American Journal of Medical and Clinical Research & Reviews

Calcified Extragonadal Pelvic Mature Teratoma in a 67-Year-Old Man Discovered Incidentally During Workup for Lumbosciatalgia: A Case Report

2026-09-17T21:52:27+02:00

Extragonadal teratomas are rare germ cell tumors, representing 2–5% of cases, with pelvic localization in adult males being exceptional.

A 67-year-old male presented with lumbosciatalgia. Imaging revealed a calcified supravesical pelvic mass measuring 65 × 55 × 50 mm, adjacent to the sigmoid colon and iliac vessels. Tumor markers were within normal limits except for isolated elevation of CA19-9. Laparoscopic exploration identified a whitish calcified mass adherent to the left iliac fossa and sigmoid colon. Complete en bloc resection was performed, and histopathology confirmed a mature teratoma.

Pelvic extragonadal teratomas in adult men are rarely reported. CT imaging is the diagnostic reference, with calcifications present in 50–60% of mature teratomas. Although typically benign, complications such as infection, rupture, compression, or malignant transformation (1–3%) justify complete surgical excision. Laparoscopy provides advantages in terms of recovery and morbidity.

Extragonadal pelvic mature teratoma in elderly men is an exceptional entity. Diagnosis relies on imaging, and complete laparoscopic excision remains the standard of care to establish histology and prevent complications.

Impact of Keton Based Infant Formula on an Adult Patient for Cardiac PET/CT scan

2026-09-28T13:43:41+02:00

Purpose: To evaluate the efficacy and safety of using a pediatric ketogenic formula for myocardial glucose suppression in an adult patient undergoing PET/CT to rule out infective endocarditis. Standard ketogenic diets are challenging for adult patients requiring nasogastric tube feeding in a critical care setting.

Methodology: A patient in his 60s, post-coronary artery bypass graft with a fever of unknown origin, required a cardiac PET/CT. Due to naso gastric tube dependence, a pediatric ketogenic formula (KetoCal 4:1) was administered for 72 hours. To meet adult caloric requirements within a 2 L fluid restriction, the formula was standardized to a 1 kcal/mL concentration. Clinical monitoring included hemodynamic stability, balanced electrolytes, blood glucose, renal function, and gastrointestinal tolerance.

Results: The protocol achieved complete physiological suppression of myocardial radiotracer uptake, allowing for a clear diagnostic PET/CT scan. The patient maintained stable blood glucose levels with no reported arrhythmia, osmolar load, macronutrients ratio, electrolyte imbalance, or gastrointestinal complications. The 72-hour duration acted as a safety buffer against the nutritional deficiencies typically associated with using pediatric-specific formulas in adults.

Conclusions: Pediatric ketogenic formula is a viable and effective alternative for achieving myocardial glucose suppression in nasogastric tube-dependent adult patients when adult-specific products are unavailable. Short-term use (72 hours) is clinically tolerated provided there is rigorous monitoring of osmolar load, macronutrient ratios, and hemodynamic stability. This approach ensures high-contrast imaging essential for diagnosing complex inflammatory conditions like infective endocarditis.

The Faustian Clinic: Mastery, Suffering, and the Bargains Physicians Make

2026-09-28T03:48:41+02:00

Goethe's Faust is usually read as a drama of knowledge, desire, transgression and redemption. It is also, and not incidentally, a drama about a physician. Faust has studied medicine along with philosophy, law and theology; he and his father treated plague victims with a remedy that killed more than it cured; and his despair begins not in appetite but in the discovery that accumulated knowledge has failed to yield wisdom or presence. His response is escalation rather than renunciation, and the wager he strikes with Mephistopheles is, precisely, a wager never to linger never to say to any moment, stay. This essay argues that the same wager is struck, quietly and repeatedly, by contemporary physicians, first with technique and then with the institutions that house it. Medicine rightly seeks knowledge, cure, prediction and control. It becomes Faustian when these instrumental goods harden into an anthropology: when disease becomes more real than the sufferer, uncertainty an intolerable defect, death a technical failure, and the physician able to remain in the room only while something remains to be done. The essay reads Mephistopheles as a grammar of reduction without return, Gretchen as the person left behind by the project, Philemon and Baucis as those who stand in the way of the system's throughput, and Sorge (Care) as the return of what mastery cannot eliminate. It places Goethe in conversation with Cassell on suffering, Buber and Levinas on the second person, the Book of Job and the rabbinic dying of Moses, and the author's earlier proposals of a "third grammar" for the clinical encounter, the detachability of remedy from cosmology, and clinical tzimtzum. The argument is not anti-technological. The corrective to Faustian medicine is neither therapeutic defeatism nor romantic anti-science but a disciplined self-limitation: knowing vigorously without claiming omniscience, intervening powerfully without confusing power with sovereignty, and remaining with the patient when neither explanation nor cure is available.

