familial anetoderma.

    A 31-year-old Caucasian male presented with a history of erythematous, saccular outpouchings of the skin on his back, shoulders, and upper extremities (Fig. 1). The patient reported that his mother and aunt had a similar skin disorder, which initially began with inflammation, but healed leaving lax skin in its wake. He did not recall the name of the skin condition. physical examination revealed large confluent zones of sac-like protrusions of erythematous skin on the back and shoulders. Histopathologic examination of the excisional biopsy revealed a relatively unremarkable epidermis. Perivascular lymphocytes were present in small numbers in the papillary dermis. Adnexal structures and deep dermis remained intact. The acid-orcein-Giemsa stain highlighted the absence of elastic fibers within the mid and lower reticular dermis (Fig. 2a,b), consistent with anetoderma.
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keywords = inflammation
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2/6. Limited Wegener's granulomatosis presenting with complete heart block.

    Complete heart block associated with Wegener's granulomatosis (WG) is rare, and has not previously been reported with 'limited' WG. The case of a 36-year-old man who presented with complete heart block due to 'limited' WG [positive cytoplasmic antineutrophil cytoplasmic antibodies (c-ANCA) on indirect immunofluorescence, positive serum antibodies to proteinase-3, and inflammatory sinus disease seen on computerized tomography (CT) without renal or pulmonary involvement] is presented. In addition, a gallium-scan fused with a myocardial perfusion scan and cardiac magnetic resonance imaging (MRI) suggested focal inflammation near the atrioventricular (AV) node.
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keywords = inflammation
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3/6. Rectal duplication cyst presenting as perianal sepsis: report of two cases and review of the literature.

    INTRODUCTION: Recurrent perianal sepsis is a difficult problem to manage in colorectal surgical practice. One cause is rectal duplication cyst, a rare congenital lesion that is easily overlooked. Many cases have associated congenital defects, especially musculoskeletal anomalies, and may provide a clue to the underlying condition. early diagnosis is important because these cysts do not resolve spontaneously and may undergo malignant change. methods: We present two cases of middle-aged females who presented with perianal sepsis secondary to rectal duplication cyst. The first case had numerous surgical procedures for a perianal fistula during a ten-year period. She had associated sacral anomalies consistent with Currarino syndrome. The second case presented with a perineal mass after a bout of perianal inflammation. Both cases had the entire cyst surgically excised. RESULTS: There were no complications postoperatively and no recurrence at follow-up. Histopathology revealed no malignancy in the cyst. CONCLUSIONS: Rectal duplication cyst is a rare cause of recurrent perianal sepsis that should be considered in difficult cases, especially in those with associated musculoskeletal anomalies. Complete surgical excision is the preferred treatment to prevent recurrence and the risk of malignant degeneration.
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keywords = inflammation
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4/6. PET detection of solitary distant skeletal muscle metastasis of esophageal adenocarcinoma.

    A 67-year-old man with progressive dysphagia was recently diagnosed with a gastroesophageal junction adenocarcinoma. Contrast-enhanced CT scans of the abdomen and pelvis reported a large GE junction tumor without evidence of metastatic disease. FDG positron emission tomography revealed intense tracer accumulation in the soft tissue mass at the GE junction consistent with the primary neoplasm. In addition, PET scan also identified a solitary focus of intense FDG accumulation at the musculotendinous junction of the right gluteus minimus muscle. Subsequent MRI demonstrated mild enhancement and could not differentiate between tumor versus inflammation. Needle biopsy was performed and confirmed metastatic esophageal adenocarcinoma. A case of skeletal muscle metastases from late-stage (IV) gastroesophageal adenocarcinoma was previously reported. However, a solitary metastasis to a distant skeletal muscle without evidence of other lymphatic and hematogenous metastasis is quite unusual. The case supports the previous report that PET is superior in detecting distant metastases for initial staging of esophageal carcinoma over CT.
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keywords = inflammation
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5/6. actinomycosis of the gallbladder: case report and review of the literature.

    actinomycosis of the gallbladder is very rare. Herein, we report the case of a 50-year-old man who presented with acute right hypochondrial pain, fever and rigors associated with positive Murphy's sign. Ultrasound showed that the gallbladder had multiple stones and an oedematous thick wall. The preoperative diagnosis was acute cholecystitis. The patient responded to conservative treatment with antibiotics. Laparoscopic cholecystectomy was performed 6 weeks later but was converted to open surgery because of dense adhesions to the duodenum and sealed duodenal perforation. Microscopic examination of the gallbladder showed moderate to severe inflammation with formation of microabscesses and numerous colonies of actinomycetes. We also review the literature on this rare disease. Although surgery is essential, prolonged postoperative antibiotic is required.
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keywords = inflammation
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6/6. Apparent sialadenopathy of the sublingual glands after general anesthesia with placement of laryngeal mask airway.

    Sialadenopathy, inflammation of the salivary glands, is a rare anesthetic complication. This case conference describes a patient who developed sialadenopathy of the sublingual glands after placement of a laryngeal mask airway during a brief surgical procedure. The patient's history is detailed, the surgical and anesthetic procedures are described, and a discussion follows, which describes the different causes of this inflammatory process. In the comment, the physiology of the salivary gland is described in detail.
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