Foreign bodies in the rectum often pose a challenging diagnostic and management dilemma that begins with the initial evaluation in the emergency department and continues through the post extraction period. Because of the wide variety of objects and the variation in trauma caused to local tissues of the rectum and distal colon, a systematic approach to the diagnosis and management of rectal foreign bodies is essential. We present a case of 34 year old gentleman presented to emergency department with complaint of constipation for 2 days and claims he had inserted a plastic bottle in his anus 2days ago and unable to remove it. After failure of extraction of the bottle trans-anally and endoscopically, a mini laparotomy and incision on the sigmoid colon done to remove the foreign body. Patient was referred to the psychiatrist for his perversion disorder, which was also mandatory for preventing recurrences.

Background: Non-communicable diseases including cardiovascular disease, hypertension, hyperlipidemia, and stroke are on the rise throughout the world. Further, there is a large proportion of individuals that have hyperlipidemia and hypertension that is not diagnosed, treated or controlled in low and middle income countries (LMICs). Notably, Asian countries including Thailand, have higher rates of mortality from stroke than from coronary heart disease. Despite several calls to action, there has been a lack of implementation of cardiovascular diseases prevention programs in LMICs largely due to insufficient investment in prevention efforts. One approach to combat these difficulties is to create a program or method aimed at early identification of those at risk for stroke. The purpose of this paper is to describe the use of a community stroke-risk focused genogram as a tool for identification of individuals in need of intervention and as a guide for the creation of educational prevention programs.

Ortner’s syndrome is rare syndrome characterised by hoarseness of voice due to recurrent laryngeal nerve involvement in cardiovascular disease. This report presents a case of left laryngeal paralysis caused by an aortic arch aneurysm and to highlight the importance of an otorhinolaryngology evaluation along with a thoracic radiologic study.

Branchial anomalies (BA) are developmental lesions that are believed to be either vestigial remnants resulting from incomplete obliteration of the branchial apparatus or the result of buried epithelial cell rests. They are classified as either first, second, third, or fourth according to their proposed pouch or cleft of origin and are relatively common findings. The incidence of BAs depends on the age of the patient and the specific type of anomaly. Some anomalies might be very small and not present until they become symptomatic from an inciting event such as infection or trauma. Most radiologists are familiar with the classic findings of the most common forms of 1st and 2nd BAs. However, some BAs can have a varied imaging appearance and may be misdiagnosed. In this paper, we present two cases of pathologically proven first branchial cleft anomalies with atypical imaging appearances.

Splenic tuberculosis (splenic TB) is extremely rare. It is likely to be misdiagnosed as carcinoma of spleen, splenic abscess, lymphoma, or others. The misdiagnosis rate is high if there is no tuberculosis history in other organs. We came across a case of 27 years old immunocompetent female from good socioeconomic background who presented with weight loss and pain in left hypochondriac region. Ultrasonography of abdomen revealed multiple hypo echoic lesions in the spleen. MRI chest and abdomen revealed multiple splenic focal lesions with no contrast enhancement and well defined mass in the posterior mediastinum. Splenectomy was performed and sample was sent for histopathological examination and also microbiological analysis. Microscopic examination revealed splenic tissue with multiple variable sized granulomas showing epithelial cells, lymphocytes and Langhan’s giant cells, the larger one showed wide necrosis with nuclear debris and suppuration together with focal increase in plasma cells. This was consistent with the diagnosis of Mycobacterial infection with MRI finding of only mediastinal lymph node involvement in the lungs.

A case of cutaneous phaeohyphomycosis of the foot affecting interdigital spaces between toes in a 31 year old immunocompetent male with no history of diabetes is illustrated. Fugal elements were found in direct microscopic examination of skin scrapping. The etiologic agent was identified as Curvularia lunata based on macromophology and microscopic examination of pure culture growth. The patient was prescribed with a topical cream containing sertaconazole nitrate and oral itraconazole by the treating dermatologist. Nondermatophyte infections clinically mimic dermatophytosis, and microscopically resemble dermatophytes. Therefore, a correct identification of etiologic agent is important for appropriate treatment.

In recent years the incidence of both amputations as total joint replacement surgery of lower limbs has been increased. So it is not rare to fi nd both circumstances in the same patient. We discuss about the technical problem of this eventuality.