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Annals of Case Reports & Reviews

Journal Papers (23) Details Call for Paper Manuscript submission Publication Ethics Contact Authors' Guide Line
1 A Challenging Case of Chemoresistance in Locally Advanced Breast Cancer     ,     Abdullah Mohammed Alshamrani, Suhaib khalid Alothmani, Mohammed Mousa Dahman, Abdulaziz Abdullah Howil, Abdulrahman Jaman Alzahrani*   General Surgery Department, Security Forces Hospital Program   *Corresponding author: Abdulrahman Jaman Alzahrani, General Surgery Department, Security Forces Hospital Program, P.O. Box 3643, Riyadh 11481 Saudi Arabia. Email: a-alrahman@hotmail.com   Citation: Alshamrani AM, Alothmani SK, Dahman MM, Howil AA, Alzahrani AJ (2020) A Challenging Case of Chemoresistance in Locally Advanced Breast Cancer. Annal Cas Rep Rev: ACRR-102.   Received Date: 06 March, 2020; Accepted Date: 11 March, 2020; Published Date: 17 March, 2020.  
Neoadjuvant chemotherapy is the standard of care in inoperable locally advanced breast cancer (LABC), as it helps in reducing tumor burden and facilitating surgical resection. We describe a 56-year-old post-menopausal woman who presented with a huge, right breast mass extending from the clavicle to the mid abdomen. A chest-abdomen-pelvis computed tomography showed the mass invading the pectoralis muscles and right axillary lymph node with no evidence of distant metastasis. A needle core biopsy revealed an infiltrating ductal carcinoma (Scarff-Bloom- Richardson grade 3). A multidisciplinary collaboration was undertaken, and the patient was started on docetaxel; however, after three cycles of docetaxel, she showed no improvement and was readmitted for palliative mastectomy with skin grafting. A post-operative histopathology examination of the excised tumor revealed an invasive micropapillary carcinoma. A multidisciplinary approach is the cornerstone for the treatment of LABC. In the case of chemoresistance, very few treatment options are available. Keywords: breast cancer, breast neoplasm, chemotherapy resistance, docetaxel.  
2 An Uncommon Presentation of Breast Adenomyoepithelioma: A Case Report   , Abdullah Mohammed Alshamrani*, Abdullah Ahmed Alzarea, Muruf Zaid Alshalwah, Eman Ali Alrabee, Alrasheedi Saud D   General Surgery Department, Security Forces Hospital Program, Riyadh, Saudi Arabia   *Corresponding author: Abdullah Mohammed Alshamrani, General Surgery Department, Security Forces Hospital Program P.O. Box 3643, Riyadh 11481 Saudi Arabia. Tel: 0096655 326 6990; Email: alshamraniabdullah92@gmail.com   Citation: Alshamrani AM, Alzarea AA, Alshalwah MZ, Alrabee EA, A D Saud (2020) An Uncommon Presentation of Breast Adenomyoepithelioma: A Case Report. Annal Cas Rep Rev: ACRR-103.   Received Date: 06 March, 2020; Accepted Date: 11 March, 2020; Published Date: 17 March, 2020.  
Background: A breast adenomyoepithelioma is an uncommon tumor characterized by the presence of epithelial and myoepithelial cells. Case Report: We describe a 47-year-old woman who presented with a right breast mass of four-year duration. An examination of the breasts revealed two masses in the right inner quadrant of the right breast measuring 1 x 1 cm and 2 x 2 cm in dimension. A mammogram favored a lesion highly suspicious of malignancy, suggesting further examination. An ultrasound examination confirmed the mammography and a biopsy was subsequently performed. A biopsy revealed findings suggestive of duct adenoma. The tumor was excised, and the specimen was sent for histopathological examination. The histopathological findings were consistent with adenomyoepithelioma. The patient was discharged one day after surgery and did not present any complaints. Conclusion: Although most adenomyoepitheliomas have a benign course, it is essential for clinicians to identify these tumors, as the radiologic and cytologic characteristics can mimic malignant lesions. A definitive diagnosis can be made after a histopathologic examination, and tumor excision may be helpful in preventing recurrence or malignant change.  
