Inflammatory myofibroblastic tumor is a rare benign neoplasm that frequently involves the lung and abdominopelvic region, and is found mainly in children and young adults. Inflammatory myofibroblastic tumor te...
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Σάββατο 8 Σεπτεμβρίου 2018
Inflammatory myofibroblastic tumor of the pleura with adjacent chest wall invasion and metastasis to the kidney: a case report
Long-term survival in a patient with pulmonary spindle cell carcinoma treated with traditional Chinese medicine
Spindle cell carcinoma (SCC) is a rare pulmonary malignancy, accounting for only 0.2%–0.3% of all lung cancers. Therefore, the prognosis and treatment of pulmonary SCC is unclear. There are only 13 reported cases in literature, only three of which had a survival of more than 11 months. Here we reported a long-term survival of a patient with pulmonary SCC who underwent treatment with traditional Chinese medicine. At the most recent follow-up in July 2018, her survival after diagnosis is 48 months and she continues to do well. To our knowledge, this is the longest survival of late stage SCC with the largest tumour burden.
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Recurrent giant cell tumour of the maxillary sinus and pterygoid process treated with denosumab
We report the case of a 74-year-old man with a giant cell tumour (GCT) of the right maxilla and pterygoid process. The patient presented to the maxillofacial and head and neck surgery clinic with an ulcerated lesion of the hard palate. Initial workup with CT revealed a mass within the right maxillary sinus and pterygoid process with associated bone expansion and erosion. Biopsy showed a GCT with mucosal ulceration. Two years after surgical resection, a follow-up CT revealed tumour recurrence involving the right pterygoid process and lateral pterygoid muscle. The patient was then proposed for therapy with denosumab. Under denosumab treatment, the lesion maintained stable dimensions and became sclerotic and heavily ossified.
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Septicaemia in an adolescent presenting with potentially fatal CA MRSA osteomyelitis
Description
A 14-year-old boy, with no prior medical history, presented with tenderness on the right knee after minor trauma while playing football the previous day. On physical examination, there were minor inflammatory signs, with no penetrating wound and he was sent home.
Two days later, due to worsening symptoms, MRI of the lower limb was performed and revealed multiple tibial lytic lesions, intraosseous abscesses and diffuse soft tissue oedema (figure 1).
Figure 1
Lower limb MRI imaging revealed multiple serpiginous lytic lesions in the proximal tibial metaphyseal region suggesting intraosseous abscesses.
Surgical debridement was performed and flucloxacillin and amikacin were initiated. The following day, his clinical status deteriorated with septic shock and respiratory failure. He was admitted in the paediatric intensive care unit.
Preoperatory blood cultures identified a methicillin-resistant Staphylococcus aureus (MRSA) Panton-Valentine leucocidin (PVL) positive and antimicrobial therapy was...
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Venous thromboembolism leading to diagnosis of de novo malignancy in an organ transplant recipient
We report the case of a patient with remote orthotopic liver transplant who was ultimately diagnosed with Merkel cell carcinoma following admission for initial venous thromboembolism. Additionally, we review pertinent literature related to the risk of skin cancer in solid organ transplant recipients and discuss the importance of yearly skin exams in this patient population.
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Goitre, lymphoma and the doughnut sign
Description
A 65-year-old woman, with a known case of Hashimoto's thyroiditis on eltroxin for 15 years, presented with progressive diffuse swelling neck for 2 months. She also gave a history of difficulty in swallowing and breathing for 1 week. On examination, she had respiratory distress, low oxygen saturation (85% on pulse oximeter) and cyanosed tongue. Systemic examination was unremarkable except for goitre (grade 2) and stridor. As the saturation was not improving with supplemental oxygen, she underwent an emergency tracheostomy. Subsequently, a contrast-enhanced CT scan of the neck showed large lobulated heterogeneously enhancing lesion in the region of thyroid gland encasing all major structure of neck including trachea (figure 1). Core biopsy and immunohistochemistry (CD45, CD20, CD10 and BCL6 positive) confirmed the diagnosis as diffuse large B cell lymphoma (DLBCL). The patient received R-CHOP chemotherapy (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone). After 1 month, she was asymptomatic with >50% decreased swelling,...
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Recurrent gallstone ileus in a patient with ileostomy successfully treated by removal of impacted gallstone via the stoma
A 75-year-old man with a permanent ileostomy presented with recurrent gallstone ileus that was treated successfully with removal of the stones via the stoma.
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Neuromyelitis optica spectrum disorder presenting in an octogenarian
This case describes an 81-year-old woman with a history of Sjögren's syndrome presenting with recurrent falls and poor balance. She subsequently developed new and rapidly evolving neurology including hyperaesthesia, spastic paraplegia and sphincteric dysfunction. Following serial clinical reviews and detailed investigations, MRI (brainstem and cervicothoracic spine) and a seropositive result for aquaporin 4 IgG, a diagnosis of neuromyelitis optica spectrum disorder (NMOSD) was made. This case describes the clinical course of this index patient with an unusual late age of onset. The report also includes a discussion on NMOSD. We review aspects of terminology, brief epidemiology, pathogenesis, notable autoimmune associations, variance in clinical presentation and current diagnostic criteria. We also review the importance of distinguishing NMOSD from multiple sclerosis in view of the significant implications for treatment and prognosis.
