Few cases of anal canal Merkel cell Carcinoma have been reported in the literature. Merkel Cell Carcinoma is rare neuroendocrine tumor which commonly found in sun-exposed areas such as extremities. We describe a case of 74-year-old male with anal canal Merkel Cell Carcinoma. He presented with peri-anal pain, tenesmus and itching. Besides, he was found to have chronic anemia. An anal nodule was found during per-rectum physical examination that was excised during endoscopy. Histological examination of the nodule confirmed the diagnosis of Merkel Cell Carcinoma. Thenceforward, patient died 7 months after diagnosis with marked metastatic disease despite initiation of Pembrolizumab therapy.
Burkitt Lymphoma of Central Nervous System in an elderly-patient: A new approach with a modified classic regimen
Burkitt’s lymphoma (BL) is one of the high-grade lymphomas, characterized by a rapid growth. They are usually treated with intensive chemotherapy regimens, being normally chemo-sensitive, but at the expense of high toxicity secondary to treatment. Additionally, the compromise of the central nervous system (CNS) implies a major risk as well as greater toxicity, taking into account a worse clinical prognosis with a requirement of more intensive schemes to achieve control of the disease. This implies doubts in the management of older patients with BL with CNS compromise, in whom toxicity is a limitation to these therapies, and there are no other alternatives that offer better benefit in terms of less frequent or severe adverse events, with similar outcomes in terms of progression-free survival (PFS) or overall survival (OS). Therefore, clarifying cases such as the one we report below allows us to provide a therapeutic alternative for older or unfit patients, in whom the intention of treatment should be to seek a good tumor response, but without ignoring the potential toxicity of chemotherapy.
Introduction: This manuscript will dealt with the outcome of emergency surgeries in COVID19 positive individuals. We are under the second wave of COVID pandemic. The research is ongoing regarding the outcome of patients who are undergoing, surgical treatment with COVID Rt-PCR positivity or become COVID positive during early postoperative period. Materials and Methods: All the patients who attended the emergency department of a tertiary care centre were screened for COVID -19 by RT-pcR and the patients who are COVID positive but needed emergency surgical procedure were included in the study. A cohort of 49 patients who were COVID positive and needed emergency surgical procedure due to various causes were included in the study. Results:The causes of acute surgical emergencies were acute appendicitis, appendicular perforation, perforative peritonitis, obstructed/ strangulated inguinal hernia, intestinal obstruction, diabetic foot and perianal abscess. Most of the patients belong to the age group between 40 – 70 years. 63.8% were males. The mortality rate was 12.8%. More than one co-morbid condition was present in 8.5% of individuals. Most of the patients got discharged in 10 – 12 days. 40.4% have co morbid conditions like diabetes or hypertension. 8.5% had more than one co morbid conditions. Diabetes was present in 27.7% of cases Conclusion: The mortality was high during the postoperative period of COVID positive cases, extreme care and precaution should be taken to avoid pulmonary complications
Successful treatment for intra-abdominal bleeding due to spontaneous rupture of huge liver cyst using transcatheter arterial embolization: a case report
Background: Non-parasitic simple liver cysts are one of the most common benign hepatic lesions. Although most liver cysts are asymptomatic and remain silent throughout the patient’s life, extremely large cysts can become symptomatic by direct compression to adjacent organs. Herein, we report a case of a spontaneously ruptured simple liver cyst, which is a rare presentation of a benign liver cyst. The patient’s liver cyst re-ruptured and was treated with transcatheter arterial embolization (TAE). Case report: A 62-year-old man presented to our hospital complaining of acute-onset lower abdominal pain. He had undergone laparoscopic fenestration of a huge liver cyst in another hospital 2 years prior. Computed tomography (CT) scan showed spontaneous rupture of a large liver cyst. Laparoscopic exploratory laparotomy showed no signs of ongoing intra-abdominal bleeding from the liver cyst; therefore, the operation was completed with peritoneal lavage. The patient was discharged from our hospital on postoperative day 5. Twelve days after the initial presentation, the patient was re-admitted to our hospital complaining of recurrence of lower abdominal pain. CT scan showed an enlargement of the previously ruptured liver cyst, with intra-abdominal bleeding and massive hematoma in the cyst. Extravasation of the cyst’s wall was also detected. Under the diagnosis of intra-abdominal bleeding from the artery in the wall of the huge cyst, emergent TAE was performed. Although the exact spot of extravasation was not detected, the anterior segment branch of the right hepatic artery, which corresponds to extravasation shown on the CT scan, was embolized. The patient was discharged from our hospital after 7 days, and the liver cyst remained stable without abdominal pain for more than 2 months. Conclusions: This case highlights a rare presentation of spontaneous rupture of a liver cyst with massive bleeding and the efficacy of TAE for the conservative treatment of ruptured liver…
Laparoscopic approach for pancreato-splenic abscess from disseminated melioidosis: Surgical outcome and review of literature
Melioidosis is a severe systemic infection caused by Burkholderia pseudomallei. It commonly affects the lungs, liver and kidneys. Pancreatic and splenic abscess from melioidosis is rare, with few reports in the literature. We present a series of 4 patients with disseminated melioidosis of pancreas and spleen who required surgical intervention. A MEDLINE database review was conducted. Relevant publications were evaluated and demographic data, clinical, radiological findings as well as management options were collected. We found 10 case reports describing this clinical condition. In our series, median age was 57. Median operative time 260 minutes. All four patients failed trial of antibiotic therapy and required surgery. Three underwent distal pancreatosplenectomy and one underwent splenectomy alone. Laparoscopic distal pancreatosplenectomy was successful in two patients. Median length of stay 11.5 days. No post-operative complications and mortality reported. Surgery is indicated in failed medical therapy and laparoscopic approach is safe and feasible.
