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A 34-year-old non hypertensive, non-diabetic and ill looking weak woman came to our emergency department with shortness of breath NYHA III-IV, severe bilateral pedal edema extending up to the thighs and gross ascites. Physical examination revealed 3mm pitting ankle and leg edema and hemodynamically was stable with raised jugular venous pressure. There was a closing and opening mechanical click on Cardiac auscultation. At the lower left sternal border, there was grade 2/6 holodiastolic rumble and a grade 2/6 systolic murmur. She had history of mitral valve replacement and tricuspid valve replacement in 2017 with mechanical valves then she had Redo tricuspid valve replacement with mechanical prosthesis again after four months. No known food or drug allergy and psychosocial issues. Her routine bloods Labs were normal and COVID-19 was negative. On chest X-ray P/A view images and echo showed markedly gross left sided pleural effusion. In Coronary angiogram showed normal coronaries and stuck tricuspid valve (Fig.1). Echocardiography report showed preserved LV systolic function (EF=57%), dilated left atrium and right atrium. Prosthetic mitral valve was seen at mitral position, well seated and well-functioning. The mechanical mitral valve was functioning well with normal disc motion with no thrombus formation. Prosthetic tricuspid valve was seen at tricuspid level with peak gradient of 22mmHg and shown stuck mechanical tricuspid discs stuck throughout the cardiac cycle, in a fully open position (Fig.2A and 2B). Atrial fibrillation was shown on ECG. The diagnosis was made as; pannus formation resulting in mechanical TV thrombosis.

UNASSIGNED: Orbital metastasis from breast cancer may be infrequently noted after the management of the primary lesion. It is rare in such cases to present with unilateral mechanical blepharoptosis without ophthalmoplegia.
METHODS: We present a case of unilateral acquired blepharoptosis of the left upper eyelid without ophthalmoplegia or exophthalmos three years after the onset of a suspicious breast mass. The patient did not disclose a history of breast cancer nor any positive family history to the ophthalmologist and anesthesiologist. The radiology images revealed an ill-defined enhanced lesion at the superior medial aspect of the left orbit. The orbital biopsy of the lesion showed poorly differentiated carcinoma as per the initial histopathology report. Vigilant history-taking enabled us to get information about a previous breast lesion and to correlate this with specific histopathological findings.
CONCLUSIONS: Management of orbital lesions might be challenging, and the approach should include detailed history and assessment. Biopsy and radio imaging are further needed to aid in providing the proper diagnosis. The clinicopathological correlation in our case has led to the final diagnosis of orbital metastatic breast cancer.
CONCLUSIONS: Ophthalmologists should be aware of variable ocular presentations of malignancy and adopt a team approach to obtain a carefully detailed history from patients presenting with orbital diseases and communicate adequately with the ocular pathologists who are handling the biopsy. Long-term follow-up and enhancement of patients\' awareness of possible late orbital metastasis are recommended in all patients with breast masses.

OBJECTIVE: To present the diagnostic, clinical, and radiological features of pigmented villonodular synovitis (PVNS), create awareness of this rare condition, and provide guidance for conservative healthcare practitioners for further referral and appropriate management.
METHODS: We present the case of a 41-year-old recreational runner who presented to the clinic with anterior hip pain of one year duration. Following a clinical history and examination, the patient was diagnosed with clinical femoroacetabular impingement. Radiographs taken at that time displayed mild degenerative joint disease of the left hip joint with coxa profunda. After four weeks of conservative care, the patient reported no improvement in symptoms. The patient was then referred for an MRI, while conservative care continued. Ten weeks later, the patient\'s symptoms and functional abilities had worsened. The MRI was obtained and the diagnosis of PVNS was made.
CONCLUSIONS: PVNS is a rare disease that can mimic mechanical hip pain. A high index of suspicion should be utilized when symptoms worsen despite conservative care. Referral for advanced imaging is critical for appropriate diagnosis of PVNS.
OBJECTIVE: Présenter les caractéristiques diagnostiques, cliniques et radiologiques de la synovite villonodulaire pigmentée (PVNP), sensibiliser le public à cette maladie rare et fournir aux praticiens de santé conservateurs des conseils pour le renvoi des patients et la prise en charge.
UNASSIGNED: Nous présentons le cas d’un coureur amateur de 41 ans qui s’est présenté à la clinique avec une douleur antérieure de la hanche depuis un an. Après une anamnèse et un examen clinique, on a diagnostiqué un conflit fémoroacétabulaire. Les radiographies prises à ce moment-là révélaient une légère maladie dégénérative de la hanche gauche avec coxa profunda. Après quatre semaines de soins conservateurs, les symptômes du patient n’étaient pas soulagés. On lui a demandé de subir un examen par IRM et on a poursuivi les traitements conservateurs. Dix semaines plus tard, les symptômes et les capacités fonctionnelles du patient s’étaient aggravés. On a obtenu les résultats de l’examen par IRM et on a diagnostiqué une PVNP.
UNASSIGNED: La PVNP est une maladie rare qui peut imiter une douleur mécanique de la hanche. L’indice de suspicion est élevé lorsque les symptômes s’aggravent malgré des soins conservateurs. Un examen par imagerie avancée est essentiel pour un établir un diagnostic de PVNP.