3 Does COVID-19 Make Your Heart Race? -Atrial Fibrillation in Novel Coronavirus   , Nitin Tandan MDa*, Ruby Maini MDa, Asad Cheema MDa, Manjari Rani Regmi MDa, Abdisamad M Ibrahim MDa, Mohammad Al-Akchar MDb, Abdul Moiz Hafiz MDb, Mohamed Rafa Labedi MDb, Momin Siddique MDb, Abhishek Kulkarni MDb  
The novel coronavirus COVID-19 has caused the first pandemic of this decade. As we continue to learn more about COVID-19, little is known about cardiovascular manifestations of COVID-19. We present a case of a patient that developed new onset atrial fibrillation as an unusual manifestation of COVID-19 infection.  
4 Life-Threatening Methemoglobinemia Caused by Topical Anesthetic Given Prior to Transesophageal Echocardiography   , Obiora Egbuche1 MD, MPH; Kenechukwu Nwagbara2* MD, MPH; Bishoy Hanna1 MD; Temidayo Abe1 MD; Anekwe Onwuanyi1,3 MD  
Topical benzocaine spray is a local anesthetic agent that is commonly used during transesophageal echocardiography (TEE). This agent is believed to be safe because it has very low systemic absorption. We report a case of life-threatening methemoglobinemia following very minimal dose of benzocaine spray.  
5 About A Lockdown: Are the Novel Etiological Therapies for the SARS-CoV-2 Effective?   , Echevarria-Castro, Nataly and Fernandez-Aristi, Augusto R*  
Even though the humankind is familiar to disease outbreaks and pandemics, one of the few that has negatively impacted not only public health, but economy, finances among other vital government sectors is the COVID-19 caused by the SARS-CoV-2. These Viral family are common pathogens that can cause a variety of clinical entities, from respiratory symptoms to gastrointestinal ones ranging from mild to death threating cases. Many countries worldwide had already reported numerous index and imported cases and the death toll continues to trend up most dramatically in European and Asian countries. For this reason, one of the main strategies to control and contain the widespread dissemination of the virus are social isolation and even lockdown. In spite this measure, the number of cases continues to trend up with the lethality rate and the burden of the disease slowly increasing. Even though this disease presents a challenge, not only in diagnosis, but in specific etiological treatment, many researchers are developing many SARS-CoV-2 specific drugs and agents to decrease the alarming numbers of mortality and death toll. Given those treatments are novel, most of them have increasingly growing information regarding effectiveness and safety. In this article, we will try to compilate all the current novel therapies that are currently being developed for this on-growing pandemic.  
6 Flecainide Induced Refractory Ventricular Arrhythmia in A Hypertrophic Cardiomyopathy Patient   , Athanasios Saplaouras*, Panagiotis Mililis, Antigoni Sakellaropoulou, George Bazoukis, Athena Batsouli, Fotios Toulgaridis, Michael Efremidis, Konstantinos Letsas  
Here in we present a 55-years-old male with end-stage hypertrophic cardiomyopathy and implantable cardioverter defibrillator that developed life threatening ventricular arrhythmia after the administration of flecainide. The patient experienced many appropriate shocks until the arrhythmia successfully terminated.   Keywords: Proarrhythmia, flecainide, ICD, HCM.  
7 Use of Flow Diverter Stent for Treatment of a Cervical Carotid Artery Dissection and Pseudoaneurysm Causing Horner’s Syndrome   , Skylar N. Wilson1, Monisha A. Patel1, Lutheria Hollis*1, Narlin B. Beaty1,2  
Summary   In 2004, a 28-year old male presented with a traumatic dissecting pseudoaneurysm of the distal left cervical internal carotid artery was followed conservatively for 12 years with cross-sectional imaging. The patient was originally diagnosed with an acute left internal carotid artery (ICA) dissection, with significant luminal narrowing. Follow-up imaging revealed the dissection was not completely healed and a small pseudoaneurysm, about 4mm in size, was formed in the distal left cervical ICA. During the twelve-year observation period, the patient’s pseudoaneurysm expanded from 4.0mm to 9.0mm and the patient presented with ptosis, aniscoria, and myosis. Flow diverter embolization resulted in radiographic cure of the pseudoaneurysm and resolution of the Horner’s syndrome.  
