A 19-year-old man with a BMI of 23.8 kg/m2 (5 ft 7 in; 152 lbs) presented with the concern of 3 years of progressively enlarging head leading to an increase in hat size. The patient fulfilled the criteria for macrocephaly as his head circumference was 62 cm, which was above the 97th percentile for his age [1]. CT head revealed homogeneous bilateral hypertrophy of the temporalis, masseter, and medial pterygoid muscles with no evidence of a neoplastic process (Fig-1, Fig-2, and Fig-3). While genetic syndromes can be a cause of out-of-range head circumference, familial and environmental factors can contribute to variations [2,3]. In this case, the patient’s history revealed a history of bruxism since adolescence, however, no other physical or developmental abnormalities were noted. As a result, our case demonstrates bruxism and subsequent masticatory muscle hypertrophy as another possible cause of macrocephaly.

Purpose: The objective of this study is to analyze characteristics of recurrent acute urinary retention (AUR) in patients with benign prostatic hyperplasia (BPH), utilizing a population based data set. Also, we sought to report on how AUR was treated, specifically regarding the need and length of catheterization and types of procedures utilized for mitigation. Materials & Methods: A retrospective observational cohort study was performed using Optum's deidentified Clinformatics ® Data Mart Database. We compared two groups, BPH patients with AUR (n = 180,737) and BPH patients without AUR (n = 1,139,760) from January 1, 2003 to December 31, 2017. Also, we analyzed the factors affecting the development of multiple episodes of AUR through age-adjusted multivariate analysis.Results: In contrast to the 47.7% of patients who had a single AUR episode, 33.5% of AUR patients developed 3 or more subsequent episodes of retention. For age matched patients, the risks of additional episodes of retention increase significantly with older age, Caucasian race, diabetes, neurologic conditions, or low income.Overall, the rate of BPH surgery in AUR patients over the study period decreased and the most common procedure was transurethral resection of the prostate.Conclusions: Risk factors for multiple episodes of AUR included age (60 and older), Caucasian race, lower income socioeconomic status, diabetes, and neurological disorders. Patients with a high probability of developing recurrent episodes of AUR are recommended to receive preemptive BPH medication before such AUR occurrences. Also, more expeditious surgical treatment should be considered rather than temporary catheterization when AUR occurs.

Renal oncocytomas (ROs) are benign tumors comprising 16% of renal masses. Due to the overlapping phenotypes seen in RO and chromophobe renal cell carcinoma (RCC) and lack of specific clinical and laboratory characteristics of RO, physicians face a challenge when arriving at a definitive diagnosis of RO. ROs additionally appear indistinct from RCCs on CT scan, contributing further to the difficulty of arriving at a clear diagnosis of RO. This is a case report of a 66-year-old man who presented with flank pain found to be related to bilateral ROs and underwent bilateral partial nephrectomies.ROs are benign small renal masses that often pose a diagnostic challenge since preoperative diagnosis can be difficult to achieve. Given advancements in technology, active surveillance with core renal biopsy is a promising approach to accurately diagnose and manage ROs conservatively. The application of these techniques has wide-reaching implications for patients and physicians by reducing the need for a potentially harmful surgery and creating a cost-effective way to manage a diagnosis.