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BACKGROUND: Chest compression is regarded as a vital component of CPR and should be initiated immediately upon recognition of cardiac arrest in order to preserve circulation and thereby maintaining vital functions. Mechanical devices for CPR are still more common in the pre- and in-hospital treatment of cardiac arrest. Injuries due to treatment with these are known to occur. The aim of this case series was to identify and characterize the injury pattern in patients who had received mechanical CPR with focus on the visceral injuries.
METHODS: From 2016 to 2018, we prospectively included all patients who had received out-of-hospital mech-CPR with a LUCAS device in the Region of Southern Denmark (RSD) who were subsequently autopsied. Both hospital and forensic autopsies were included. We excluded cases with age less than 18, trauma immediately preceding the cardiac arrest, or known pregnancy.
RESULTS: A total number of 50 cases were included in this study. Overall, 38 (76%) had injuries. In the remaining 12 cases (24%) we found neither skeletal or visceral injuries nor any bruising of the chest. 11 (22%) had visceral injuries. Four patients suffered abdominal injuries. The remaining patients had thoracic injuries only. In five cases, the pathologist considered the injuries life-threatening had the patients otherwise survived. These five cases were less than 55 years old and had no known or observed conditions which could explain the extend of injury.
CONCLUSIONS: We found five iatrogenic injuries which in itself could have been fatal had the patients survived the incident. It is of great importance for the forensic pathologists to be aware of the possible types of injuries and their severity caused by compressions when dealing with patients treated with mechanical CPR as they are both diverse and can be extensive.

Cardiopulmonary resuscitation (CPR) quality, including chest compression rate, depth, and fraction of hands-on time, is integral to cardiac arrest survival. Introducing mechanized devices to target these measures of quality in the challenging prehospital environment holds great promise. Comparing mechanical to manual CPR, animal models deliver favorable results on markers of perfusion and manikin studies demonstrate improved consistency of high-quality CPR performance with device use. Factoring in real-world application with prospective randomized human trials; however, repeatedly fails to show improvements in patient-centered outcomes and thus cannot be supported by current scientific evidence.

We report a case where migrated Onyx could be removed safely with a mechanical thrombectomy device after withdrawal of the damaged microcatheter. A microcatheter was retained in the superior cerebellar artery with attached Onyx fragments on its tip during embolization of a bled cerebellar AVM. During retrieval maneuvers microcatheter shaft was ruptured and Onyx fragments were released into the vertebrobasilar system causing occlusion. Finally, Onyx fragment on tip of the microcatheter could be detached with dimethyl sulfoxide injection and the microcatheter could be withdrawn. A Merci retriever device (Concentric Medical, Mountain View, CA, USA) was successfully used to retrieve most of the dislodged Onyx material and recanalize the vertebrobasilar circulation.

BACKGROUND: Diaphragmatic paralysis in newborns is related to brachial plexus palsy. It can cause respiratory failure necessitating prolonged mechanical ventilation and subsequent extubation failure.
METHODS: We present a two-hour-old male newborn with a birth weight of 4500 grams who had a right-sided brachial plexus palsy and right diaphragmatic paralysis due to shoulder dystocia. He developed respiratory distress due to isolated paralysis of the right hemi diaphragm. The clinical course was progressive, his condition worsening despite oxygen application. Physical examination, chest X-rays and M-mode ultrasonography of the diaphragm confirmed the diagnosis diaphragmatic paralysis. Surgical plication of diaphragm was done earlier than the usual time because of recurrent extubation failure. Diaphragmatic plication led to rapid improvement of pulmonary function and allowed discontinuation of mechanical ventilation in less than 3 days.
CONCLUSIONS: Early diaphragmatic plication enhances weaning process and may prevent or minimize the morbidity associated with long-term mechanical ventilation in a neonate with diaphragmatic paralysis.