8 Experience of Using Silicone Gel Sheet (Lady Care3) for Laparoscopic Surgical Wounds: An Investigation into Safety and Efficacy   , Toshiyuki Kakinuma*, Kaoru Kakinuma, Yoshio Matsuda, Ikuo Sato, Kaoru Yanagida, Michitaka Ohwada  
Background and Objective: While there has been an increase in the number of laparoscopic surgery in Japan, few studies have reported about scars from wounds by laparoscopic surgery. Silicone gel sheets are widely used as part of multidisciplinary treatment for hypertrophic scars and keloids, and their usefulness has been reported. The present study examined the efficacy and safety of a silicone gel sheet (Lady Care3) for laparoscopic surgical wounds. Subjects and methods: Subjects were 15 cases who underwent laparoscopic surgery during the period from March 2017 to March 2018. Silicone gel sheets (Lady Care3) were applied to the wounds (umbilicus, lower abdomen) for one week to six months postoperatively. The JSW Scar Scale was used in evaluating the wounds. The wounds were evaluated visually and through interviews before the application of silicone gel sheets, at three months following surgery, and six months following surgery. Results: The JSW Scar Scale scores for the umbilicus surgical wound were 7.4±2.4 before application, 2.7±1.6 at three months following surgery, and 0.9±0.7 at six months following surgery. Those for the lower abdomen surgical wounds were 4.7±2.3, 0.8±1.1, and 0.3±0.5, respectively. Three cases reported pruritus; however, all were mild, and it was tolerable to continue to use silicone gel sheets in those cases. Conclusion: Significant decreases were observed in the JSW Scar Scale scores from an early postoperative stage, and no serious adverse events were observed. Therefore, the present study suggested that the silicone gel sheet (Lady Care3) is safe and efficacious.   Keywords: Hypertrophic scar, keloid, silicone gel sheet, laparoscopic surgery  
9 A Case of Arrythmogenic Right Ventricular Cardiomyopathy Presenting as An Inferior STEMI     , Ech-chenbouli Amine (MD)*, Benouna Mohamed Elghali (MD), Benmallem Othmane (MD), Arous Salim (MD), Choukrallah Hamza (MD), El Adaoui Abdelmajid (MD), Asklou Abdesamad (MD), Habbal Rachida (MD)  
Arrythmogenic right ventricular cardiomyopathy is considered to be the most frequent arrhythmogenic cardiomyopathy. It is a rare condition in the general population with an estimated prevalence of 1:5000. We report the case of a 65 y.o man who was admitted to our emergency department for syncope and chest pain with a typical EKG of inferior STEMI who turned out to be an arrythmogenic right ventricular cardiomyopathy. Surprisingly the coronary angiogram was in the limit of normal and right ventricularography showed a typical aspect of stack of plates suggestive f arrythmogenic right ventricular cardiomyopathy. On echocardiography we objectified a dilated right ventricle with an anterior wall hypokinesia, cardiac MRI showed in addition of right ventricular dilatation and segmental akinesia a fatty infiltration on late gadolinium enhancement.   Keywords: Arrythmogenic right ventricular cardiomyopathy, STEMI, Cardiac MRI  
10 Infective Endocarditis of Tricuspid Valve in a COVID-19 Patient   , Ouissal Aissaoui1*, Afak Nsiri1, Anass Erragh1, Hanane Ezzouine1, Aboubakar Charra1, Rachid Alharrar1 Elghali Bennouna2, Rim Benmalek2, Anass Maaroufi2  
Infective endocarditis involving the tricuspid valve is rare. It can be a serious complication of central venous catheterization. COVID-19 patients with ARDS require prolonged ICU stay where central venous catheterization are common procedures. Additionally, immunodepression and pro-thrombotic conditions encountered with these patients may be precipitating risk factors of infective endocarditis.   A 76-year-old female with a known history of hypertension and diabetes mellitus is admitted to our ICU for acute respiratory distress syndrome (ARDS) due to “SARS-Cov-2” infection. Chest computed tomography identified bilateral ground glass opacities with a crazy paving aspect.  
