IntroductionDiphenhydramine, a first‑generation H₁‑antihistamine widely used for allergic symptom relief and as premedication for biologic and immunoglobulin infusions, is an exceedingly rare cause of true systemic hypersensitivity. Most published reports about reactions to diphenhydramine describe contact or photoallergic dermatitis: Heine first highlighted diphenhydramine as a “forgotten allergen,” reporting contact dermatitis in sensitized individuals [1], and Teixeira et al. documented a severe connubial allergic contact dermatitis from topical diphenhydramine use [2]. Paradoxically, antihistamines have also been implicated in immediate‑type reactions. Type I (immediate) hypersensitivity reactions are mediated by allergen‑specific IgE bound to mast cells and basophils that, upon re‑exposure, cross‑link and trigger rapid degranulation with histamine release, leading to symptoms such as urticaria, angioedema, bronchospasm, or anaphylaxis [4] Rutkowski and colleagues reviewed cases of antihistamine hypersensitivity, coining the term “paradox of antihistamine hypersensitivity,” and described presentations ranging from urticaria to anaphylaxis [3]. Further illustrating this phenomenon, cetirizine—another H₁‑antagonist—has been reported to induce fatal anaphylaxis in rare instances [51122]. Given the scarcity of systemic reactions to diphenhydramine and the potential for anxiety‑mediated nocebo responses, objective confirmation of immediate hypersensitivity is imperative. Here, we present double‑blind, placebo‑controlled challenge to confirm type 1 hypersensitivity to diphenhydramine.

IntroductionSialolithiasis, a prevalent cause of salivary gland obstruction, poses significant clinical challenges due to its potential to disrupt salivary flow, leading to painful symptoms and recurrent infections that impair patients’ quality of life. This condition arises from the formation of calcified deposits within the salivary glands or their ducts, with stone sizes ranging from 2 mm to over 1.7 cm(1-4).These calculi can obstruct the ductal lumen, resulting in sialadenitis, characterized by glandular swelling, pain, purulent discharge, and systemic symptoms such as fever and malaise(2, 3). Compositional analyses of sialoliths indicate a combination of organic and inorganic materials, contributing to their variable size and clinical impact(5).While conservative treatments, such as hydration, salivary stimulation, and antibiotics, are often employed, they may be insufficient for larger or multiple stones(6). Traditional surgical approaches, such as open sialadenectomy, carry risks including facial nerve damage, scarring, and loss of salivary gland function(7). Sialendoscopy has revolutionized the management of sialolithiasis by offering a minimally invasive method for direct visualization and stone extraction, achieving success rates of 80–90% while preserving gland function(8, 9)\RL.A study involving over 1,000 patients demonstrated that sialendoscopy successfully removed stones in 85% of parotid cases with minimal complications(10)\RL.However, the literature also highlights challenges in managing complex cases, such as those involving multiple or large stones, which may require advanced techniques or combined approaches \RL \RL(11).For instance, Koch et al. (2021) emphasized that multiple stones within a single duct, particularly Stensen’s duct, are rare and technically challenging due to the duct’s narrow anatomy and proximity to critical structures(7)\RL.This case report describes the sialendoscopic removal of 32 salivary stones from a single Stensen’s duct, an exceptionally rare presentation of parotid sialolithiasis. The unprecedented number of calculi and the successful application of sialendoscopy in this complex scenario underscore the technique’s potential in challenging cases. By contributing to the sparse literature on extensive multi-stone sialolithiasis, this report aims to provide valuable insights into the technical considerations and outcomes of sialendoscopy, reinforcing its pivotal role in modern salivary gland surgery.