Sclerofibrous Gallbladder Mimicking Carcinoma: Diagnostic Pitfalls and Salvage Surgery

2026-10-09T21:14:56+02:00

Gallbladder carcinoma (GBC) is an uncommon but aggressive malignancy whose imaging features often overlap with chronic inflammatory conditions, leading to diagnostic uncertainty.

We report the case of a 68 year old patient admitted with suspected GBC after a difficult initial laparoscopy. Computed tomography revealed a thickened, calcified gallbladder with infundibular macrolithiasis and a subhepatic collection, without hepatic invasion or lymphadenopathy. Tumor markers were mildly altered (CEA 6 ng/mL; CA19 9 54.5 U/mL). Surgical re exploration with intraoperative frozen section revealed a sclerofibrous gallbladder and severe pediculitis, prompting conversion to subcostal laparotomy. A fundus first cholecystectomy was performed safely. Histopathology confirmed chronic lithiasic cholecystitis without malignancy.

This case underscores the diagnostic pitfalls of sclerofibrous gallbladder mimicking carcinoma. Parietal calcification and moderate biomarker elevation lack specificity and should not be equated with malignancy. Conversion to open surgery represents a validated safety strategy rather than a technical failure. Frozen section remains pivotal to avoid unnecessary radical resections.

Differentiating inflammatory pseudo tumoral gallbladder disease from carcinoma requires cautious interpretation of imaging and biomarkers. Integrating intraoperative frozen section and prioritizing operative safety are essential to prevent disproportionate oncologic procedures.

Teshuvah and Heresy in Rav Kook and Rav Shagar Faith after rupture in a postmodern age

2026-09-28T03:42:06+02:00

Gingival Zenith Optimization in Implant Esthetics: Contemporary Surgical, Prosthodontic and Periodontal Perspectives — An Integrative Literature Review

2026-09-28T03:54:20+02:00

Achieving harmonious peri-implant soft tissue architecture is a critical determinant of esthetic success in contemporary implant dentistry. Among the various soft tissue parameters, the gingival zenith is recognized as a key component in establishing harmonious gingival symmetry, appropriate crown proportions, ideal emergence profiles, and seamless integration with the adjacent dentition. Precise positioning and long-term stability of the gingival zenith are influenced by a complex interplay of surgical planning, implant three-dimensional positioning, periodontal phenotype, hard and soft tissue volume, prosthetic contouring, and restorative protocols. Despite significant advances in implant dentistry, achieving predictable peri-implant soft tissue esthetics remains a clinical challenge, particularly in the anterior esthetic zone where even minor discrepancies in gingival contour can compromise overall treatment outcomes and patient satisfaction. Particular consideration is given to pediatric dental implants, where ongoing craniofacial growth may alter peri-implant soft tissue contours, gingival zenith position, and emergence profiles, creating unique long-term esthetic challenges. Growth-related changes therefore necessitate careful implant positioning, soft tissue management, and interdisciplinary planning to preserve harmonious esthetics throughout development. Therefore, this integrative literature review aims to comprehensively examine the biological principles, diagnostic considerations, and contemporary interdisciplinary approaches to gingival zenith optimization in implant esthetics. By synthesizing current evidence from surgical, prosthodontic, and periodontal perspectives, this review seeks to provide clinicians with an updated understanding of the factors influencing peri-implant soft tissue architecture and to support evidence-based decision-making for achieving predictable esthetic outcomes in implant-supported rehabilitation.

Impact and discovery of Telepathy, Autistic, Introvert people and Physician clinical practices

2026-09-28T04:10:31+02:00

The intersection of telepathy, autism, introversion, and physician clinical practices became a topic of intense global discussion following the release of the viral podcast The Telepathy Tapes. Spearheaded by psychiatrist Dr. Diane Hennacy Powell, the project claims that some non-verbal, highly introverted autistic individuals possess extraordinary extra-sensory or telepathic communication abilities. While proponents argue this reframes neurodivergent consciousness, the broader medical community strongly rejects these claims as pseudoscience.