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Effect of halo-type frontal cockpit protection on overtaking
In 2018, the Fédération Internationale de l'Automobile introduced the halo frontal cockpit protection system into Formula 1. While extensive testing was conducted to confirm that the halo protects the driver from contact, the halo's effect on the driver during overtaking was not tested prior to its introduction. Here, we describe the effect of a halo-type structure on the neck muscle activity of one of the authors, a national-level amateur racing driver, during on-track simulations designed to practise overtaking. We found that the halo-type structure caused an increase in the rates of fatigue and workloads of sternocleidomastoid and cervical erector spinae. The results suggest that the driver adopted a forward and right laterally flexed head position, presumably to clear the central pillar from his visible field. This has the potential to increase compressive loading of the cervical spine and affect the ability to use visual cues during steering manoeuvres.
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Adjuvant conundrum in central mucoepidermoid carcinoma of the mandible: case presentation and literature review
The cornerstone modality of treatment of central mucoepidermoid carcinoma (CMEC) of the mandible is surgery, optimally, an en bloc resection with/without segmental or hemimandibulectomy. Notwithstanding the documentation of a survival benefit in few case reports with the addition of postoperative radiotherapy in carefully selected high-risk patients, there does not exist a clearly defined consensus regarding the role of adjuvant radiotherapy. We report the case of a 49-year-old man who presented with right lower jaw swelling which on imaging was found to be a multiloculated lesion causing bony expansion and cortical destruction of the mandible and was diagnosed with CMEC after radiological and histopathological criteria were met. He underwent right hemimandibulectomy and histopathology showed squamous and mucinous cells with positive mucicarmine staining and characteristic immunohistochemistry markers confirming the diagnosis of CMEC. He subsequently underwent adjuvant radiotherapy and is disease free 5 years since treatment completion.
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Neuroblastoma with flat genomic profile: a question of representativity?
Neuroblastoma is one of the most common paediatric malignancies. Detection of somatic genetic alterations in this tumour is instrumental for its risk stratification and treatment. On the other hand, an absence of detected chromosomal imbalances in neuroblastoma biopsies is difficult to interpret because it is unclear whether this situation truly reflects the tumour genome or if it is due to suboptimal sampling. We here present a neuroblastoma in the left adrenal of a newborn. The tumour was subjected to single-nucleotide polymorphism array analysis of five tumour regions with >80% tumour cells in histological mirror sections. This revealed no aberrations compared with a normal reference sample from the patient. Whole exome sequencing identified two single-nucleotide variants present in most tumour regions, corroborating that the tumour resulted from monoclonal expansion. Our data provide proof-of-principle that rare cases of neuroblastoma can have a normal whole genome copy number and allelic profile.
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Unusual cause for small bowel obstruction
Description
Foreign body ingestion is a common occurrence. Although over 80% of ingestions resolve spontaneously, approximately 1% of cases will require open surgical intervention. We present a rare case of foreign body ingestion in an 18-year-old man causing distal mechanical small bowel obstruction, requiring exploratory laparotomy and enterotomy.
An 18-year-old man with no significant medical history and no previous abdominal operations presented to a regional hospital with a 5-day history of persistent nausea, vomiting, absolute constipation and generalised abdominal pain. On clinical examination, he was tachycardic (116 beats/min) with a low-grade temperature (37.8°C), and had abdominal distension with central abdominal guarding. Plain films showed dilated loops of small bowel, consistent with small bowel obstruction. White cell count was 7.5x109/L and C reactive protein was 74 mg/L.
Subsequent evaluation with a CT scan demonstrated appearance of small bowel obstruction with at least one transition point in the left lower abdomen, with...
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Intraoperative Mortality in Malawi
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Radiation Safety Perceptions and Practices Among Pediatric Anesthesiologists: A Survey of the Physician Membership of the Society for Pediatric Anesthesia
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Perioperative Considerations for Evolving Artificial Pancreas Devices
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Evaluation of the Determinants of Satisfaction With Postoperative Pain Control After Thoracoscopic Surgery: A Single-Center, Survey-Based Study
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Elevated Presepsin Is Associated With Perioperative Major Adverse Cardiovascular and Cerebrovascular Complications in Elevated-Risk Patients Undergoing Noncardiac Surgery: The Leukocytes and Cardiovascular Perioperative Events Study
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National Trends and Factors Associated With Inpatient Mortality in Adult Patients With Opioid Overdose
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Nighttime Extubation Does Not Increase Risk of Reintubation, Length of Stay, or Mortality: Experience of a Large, Urban, Teaching Hospital
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A Study of Practice Behavior for Endotracheal Intubation Site for Children With Congenital Heart Disease Undergoing Surgery: Impact of Endotracheal Intubation Site on Perioperative Outcomes—An Analysis of the Society of Thoracic Surgeons Congenital Cardiac Anesthesia Society Database
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Pharmacokinetics of Dexmedetomidine in Infants and Children After Orthotopic Liver Transplantation
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An In Vitro Model for Identifying Cardiac Side Effects of Anesthetics
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Transversus Abdominal Plane Block in Children: Efficacy and Safety A Randomized Clinical Study and Pharmacokinetic Profile
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Role of Endocannabinoid System in the Peripheral Antinociceptive Action of Aripiprazole
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What Is New in Obstetric Anesthesia: The 2017 Gerard W. Ostheimer Lecture
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Pupillary Pain Index Changes After a Standardized Bolus of Alfentanil Under Sevoflurane Anesthesia: First Evaluation of a New Pupillometric Index to Assess the Level of Analgesia During General Anesthesia
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