New Horizons in Clinical Case Reports最新文献

{"title":"Survival of the Unfittest: A case of End-Stage Heart Failure and advanced esophageal cancer managed successfully with an implantable Left Ventricular Assist Device (LVAD) and aggressive chemoradiation therapy","authors":"Louis Samuels * ,&nbsp;Elena Casanova-Ghosh ,&nbsp;Steve Domsky ,&nbsp;Christopher Droogan ,&nbsp;Zonera Ali","doi":"10.1016/j.nhccr.2017.10.003","DOIUrl":"10.1016/j.nhccr.2017.10.003","url":null,"abstract":"<div><h3>Introduction</h3><p>End-stage heart failure and advanced esophageal cancer carry an extremely poor prognosis with a disabling quality of life (QOL). Individually, the 3-year survival is poor; simultaneously, it is unreported, but predictably dismal. LVAD implantation as Destination Therapy (DT) for non-transplant candidates has proven to prolong survival with an improved QOL. However, some DT-LVAD patients have survived their cardiovascular condition only to discover that they have serious malignancies. Treatment of these cancers in an LVAD patient is challenging. Anecdotal reports are beginning to appear in the literature as the DT-LVAD patient population continues to grow.</p></div><div><h3>Case description</h3><p>A 72 year-old man with end-stage heart failure was implanted with a Heartmate II® LVAD as Destination Therapy. The surgery was uneventful and he was discharged on postoperative day 16. Seven months later, he developed melena and was found to have an ulcerated mass at the gastroesophageal (GE) junction that was pathologically adenocarcinoma. CT/PET scanning and upper endoscopic sonography staged the disease at III (T3N1M0). Subsequent imaging showed a lytic L4 lesion that was biopsy proven metastatic disease. Due to the presence of the LVAD, the patient was not a surgical candidate for resection. Treatment consisted of chemoradiation therapy in the following manner: Two cycles of Paclitaxel (Taxol®)-Carboplatin followed by Paclitaxel-Carboplatin with radiation therapy (XRT) to the GE junction for six weeks followed by maintenance Folinic Acid-Oxaliplatin-Fluorouracil (FOLFOX 6) every two weeks. Drug dosing was modified in accordance with complete blood count (CBC) results. Serial PET scans were performed to assess efficacy, showing a range of complete absence of abnormal ¹⁸F-FDG uptake to occasional uptakes in various locations with mild to moderately elevated maximal SUV units. At present, the patient is alive with a good QOL approximately 3.5 years from LVAD implantation and 3 years from esophageal cancer diagnosis.</p></div><div><h3>Results and Conclusions</h3><p>Multi-disciplinary therapies were instituted to treat two lethal conditions: end-stage heart failure and advanced esophageal cancer. The combination of medical therapy with chemotherapy, interventional therapy with radiation, and surgical therapy with an LVAD proved efficacious in this otherwise fatal case. As more patients with end-stage heart failure are implanted with LVADs - particularly for DT - the likelihood of non-cardiac conditions will undoubtedly appear cancer among them. The challenge will be to determine how to best approach these conditions. This case illustrates the power of a collaborative approach in the management of this complex problem.</p></div><div><h3>Take home message</h3><p>The use of the implantable LVAD has enabled patients with end-stage heart failure to live longer and with an improved QOL. As a result of not dying from heart","PeriodicalId":100954,"journal":{"name":"New Horizons in Clinical Case Reports","volume":"2 ","pages":"Pages 20-21"},"PeriodicalIF":0.0,"publicationDate":"2017-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.nhccr.2017.10.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83019546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The chemo brain: Severe cognitive decline following chemotherapy of breast cancer","authors":"Wolfgang P. Kaschka ,&nbsp;Jürgen Steyer ,&nbsp;Iris N. Kaschka ,&nbsp;Martin Jandl ,&nbsp;Steve Hodgkinson","doi":"10.1016/j.nhccr.2017.05.001","DOIUrl":"10.1016/j.nhccr.2017.05.001","url":null,"abstract":"","PeriodicalId":100954,"journal":{"name":"New Horizons in Clinical Case Reports","volume":"2 ","pages":"Pages 4-6"},"PeriodicalIF":0.0,"publicationDate":"2017-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.nhccr.2017.05.