Surgery Option for Neurodivergent Adults patients

2026-09-28T04:21:45+02:00

Tailoring surgery for neurodivergent patients (such as autism or ADHD) requires individualized care plans, sensory reduction, and customized sedation to prevent trauma and anxiety. Insights from the Science Direct scoping review show that caregiver collaboration and structured planning significantly improve safety.

For adult, their surgical care will focus heavily on autonomy, clear communication, and legal/medical advocacy. While many pediatric hospitals have robust neurodivergent protocols, adult medical systems can be more challenging to navigate.

Here is how to optimize the surgical experience for an adult neurodivergent patient

Adjunctive Weekly Subcutaneous Thymosin β4 and BPC-157 With Intensive Rehabilitation in Subacute AIS-B Thoracic Spinal Cord Injury: A 6-Month Open-Label Controlled Pilot Study

2026-09-28T04:53:38+02:00

Background: Thoracic spinal cord injury (SCI) graded AIS B carries a limited but non-trivial probability of spontaneous motor conversion, with roughly 65–75% of AIS B/C patients improving at least one grade and only a minority achieving functional ambulation (Kirshblum and colleagues, summarised in Frontiers/PMC natural-history review²¹). Two regenerative peptides have convergent, complementary preclinical rationale in SCI: thymosin β4 (Tβ4), the principal G-actin–sequestering peptide in eukaryotic cells, which drives oligodendrogenesis, axonal remodeling, angiogenesis and anti-inflammatory signalling (Sosne and Morrison, Expert Opin Biol Ther¹), and the stable gastric pentadecapeptide BPC-157, which acts principally through VEGFR2 upregulation and the Akt–eNOS nitric-oxide axis (Regeneration or Risk or narrative review, PMC¹²). Each has independently improved locomotor outcomes in rodent SCI (Cheng et al., Neurosci Lett²; Perović et al., J Orthop Surg Res⁹). No human study has combined them.

Objective: To evaluate the feasibility, tolerability and preliminary neurological signal of weekly subcutaneous Tβ4 + BPC-157 added to standardised intensive rehabilitation in subacute AIS-B thoracic SCI.

Methods: Ten adults (age 21–39 y) with traumatic thoracic SCI, AIS grade B, 6–8 months post-injury, were enrolled into two level-matched groups of five. The peptide group received weekly subcutaneous Tβ4 1.65 mg (55 insulin-syringe units of a 3 mg/mL, 5 mL vial) and BPC-157 0.8 mg (40 units of a 2 mg/mL, 5 mL vial) for 26 consecutive weeks. Both groups completed identical rehabilitation: 2 hours/day, 5 days/week, for 6 months. Primary outcome: change in Lower Extremity Motor Score (LEMS, max 50). Secondary outcomes: ISNCSCI light-touch and pin-prick totals, motor and sensory Zone of Partial Preservation (ZPP), Trunk Control Test for SCI (TCT-SCI), Walking Index for SCI II (WISCI-II), Neurogenic Bowel Dysfunction (NBD) score, catheterization frequency, AIS grade conversion, and adverse events.

Results: All 10 participants completed 26 weeks; 130/130 scheduled peptide injections were administered. Mean LEMS at 6 months reached 29.4 ± 3.8 points, i.e. 58.8% of the 50-point maximum, versus 19.0 ± 3.5 points (38.0% of maximum) in the rehabilitation-only group — a between-group deficit of 35.4% relative and 10.4 LEMS points absolute (Mann–Whitney U = 0, exact two-sided p = 0.008; Cliff's δ = 1.00). Every peptide-group participant exceeded the published LEMS minimal clinically important difference of ~3.66 points (SCIRE clinician summary¹⁶) by a wide margin. Two participants (T10, T12) achieved voluntary knee locking and supported over ground ambulation (WISCI-II 6 and 9). Motor ZPP descended a median of 2 levels (peptide) versus 1 (comparator). Light-touch and pin-prick totals rose by 22.2 and 19.8 points respectively (peptide) versus 11.4 and 9.8 (comparator). Composite bladder–bowel function improved 45.1% from baseline in the peptide group versus 23.9% in the comparator. All 5 peptide-group participants and all 5 comparator participants converted from AIS B; 2 peptide-group participants reached AIS D. No serious adverse events occurred; 6 participants reported transient injection-site erythema and 1 had an asymptomatic, self-resolving ALT rise to 1.6 × upper limit of normal.