1. IntroductionAfter extracting the posterior teeth in the upper jaw, there may be insufficient bone height available for implant installation. Ongoing maxillary sinus pneumatization and crestal bone loss are factors that can have a significant impact on the RBH. According to several studies, the reduction of RBH around dental implants may be attributed more significantly to crestal resorption than to sinus pneumatization.1 In situations where it is necessary to enhance bone height, one of the viable approaches is to elevate the sinus floor through the lateral or crestal method. In general, the RBH value is the decisive factor in selecting between the lateral and crestal techniques. When the RBH is less than 5 mm, it is recommended to employ a lateral approach utilizing grafting material.2The technique of the crestal approach, which was originally introduced by Tatum in 1986, underwent a significant modification by Summers in 1994.3, 4 This technique involves the utilization of an osteotome, which may induce complications for the patient as a result of enduring multiple blows.5, 6 Subsequently, this approach has been gradually replaced by other methods that offer a safer alternative. In 2020, a modified technique known as VEST (Vertically Expander Screw Technique) was proposed to gradually separate the sinus membrane from the sinus floor bone. This innovative technique employs screws from bone expander kits to elevate the membrane upwards.7 It should be noted that the crestal method, despite its efficacy, still presents certain concerns, particularly the potential sinus membrane perforation due to its inherent blind nature.8According to research conducted using endoscopic techniques to evaluate the risk of sinus membrane perforation, it has been demonstrated that sinus floor elevation with a crestal approach between 3 and 5 mm is associated with the lowest risk of perforation.9, 10Based on the findings of a recent systematic review, it has been suggested that dental implants with a shorter length (less than 8 mm) may present a viable alternative to the standard implants of 10 mm or more in cases of residual bone height deficiency in the posterior maxilla.11 In situations where RBH falls within the range of 4-6 mm, it is advisable to use an implant that is around 6-8 mm long, with a suitable diameter to ensure the safe elevation of the sinus floor from the crestal bone.When performing sinus floor elevation via the crestal approach, it is essential to consider the risk of membrane perforation due to direct contact with the schneiderian membrane. In this regard, three factors may increase the possibility of membrane perforation. The first is the direct contact of the sinus floor elevation instrument with the membrane, which may occur if the force applied is not carefully controlled. For instance, the use of an osteotome may increase the likelihood of such an outcome. Second, direct contact of the bone graft material with the sinus membrane and the associated risk of perforation, which stems from the irregularity of graft particles. Third, direct contact between the implant apex and the sinus membrane during implant insertion. Therefore, the implant’s geometry plays a pivotal role in the prevention of sinus membrane perforation.In the context of the sinus floor elevation procedure, the utilization of flexible graft materials such as PRF prior to device or implant insertion may potentially mitigate the incidence of membrane perforation.This article presents a modified technique of VES, using the bone Tap drill available in the Straumann surgical kit, combined with PRF to safeguard the sinus membrane while simultaneously placing 8 mm implants.

Mpox with digestive manifestations in a 16-year-old adolescent girl; A case report

1.INTRODUCTIONLymphangiomas are characterized as abnormal formations of the lymphatic system[1]. Lymphangiomas are categorized as either congenital or acquired. Lymphangiomas can occur anywhere in the body. The majority (95%) are found in the neck and axilla, and the remaining 5% occur in locations such as the mediastinum, bone, retroperitoneum, kidney, and liver[2]. There are few cases of scrotal lymphangioma that have been reported[3-5]. Due to its rarity, diagnosis and treatment can be challenging. Herein, we reported a rare case of cystic lymphangioma in the scrotum to contribute to the knowledge of proper management of this condition.

A document by Asteway Haile. Click on the document to view its contents.

DEVASTATING CERVICAL SPINE CHALK-STICK FRACTURE AND DEATH FOLLOWING TRIVIAL TRAUMA IN ANKYLOSING SPONDYLITIS: A RARE CASE REPORT

Percutaneous coronary intervention of an atherosclerotic right coronary artery with anomalous origin from the left sinus of Valsalva: a case report and literature reviewMulualem Alemayehu1, Kefelegn Dejene2, Gashaw Solela3*

A document by Denis Mucunguzi. Click on the document to view its contents.

A document by Saba Ebrahimian . Click on the document to view its contents.