11 COVID-19 Patients with Acute Coronary Syndrome: Why It Is More Than A Challenging Case?   , Mohamed EL Ghali Benouna1,3*, Othmane Benmallem1,3, Amine Ech-chenbouli1,3, Salim Arous1,3, Rachida Habbal1,3, Ouissal Aissaoui2,3*, Afak Nsiri2,3, Rachid Elharrar2,3, Chafik EL Kettani2,3, Lahoucine Barrou2,3  
COVID-19 is a disease caused by the SARS-COV-2 virus and was recently declared as a pandemic by WHO on March 11, 2020. There are more than 3 million of COVID-19 patients with more than 200000 deaths. As we observed in the previous viral epidemics, the excessive inflammatory process, hyper coagulation and hypoxia leads to an atherosclerotic plaques destabilization, which can explain the growing number of acute coronary syndrome (ACS) in this context. We present in this essay two cases presenting respectively STEMI and NSTEMI, describing the management of their acute myocardial infarction with all the challenges that can present a COVID-19 patient during the procedure.   Keywords: COVID-19, STEMI, NSTEMI, Acute coronary syndrome, thrombotic burden.  
12 Peripartum Cardiomyopathy: An Atypical Presentation Of COVID-19 Infection   , Benouna Mohamed EL Ghali (MD)1, Ech-chenbouli Amine (MD)1, Bendahou Hajar (MD)1 Benmallem Othmane (MD)1, Arous Salim (MD)1, Habbal Rachida (MD)1, Aissaoui Ouissal (MD)2, Salmi Said (MD)2, Barou Lahoucin(MD)2 ,Kettani Chafik (MD)2, Afif Hicham(MD)3  
Sars-cov-2 is a pandemic infection by the coronavirus called Covid19. They are more than 3 millions of covid 19 positifs patients with more than 200000 deaths related to this virus till this day, all over the world. PPCM refers to an uncommon form of idiopathic heart failure that occurs during pregnancy or until 5 months postpartum, her association with COVID-19 was never reported until this case. We report a case of 19 years old women who experienced a positive test of COVID-19 associated with peripartum cardiomyopathy 6 days after delivering a twin. Her condition being aggravated she was put on artificial respiration and received a prolactin inhibitor with hydroxycholoroquine associated with azithromycin with a good clinical course. The viral origin of peripartum cardiomyopathy was often raised. This case suggests although the SARS-COV-2 virus may be responsible for myocarditis which is associated with a context of peripartum can be extremely severe.                                                                                        Keywords: COVID-19, Peripartum cardiomyopathy; hydroxychloroquine.  
13 Has Regular Heart Rhythm A Positive Influence on Nightly Desaturations? The Possible Answer in A Case Report   , Nicola Vitulano MD*, Antonio Di Monaco MD, Federico Quadrini MD, Federica Troisi PhD, Massimo Grimaldi PhD   Cardiology and Arrhythmology Unit-Ente Ecclesiastico Ospedale Regionale “F. Miulli”-SP 127 Acquaviva-Santeramo Km. 4,100, 70021 Acquaviva delle Fonti (BA)- Italy   *Corresponding author: Dr. Nicola Vitulano, P.co dei Cedri, 46-71043 Manfredonia (FG)-Italy. Tel: 00393923975425; Email: nicola.vitulano@gmail.com   Citation: Vitulano N, Di Monaco A, Quadrini F, Troisi F, Grimaldi M (2020) Has Regular Heart Rhythm A Positive Influence on Nightly Desaturations? The Possible Answer in A Case Report. Annal Cas Rep Rev: ACRR-122.   Received Date: 21 May, 2020; Accepted Date: 25 May, 2020; Published Date: 31 May, 2020  
