^3rd Global Experts Meeting on Medical Case Reports May 09-10, 2016 New Orleans, Louisiana, USA

Nohuz E has completed his PhD from Auvergne University, France and Postdoctoral studies from Clermont-Ferrand University School of Medicine, France. He is an expert Surgeon who has a pronounced affinity for Endoscopic Surgery (Laparoscopy and Hysteroscopy). He is the chief of Department of Obstetrics, Gynecology and Surgery at Thiers’s Hospital, France. He has published more than 30 papers in reputed journals and serves as a Reviewer in medical journals of repute.

The female genital tract is rarely the primary site for hematologic malignancies which predominantly affect lymph nodes and bone marrow. We report a case of a 59 years old patient complaining of vaginal bleeding and puruloid discharge. Speculum examination showed a vaginal fungating necrotic ulcerated mass. Histopathological diagnosis, obtained after a second biopsy, identified a very rare type of primary, vaginal, diffuse, large B-cell non-Hodgkin lymphoma (NHL). The patient underwent 8 courses of R-CHOP immuno-chemotherapy (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone). Complete remission was achieved without any relapse during a 24 month follow-up. Primary vaginal NHL is a rare occurrence accounting for less than 1% of genital neoplasms. This entity is uncommon and clinically difficult to differentiate from inflammatory diseases or vaginal cancer. The circumstances of discovery are variable and can be related to the consequences of local tissues involvement by the tumor. The usual symptoms of lymphoma like fever, peripheral lymphadenopathy, weight loss or night sweats are frequently absent. Abnormal vaginal bleeding and discharge have appeared to be the most frequent symptoms in many cases. Other symptoms include perineal discomfort or pain, pruritus, pain during sexual intercourse, dysuria, acute urinary retention and tenesmus. Consequently, vaginal lymphoma should always be considered in the differential diagnosis of patients suffering from symptoms such as these in order to avoid radical surgery. This case focuses on the need of accurate and early histo-pathological diagnosis which has therapeutic and prognostic implications. However, this requires a workable sample insofar as biopsies may give false negative results.

Fatemeh Ghani Dehkordi is currently associated with Department of Nursing at Bushehr University of Medical Sciences, Iran.

Therapy or coronary artery occlusion are generally three ways, the most important treatment is still medication. But sometimes when heart vessel cramps are severe or new, cardiologists, interventional treatment ahead are two ways: The first is the older, open-heart surgery (Coronary artery bypass graft: CABG) is that in these cases the artery open heart surgery (bypass) are used. The terms single bypass, double bypass, triple bypass, quadruple bypass and quintuple bypass refer to the number of coronary arteries bypassed in the procedure. In other words, a double bypass means two coronary arteries are bypassed (e.g., the left anterior descending (LAD) coronary artery and right coronary artery (RCA)); a triple bypass means three vessels are bypassed (e.g. LAD, RCA, left circumflex artery (LCX)); a quadruple bypass means four vessels are bypassed (e.g. LAD, RCA, LCX, first diagonal artery of the LAD) while quintuple means five. Bypass of more than four coronary arteries is uncommon. A greater number of bypasses does not imply a person is "more sick", nor does a lesser number imply a person is "healthier". The elderly who suffer from severe aortic atherosclerosis and the surgeon feels that aortic cross-clamping either full or partial basis for the arrest of the heart and aorta anastomosis is impossible and there are the possibilities of severe damage of the aorta, aortic dissection and small debris may be dislodged from aorta that cause peripheral and brain embolization. So, in the situation one of the substitution ways for surgeon is to use Conduits as Lima instead of the ascending aorta for anastomosing. In this case, saphenous vein graft and the other Conduits with caution anastomosis to Lima artery. After a while Lima which is powerful because of the diameter and cells per time and ultimately adequate blood supply is the best place for anastomosing all of the Conduits. This is very successful in elderly and reduces the complications such as embolism and CVA.

Matthieu Marchetti is a Physician at Emergency Department, University Hospital Center of Poitiers, France. His research interests include cardiology, heart diseases and echocardiography in emergency medicine.

Introduction: Takotsubo cardiomyopathy (TTC) is an entity firstly described in 1991, characterized by acute but reversible left ventricular systolic dysfunction in the absence of atherosclerotic coronary artery disease. Acute physical or psychological stresses seem to be the most common causes of takotsubo. We reported a case of atypical TTC, during a dental procedure, including 2% xylocaine injection into gum. Case Report: A 51 year old Caucasian female underwent dental procedure. The dentist injected a solution of 2% xylocaine into the gum and three minutes following the procedure, the patient complained for chest pain, during one hour. Electrocardiogram revealed T waves inversions into inferolateral leads. Troponin level performed at admission was 23 ng per mL (N≤0.05). Clinical examination, echocardiography and coronary angiography were normal. Cardiac magnetic resonance imaging (MRI) found a global left ventricular hypokinesis with ejection fraction of 40%, without late Gadolinium enhancement. The patient was discharged from hospital six days later, with beta blocker treatment. Left ventricular ejection fraction has been checked normal (65%) after five weeks of treatment. Conclusion: This case reports an atypical presentation of TTC, induced by xylocaine injection, during the dental procedure. This is an unexpected cardiac side effect of the xylocaine drug mechanism. Takotsubo was first described in 1991; since this is a new clinical entity, knowledge are likely to evolve in the coming years. In particular, its physiology must be better defined. Our case shows that some drugs, like local anesthetics, may be responsible of takotsubo with atypical presentation.