Surgical treatment of lung adenocarcinoma tumor thrombus extending into the left atrium: A case reportZhongjian Chong1+, Yu Tang1+, Aiping Zhang1*, Zijian Ma1*1 Department of Thoracic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China+Zhongjian Chong and Yu Tang contributed equally to this work.*Correspondence: Zijian MaDepartment of Thoracic and Cardiovascular Surgery,Nanjing First Hospital, Nanjing Medical University, 68 Changle Road,Nanjing 210029, China(13092361011@163.com)Aiping ZhangDepartment of Thoracic and Cardiovascular Surgery,Nanjing First Hospital, Nanjing Medical University, 68 Changle Road,Nanjing 210029, China(apzhdoc68@163.com)Key Clinical Message：When lung adenocarcinoma with a tumor thrombus extending into the left atrium through the pulmonary vein, it is already at stage IIIA. Patients with such conditions often face a poor prognosis.This article reports a case of surgical treatment for lung adenocarcinoma with tumor thrombus extending to the left atrium.Key words: lung adenocarcinoma, left atrial tumor thrombus, local advanced stage, driver gene

Abstract:Hydatid disease is a parasitic infection that primarily affects the liver and lungs, but spinal involvement is very rare. We report a case of recurrent primary vertebral and paravertebral hydatid cysts and discuss the diagnostic and therapeutic challenges associated with this condition. A 48-year-old woman with a history of lumbar spinal hydatidosis resection eight years earlier presented with mid-back pain and intermittent fever. Magnetic resonance imaging (MRI) showed two masses, measuring 21 mm and 22 mm, located at the anterolateral border of the T3 vertebral body and in the adjacent soft tissues. The patient underwent spinal revision surgery, and histopathological evaluation confirmed the diagnosis of hydatid cysts. Since spinal hydatidosis is associated with high morbidity and is often misdiagnosed, it should be considered in the differential diagnosis of spinal cystic lesions, particularly in regions endemic for echinococcosis.Keywords: Spinal hydatidosis, Hydatid cyst, Echinococcus, Spine, Case report

A document by Minoosh Shabani Barzegar. Click on the document to view its contents.

A Historic Giant Mass: Forequarter Amputation for Advanced Humeral Osteosarcoma in an Adult.

Title:Atypical Retinitis Pigmentosa with Systemic Features in Bardet–Biedl SyndromeAuthor1-Muhammad Umar Ahsan, MBBS E-mail:umarahsan219@gmail.com Affiliation: D.G.Khan medical college, Dera Ghazi Khan, Pakistan ORCID: 0009-0008-0627-2521 2- Dr Saba Shaheen E-mail: ksaba4212@gmail.com Affiliation: Allama Iqbal teaching hospital, Dera Ghazi Khan, Pakistan 3- Somaiya Ahmed, MBBS E-mail: somaiyaahmed1996@gmail.com Affiliation: Sir Salimullah Medical College, Dhaka, BangladeshCorresponding author:Somaiya Ahmed E-mail: somaiyaahmed1996@gmail.com Affiliation: Sir Salimullah Medical College, Dhaka, BangladeshKeywords:Bardet–Biedl Syndrome; Retinitis Pigmentosa; Rod–Cone Dystrophy; Electroretinography; Polydactyly; MaculopathyKey Clinical message: Recognition of systemic features such as polydactyly and puffed hands in a patient with retinitis pigmentosa is crucial for early diagnosis of Bardet–Biedl syndrome, guiding genetic counseling and supportive care.Question: What syndromic association should be considered when a patient presents with retinitis pigmentosa and a history of polydactyly?Answer: Bardet–Biedl syndrome (BBS), a rare ciliopathy characterized by retinal dystrophy, polydactyly, obesity, renal anomalies, and developmental features. Early recognition enables genetic counseling and supportive care.

Case ReportRare Presentation of A Viable Secondary Abdominal Ectopic Pregnancy in the Rudimentary Horn of a Bicornuate Uterus: A Case ReportProf. Dr. Shazia Fakhar (Professor of Obstetrics and Gynaecology a)Dr. Irram Asghar (Senior Medical Officer Obstetricsa)Dr. Atif Rana (Consultant Interventional Radiologista)Rida Inam(Medical studentb)

An Infant with Phakomatosis Pigmentovascularis Complicated by Multisystem Damage: Elaborate Care Leads to a Positive Outcome

Pneumatosis cystoides intestinalis complicated by gastric signet ring cell carcinoma misdiagnosed as gastrointestinal perforation: a case reportYongshuai Lin1, Weimin Wu1, Xin Zhao1, Jun Wang1*1Department of General Surgery, The 928th Hospital of the Joint Logistics Support Force, CPLA, Haikou, 570100, Hainan, China.*Corresponding author. E-mail: wj17547@163.com.