In the last decades several findings have documented the strong association between sleep apnea and cardiovascular disease, above all in the arrhythmologic field. The hypoxic trigger due to repetitive nightly apnoic events may be responsible of the onset and the maintenance of the arrhythymias such as atrial fibrillation or atrial flutter. The evidence supports a close link between these two pathological entities. Even if the perspective was always directed from sleep apnea to cardiovascular disease, the physiopathological pathways that link both are not still completely know. So it is thinkable that also the cardiovascular condition might influence the respiratory trend as the first input regarding the continuous changes happening during alternance between arrhythymias and restore heart rate stability. This case report could be an opportunity of reflection in this way. Future research is expected to clarify the real link between heart and sleep in the different cardiac condition and vice versa.   Keywords: Sleep apnea syndrome, nightly desaturation, atrial fibrillation, atrial flutter  
14 SARS CoV 2 Infection Revealed with Type 2 Sinoatrial Block   , Ellouadghiri A1, Seddiki K1, Damaane K1, Maghfour A1, Magramane A1, Ezzouine H1, Charra B1, Bennouna E2, Abouriche A2, Choukrani H2, El Moqri A 2, Abouradi S2   1COVID-19 Dedicated ICU, University hospital of Casablanca, Morocco 2COVID-19 Dedicated Cardiology team, University hospital of Casablanca, Morocco   *Corresponding author: Ellouadghiri A, COVID-19 Dedicated ICU, University hospital of Casablanca, Morocco. Email: idrissa4231@gmail.com   Citation: Ellouadghiri A, Seddiki K, Damaane K, Maghfour A, Magramane A, et al. (2020) SARS CoV 2 Infection Revealed with Type 2 Sinoatrial Block. Annal Cas Rep Rev: ACRR-120.   Received Date: 14 May 2020; Accepted Date: 18 May 2020; Published Date: 26 May 2020  
COVID 19 (SARS-CoV-2 infection) was declared as a pandemic by the WHO on March 11th, 2020. Its mortality risk is correlated to its pulmonary complications and refractory hypoxemia. Although CoViD 19 can have a direct impact on the cardiovascular system, cardiovascular diseases history can either predispose or worsen the corona virus infection. An association with a sinoatrial block was rarely noted in previous studies. The authors of this article report a rare case of association of COVID-19 infection and sinoatrial block, emphasizing the difficulties of the pharmacological treatment.  
15 Propofol Infusion Syndrome in a COVID19 Patient: A Case Report   , Anas Erragh, Mohamed Anass Fehdi, Hasna Darouich, Afak Nsiri, Ouissal Aissaoui, Rachid Alharrar   *COVID-19 Dedicated ICU University Hospital of Casablanca, Morocco **Hassan II University Ain Chock, Faculty of medicine and pharmacy, Casablanca, Morocco   Correspondent author: Anas Erragh, COVID-19 Dedicated ICU University Hospital of Casablanca, Morocco. E-mail: Erragg44anas@gmail.com   Citation: Erragh A, Fehdi MA, Darouich H, Nsiri A, Aissaoui O (2020) Propofol Infusion Syndrome in a COVID19 Patient: A Case Report. Annal Cas Rep Rev: ACRR-121.   Received Date: 19 May 2020; Accepted Date: 21 May 2020; Published Date: 28 May 2020  
SARS-CoV-2 causes a severe respiratory illness, named "COVID-19" by the World Health Organization (WHO), responsible for a pandemic today. The management of these patients requires hospitalization in intensive care unit and the use of mechanical ventilation with prolonged sedation. Propofol is one of the molecules that can be used. Propofol infusion syndrome (PRIS) is rare, occurring after long-term administration of propofol. It is a real challenge for the critical care practitioner. We report the case of a patient with COVID-19 with PRIS.  