Traditional Chinese Medicine (TCM) is based on the belief of vital energy (qi) within the body and attributes disease with imbalance in energies (yin and yang). The COVID-19 pandemic has necessitated unique physical barriers, including increased physical distancing, use of personal protective equipment (PPE), and telehealth services, which complicate existing efforts to understand alternative health practices. This case report highlights the importance of cultural competency training for healthcare providers, as evident in improved patient care when recognizing and acknowledging TCM customs in association with the COVID-19 pandemic.
Effect of RevX solution adjunct to standard therapy in a patient with metastatic lung adenocarcinoma: A case report
RevX solution is a liquid fermented grain extract obtained through a unique extraction technology, and its ingredients contain phytosterols, sulfonamides, organic acids, and anti-inflammatory substances. The adjunct treatment of RevX for lung adenocarcinoma has not yet been surveyed in vitro or in vivo experiments. A 71-year-old woman was diagnosed with lung adenocarcinoma. She underwent the targeted therapy and continually took the RevX solution (3 to 5 ml per day). Sixteen months after diagnosis and targeted therapy, multiple lung metastases appeared. After the second-line targeted therapy and wedge resection for 16 months, the patient was still alive. The distinct improvement of hypodynamia and fewer complication was found during targeted therapy treatment complemented with the RevX solution for longer than 4 years. Thus, the RevX solution might potentially be an adjuvant therapy for patients with metastatic lung adenocarcinoma.
Treatment of oversize and recurrent pancreatic pseudocyst after an episode of acute pancreatitis: a case report and review management
Pancreatic cysts are being diagnosed more frequently because of the increasing usage of multiple noninvasive imaging modalities. Moreover, pancreatic pseudocysts (PPs) present a challenging problem for physicians dealing with pancreatic disorders, especially in cases where their treatment will be required. The diagnosis of a PP needs imaging with ultrasonography, Computed Tomography (CT) scan or Magnetic Resonance Imaging (MRI). In most cases, pancreatic pseudocysts are asymptomatic and resolve spontaneously. [1-3] Asymptomatic PPs up to 6 cm in diameter can be safely observed and monitored with serial imaging. If they evolve and increase in size, they become symptomatic through compression of the adjacent organs and need interven-tion.[1, 4-6] Their management demands the cooperation of surgeons, radiologists and gastroenterolo-gists. The treatment of PPs has evolved considerably over the past decade, moving from what was once open surgical management to increasingly minimally invasive techniques, both by surgery and by endoscopy. Thus, many studies have reported successful drainage through the use of various techniques.[1, 3, 4] However, the absence of a large number of cases as well as guidelines for dealing with them raise even today dilemmas regarding the treatment of choice. Here we present a case of a large pancreatic pseudocyst and a brief review of the literature.
Uterine wall rupture is a rare yet catastrophic complication of pregnancy with a high mortality rate of both the mother and the fetus. The condition could be classified according to etiology into primary unscarred uterus, and secondary scarred uterus or according to the site of rupture. Our case presented with scarred uterine rupture through a posterolateral injury. The patient had history of 3 previous CS and a D&C procedure. The rupture was complicated by EIV injury. Uterine rupture does not always present with profound manifestations of shock especially in posterior wall rupture and timely management ensures the best possible outcome. Finally, meticulous examination of the anatomically related structures and vessels, and the repair of any associated injuries, is essential.
Bilateral acute renal infarction treated by endovascular therapy: A case report and literature review
Renal infarction is a rare emergency and the estimated incidence is extremely low according to the literature. In addition, simultaneous bilateral renal infarction was only about 20% in these rare cases. Herein we reported a case of acute renal failure related to bilateral renal infarction and successfully treated by endovascular therapy including angioplasty and catheter-directed thrombolysis. His renal function also significantly improved after the intervention. This rare case reminds physician that early endovascular therapy might improve renal function and result in better renal outcome for patients with simultaneous bilateral renal infarction.