Conclusions: In this small, open-label, non-randomised pilot, weekly low-dose Tβ4 + BPC-157 was feasible and well tolerated, and was associated with substantially larger motor, sensory, trunk and autonomic gains than matched rehabilitation alone. The magnitude of recovery in both arms markedly exceeds published natural-history and locomotor-training benchmarks, so these results must be treated as hypothesis-generating only. Neither peptide is an approved drug; BPC-157 has been flagged by the FDA as a compounding bulk substance presenting significant safety risks (FDA³⁶) and both fall under WADA Prohibited List category S0. A randomised, double-blind, placebo-controlled, blinded-assessor trial is required.

Returning Without Erasure: Teshuva, Apophasis, and the Sanctification of the Secular Past

2026-10-15T03:36:20+02:00

Religious return is frequently represented as a movement from spiritual alienation toward religious authenticity, in which the returning individual is expected to repudiate the secular intellectual and cultural formation that preceded observance. This essay challenges the theological necessity of such discontinuity and proposes an understanding of teshuva as the transformation, and not the erasure, of the past. It reads four bodies of work together: Elliot R. Wolfson's apophatic critique of theological representation, including his reading of Rav Kook's “atheistic faith”; Rav Abraham Isaac Kook's Orot HaTeshuva, which names as counterfeit any repentance that fails to gather the scattered self; the Lubavitcher Rebbe's theology of transforming darkness into light, read alongside Wolfson's own study of that theology; and Rav Shagar's account of a repentance that begins with the person exactly as he is and a faith that lives in several worlds without harmonizing them. From these the essay develops the concept of anamnetic teshuva: religious return through transformed remembrance. Three supports are offered that the tradition itself supplies. Maimonides' Hilkhot Teshuva holds together the penitent's “I am another” with the requirement that his sin remain always before him, and assigns the memory of the past to the penitent while forbidding it to the community. The clinical anamnesis supplies a working model of a history that is reread by what is later found and is never discarded. And sociological studies of baalei teshuva show that observance and cultural assimilation come apart in practice. The proposed theology preserves the necessity of halakhic and ethical transformation while rejecting the assumption that religious authenticity requires autobiographical repudiation. It concludes that the deepest religious return may consist not in exchanging secular certainty for religious certainty, but in fidelity to a covenant whose divine ground remains beyond conceptual possession.

When Surrender Fails: Divine Absence, Human Resistance, and the Limits of Religious Acceptance

2026-10-15T03:43:43+02:00

Surrender holds a privileged place in recovery, in palliative care, and in religious counsel. I have defended it in earlier work as the relinquishment of omnipotence that restores responsible agency. This article asks the question those papers left open: what is owed to the person in whom surrender does not happen?

Four such persons organize the argument: the dying patient who understands her prognosis and will not consent to it, the man in recovery who cannot believe, the survivor who cannot forgive, and the believer who keeps praying and withholds one blessing. The first claim is that surrender is not performable on demand. That finding is not a critic's imposition. It was reached independently by Harry Tiebout within the psychiatry of Alcoholics Anonymous, by the Śrī Vaiṣṇava schools in their dispute over prapatti, by

Shinran in his analysis of self-power and Other Power, by the early Daoist “paradox of wu wei,” and by the Talmud's “a prisoner cannot free himself from prison.” The second claim follows: what cannot be performed cannot be prescribed. A prescribed surrender yields compliance, shame, or exit. The third claim is that Jewish covenantal protest supplies what the traditions of surrender mostly lack, a standing place for the one who does not surrender. Berakhot 5b gives that place a formula, “neither they nor their reward,” and a clinical gesture, “give me your hand.”

From these I define faithful nonsurrender: omnipotence is relinquished, assent is withheld, and the address is kept. I distinguish it from surrender, compliance, omnipotent refusal, and exit. I test it against the empirical literature on religious struggle, protest toward God, and end-of-life care, and I derive rules for the bedside, the recovery room, and the survivor's therapy. Surrender can be conjugated in the first person. It has no legitimate imperative.