16 Acute Acalculous Cholecystitis in Patient with Severe Coronavirus Disease 2019 (Covid-19): Case Report   , Aziza Kantri1*, Amal Haoudar1, Jihane Ziati1, Karim Elaidaoui1, Mohamed Miguil1, Khalid Sair2, Chafik Elkettani3   1Department of Anesthesia and intensive care unit, Cheikh Khalifa International University Hospital, Casablanca, Morocco 2Surgery Department, Cheikh Khalifa International University Hospital, Casablanca, Morocco 3Department of anesthesia and intensive care unit, Ibn Rochd University Hospital, Casablanca, Morocco   *Corresponding author: Aziza Kantri, Cheikh Khalifa International University Hospital, Mohamed VI University of Health Science (UM6SS) 67 Nassim Islane, Morocco. Tel: 00212670881027; Email: azizakantri@gmail.com   Citation: Kantri A, Haoudar A, Ziati J, Elaidaoui K, Miguil M, et al. (2020) Acute Acalculous Cholecystitis in Patient with Severe Coronavirus Disease 2019 (Covid-19): Case Report. Annal Cas Rep Rev: ACRR-125.   Received Date: 28 May 2020; Accepted Date: 02 June 2020; Published Date: 08 June 2020  
Acute Acalculous cholecystitis (AAC) is a potentially fatal gallbladder infection occurring in severely ill patients. Combining it with other serious conditions such as advanced forms of SARS-COV infection19 will worsen the prognosis of these patients. Difficulties in the diagnosis of AAC due to the infectious syndrome overwhelmed by the SARS-COV19-related severe inflammatory syndrome are often encountered. The various stages of medical and surgical management in the intensive care unit and operating room will be impacted by the COVID19 context with the difficulty of respiratory and hemodynamic management of these patients and the precautions to be taken to minimize transmission of the infection.   The authors propose this rare clinical case to illustrate the data in the literature for the etiopathogenic understanding of AAC and its management in the context of C0VID 19.   Keywords: Acute Acalculous cholecystitis, SARS-COV 19, Inflammatory Syndrome, cholecystectomy.  
17 Seizure, Not Always A Referral for The Neurologist. A Case of Insulinoma Presenting as Confusion, Odd Behavior and Grand -Mal Seizure   , Jacqueline T. Weslow*   Department of Internal Medicine, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA.   *Corresponding author: Jacqueline T. Weslow, Department of Internal Medicine, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA. Email: Jacqueline.Wesolow@moffitt.org   Citation: Weslow JT (2020) Seizure, Not Always A Referral for The Neurologist. A Case of Insulinoma Presenting as Confusion, Odd Behavior and Grand -Mal Seizure. Annal Cas Rep Rev: ACRR-123.   Received Date: 26 May 2020; Accepted Date: 30 May 2020; Published Date: 05 June 2020  
Insulinoma is a rare neuroendocrine tumor of the pancreas that produces insulin in an uncontrolled fashion. Due to high circulating insulin levels in the blood, patients will often, if not most times, present with neurological symptoms. Symptoms can range in severity depending on the degree of hypoglycemia. In the most severe form, patients can experience seizures and coma. In less severe cases, they can present with fatigue, confusion, weakness, change in personality. Symptoms that resolve with food intake is a traditional hallmark. This hallmark diagnostic criteria should alert the health care provider to this diagnosis when a patient presents as such.  
18 First COVID-19 Critical Case Hospitalized in Intensive Care Unit at Ibn Rochd University Hospital Casablanca, Morocco   , Charra B*, Ezzouine H, Raja A, El Ouardi M, El Attak B, Simou M, Mouataz S, Salem H, Driouich H   COVID-19 Dedicated ICU, University hospital of Casablanca, Morocco   *Corresponding author: Boubakar Charra, Head of the medical intensive care unit at Ibn Rochd University Hospital, HASSAN II University, Casablanca, Morocco.   Citation: Charra B, Ezzouine H, Raja A, El Ouardi M, El Attak B, et al. (2020) First COVID-19 Critical Case Hospitalized in Intensive Care Unit at Ibn Rochd University Hospital Casablanca, Morocco. Annal Cas Rep Rev: ACRR-124.   Received Date: 27 May 2020; Accepted Date: 01 June 2020; Published Date: 05 June 2020
SARS-CoV-2, the virus responsible for COVID-2019, is a new coronavirus discovered in the city of Wuhan in China in December 2019. It is responsible for an epidemic which epicenter was in China, Human-to-human transmission caused spread of the virus to Europe then to other countries, causing a pandemic. We report the first SARS-COV2 case confirmed hospitalized in intensive care in Morocco and describe the diagnostic procedure, clinical evolution and its management. This case highlights the importance of close coordination between clinicians and public health authorities at the national level.   Keywords: 2019-nCoV, intensive care, gravity, Respiratory support  
19 Management of Basal Cell Carcinoma That Developed in The Vulva: Based on Treatment Experience of 2 Cases of Basal Cell Carcinoma , Toshiyuki Kakinuma* , Kaoru Kakinuma, Masataka Kagimoto, Ayaka Kaneko, Yuka Sakamoto, Yoshio Matasuda, Kaoru Yanagida, Michitaka Ohwada
Summary Vulvar carcinoma is rare as a gynecologic malignant tumor, and among vulvar carcinoma, basal cell carcinoma is extremely rare. We encountered 2 cases of basal cell carcinoma that developed in the vulva. Case 1: A patient was an 81 year-old female. The patient presented with a chief complaint of sensation of mass in the left side of the vulva. The mass in the left side of the vulva was 1 cm in size and diagnosed as basal cell carcinoma based on biopsy results. Systemic examination showed no distal metastasis and local resection was performed. Case 2: A patient was an 84-year-old female. The patient presented with a chief complaint of atypical genital bleeding. Mass of 3 cm in size was present in the left side of the vulva, and biopsy of that site was performed and basal cell carcinoma was diagnosed. Systemic examination showed no distal metastasis, and local resection was performed. Postoperative course was uneventful and recurrence has not occurred in both cases. In differential diagnosis of external genitalia lesion, basal cell carcinoma should be put in mind and if abnormal lesion is observed, biopsy should be actively performed aiming at early detection, and appropriate operative procedure should be selected.
20 Experience of Using Silicone Gel Sheet (Lady Care3) for Laparoscopic Surgical Wounds: An Investigation into Safety and Efficacy , Toshiyuki Kakinuma*, Kaoru Kakinuma, Yoshio Matsuda, Ikuo Sato, Kaoru Yanagida, Michitaka Ohwada  
Background and Objective: While there has been an increase in the number of laparoscopic surgery in Japan, few studies have reported about scars from wounds by laparoscopic surgery. Silicone gel sheets are widely used as part of multidisciplinary treatment for hypertrophic scars and keloids, and their usefulness has been reported. The present study examined the efficacy and safety of a silicone gel sheet (Lady Care3) for laparoscopic surgical wounds. Subjects and methods: Subjects were 15 cases who underwent laparoscopic surgery during the period from March 2017 to March 2018. Silicone gel sheets (Lady Care3) were applied to the wounds (umbilicus, lower abdomen) for one week to six months postoperatively. The JSW Scar Scale was used in evaluating the wounds. The wounds were evaluated visually and through interviews before the application of silicone gel sheets, at three months following surgery, and six months following surgery. Results: The JSW Scar Scale scores for the umbilicus surgical wound were 7.4±2.4 before application, 2.7±1.6 at three months following surgery, and 0.9±0.7 at six months following surgery. Those for the lower abdomen surgical wounds were 4.7±2.3, 0.8±1.1, and 0.3±0.5, respectively. Three cases reported pruritus; however, all were mild, and it was tolerable to continue to use silicone gel sheets in those cases. Conclusion: Significant decreases were observed in the JSW Scar Scale scores from an early postoperative stage, and no serious adverse events were observed. Therefore, the present study suggested that the silicone gel sheet (Lady Care3) is safe and efficacious. Keywords: Hypertrophic scar, keloid, silicone gel sheet, laparoscopic surgery
21 A Triple Negative Breast Cancer That Does Not Require Chemotherapy: A Case Report of Adenoid Cystic Carcinoma of the Breast , Mohammed Al Duhileb1* , MD; Jamila Alazhri1, MD; Miral Mashhour2, MD; Ahmed Alwbari3, MD *Corresponding author: Dr Mohammed Al Duhileb, Breast and endocrine surgery, King Fahad Specialist-Dammam. Saudi Arabia.
Background: Adenoid cystic carcinoma (ACC) of the breast is a rare neoplasm accounting for 0.1%. It is of special interest because of its favorable prognosis and unique management approach.                        Case Presentation: A 42-year-old female presented with a palpable lump in the left breast. Tru-cut biopsy revealed invasive ductal carcinoma ACC form. A breast conserving surgery with sentinel lymph node biopsy were performed. Histopathology revealed ACC with estrogen receptor negative, progesterone receptor negative and HER2-Neu negative type. The multidisciplinary tumor board recommended that neither neoadjuvant nor adjuvant systemic treatment to be offered to this patient. She received adjuvant radiation therapy. In this report, we present a comprehensive review of the literature and discuss the unique characteristics of ACC, its prognosis compared to other triple negative breast cancer subtypes, and the evidence as well as the controversy in different treatment approaches.  Keywords: Adenoid Cystic Carcinoma, Breast Cancer.
22 Characterization of Chromosomal Abnormalities in Saudi Patients with Autism Syndrome *Corresponding author: Samia M Ahmed, 7Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Taibah University, AL-Madinah, Saudi Arabia. smmohammed@taibahu.edu.sa , Samaher S Alhjori1, Shifaa R Alhazmi2, Safiah O Albaghdadi3, Aisha A Alzaidi4, Sarwat M Khan5, Dimah Zaytuni6, Samia M Ahmed7*
Autism spectrum disorder (ASD) is a deficit that impairs the development of social skills, verbal and nonverbal communication, and repetitive patterns of behavior. This is the result of a neurological disorder that affects the manner in which information is collected and processed by the brain, causing problems in social skills. This study aimed to identify some aspects that might be involved in the pathogenesis of autism which is necessary for offering proper genetic counseling to families of autistic patients and their role in the diagnosis of autism in AlMadinah Almonawwarah. A total of 30 mothers of children who filled a questionnaire were enrolled in this study; 27 of those mothers had only one autistic child, whereas 3 mothers of them have two autistic children. Chromsomoal analysis was carried out for 18 patients participated including 9 autistic children and their mothers; all autistic children and their mothers showed normal karyotyping, only one autistic child (a sister twin) had heterochromatin in chromosome 16; actually, this child was not fully diagnosed ASD. This means that karyotyping is not enough for genetic diagnosis; but DNA sequencing may be more valuable. Furthermore, multidisciplinary approach that involves pediatrics, geneticists, neurologist and psychiatrist is required for diagnosis and management of autism cases.  
23 Characterization of Chromosomal Abnormalities in Saudi Patients with Autism Syndrome , Samaher S Alhjori1, Shifaa R Alhazmi2, Safiah O Albaghdadi3, Aisha A Alzaidi4, Sarwat M Khan5, Dimah Zaytuni6, Samia M Ahmed7* 1Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Taibah University, AL-Madinah, Saudi Arabia.  2Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Taibah University, AL-Madinah, Saudi Arabia.  3Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Taibah University, AL-Madinah, Saudi Arabia.  4Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Taibah University, AL-Madinah, Saudi Arabia.  5Center for Genetics and Inherited Diseases, Taibah University AL-Madinah, Saudi Arabia.  6Center for Genetics and Inherited Diseases, Taibah University AL-Madinah, Saudi Arabia.  7Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Taibah University, AL-Madinah, Saudi Arabia.  *Corresponding author: Samia M Ahmed, 7Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Taibah University, AL-Madinah, Saudi Arabia.  Citation: Alhjori SS, Alhazmi SR, Alboghdadi SO, Alzaidi AA, Khan SM, et al. (2020) Characterization of Chromosomal Abnormalities in Saudi Patients with Autism Syndrome. Annal Cas Rep Rev: ACRR-159. Received Date: 26 September 2020; Accepted Date: 05 October 2020; Published Date: 12 October 2020
Abstract Autism spectrum disorder (ASD) is a deficit that impairs the development of social skills, verbal and nonverbal communication, and repetitive patterns of behavior. This is the result of a neurological disorder that affects the manner in which information is collected and processed by the brain, causing problems in social skills. This study aimed to identify some aspects that might be involved in the pathogenesis of autism which is necessary for offering proper genetic counseling to families of autistic patients and their role in the diagnosis of autism in AlMadinah Almonawwarah. A total of 30 mothers of children who filled a questionnaire were enrolled in this study; 27 of those mothers had only one autistic child, whereas 3 mothers of them have two autistic children. Chromsomoal analysis was carried out for 18 patients participated including 9 autistic children and their mothers; all autistic children and their mothers showed normal karyotyping, only one autistic child (a sister twin) had heterochromatin in chromosome 16; actually, this child was not fully diagnosed ASD. This means that karyotyping is not enough for genetic diagnosis; but DNA sequencing may be more valuable. Furthermore, multidisciplinary approach that involves pediatrics, geneticists, neurologist and psychiatrist is required for diagnosis and management of autism cases.   Keywords: Autism spectrum disorder, Autism.