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81683980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Standard versus minimally invasive transforaminal lumbar interbody fusion: A prospective randomized study","authors":"Gabriel Tender * ,&nbsp;Daniel Serban ,&nbsp;Anthony DiGiorgio","doi":"10.1016/j.nhccr.2017.10.018","DOIUrl":"https://doi.org/10.1016/j.nhccr.2017.10.018","url":null,"abstract":"<div><h3>Introduction</h3><p>Symptomatic spondylolisthesis patients may benefit from surgical decompression and stabilization. The standard (S) technique is a transforaminal lumbar interbody fusion (TLIF). Newer, minimally invasive (MI) techniques seem to provide similar results with less morbidity. However, prospective studies comparing S versus MI TLIF are rare.</p></div><div><h3>Case description</h3><p>Patients with at least 6 months of symptoms and image-confirmed low-grade spondylolisthesis (grade 1 or 2) were enrolled, at a single academic institution, between 2011 and 2015. The patients were randomized to either S or MI TLIF. Iliac crest graft, polyether ether ketone (PEEK) interbody cages, and pedicle screw-rod constructs were used in both groups. The primary outcome measure was the Oswestry Disability Index (ODI) improvement at 1 year. Secondary outcome measures included length of operation, estimated blood loss, length of hospitalization, and fusion rates at 1 year. Complications were also recorded.</p></div><div><h3>Results and Conclusions</h3><p>Forty patients were enrolled in each group. There was no crossover between groups. The age was 50.12+/-11.09 years in the S TLIF group and 51.3+/-9.36 years in the MI TLIF group. There were 23 and 24 females in the S and MI TLIF group, respectively. The mean operative time and estimated blood loss in the S versus MI TLIF group were 297+/-101 versus 323 +/-85 minutes and 417+/-211 versus 351+/-198 ml, respectively. There were 4 transfusions in the S TLIF and 3 transfusions in the MI TLIF group. The patients were discharged after surgery at 4.12+/-0.88 days for the S TLIF group and 1.92+/-0.52 days for the MI TLIF group. The ODI improved from 37+/-6 to 11+/-6 in the S TLIF group (ODI difference: 26+/-7) and from 38+/-7 to 11+/-6 in the MI TLIF group (ODI difference: 26+/-8). The fusion was considered solid (Grade I) in 36 (90%) and partial (Grade II) in 4 (10%) patients at 1 year. There were no reoperations for pseudarthrosis or any other postoperative complication. There were 2 superficial wound infections in the standard TLIF group, which resolved with oral antibiotic treatment alone.</p></div><div><h3>Take home message</h3><p>In this prospective randomized study, the standard and minimally invasive TLIF in patients with symptomatic spondylolisthesis provided similar clinical and radiological outcomes at 1 year. The patients undergoing MI TLIF had a shorter hospital stay. Both surgical techniques yielded good results at 1 year.</p></div>","PeriodicalId":100954,"journal":{"name":"New Horizons in Clinical Case Reports","volume":"2 ","pages":"Page 27"},"PeriodicalIF":0.0,"publicationDate":"2017-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.nhccr.2017.10.018","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91994133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case report: A rare presentation of right illiac fossa pain","authors":"Abida Sultana *,&nbsp;Ahmed Saad,&nbsp;Yan Mei Goh,&nbsp;Kyi Toe","doi":"10.1016/j.nhccr.2017.10.026","DOIUrl":"10.1016/j.nhccr.2017.10.026","url":null,"abstract":"<div><h3>Introduction</h3><p>Duplex appendix is a rare congenital abnormality with an incidence of 2 in 50,000. Incidences of duplex appendicitis are a rare but recognised phenomenon. Unusual presentation of this congenital abnormality can lead to delays in diagnosis and management.</p></div><div><h3>Case description</h3><p>A 42-year-old male presented with a two-day history of right iliac fossa pain and raised inflammatory markers. He underwent diagnostic laparoscopy where a normal appendix was seen. Laparoscopic appendicectomy was not performed. He represents several years later with similar symptoms and another diagnostic laparoscopy was performed revealing a normal appendix. Subsequent laparoscopic appendicectomy was performed which was histopathology confirmed as a normal appendix. His symptoms did not improve after surgery and he developed localised guarding in the right iliac fossa, low grade pyrexia, tachycardia and raised inflammatory markers. An ultrasound scan was performed which was unremarkable. Computed tomography (CT) abdomen revealed a small collection from which extended a thin tubular structure ending in the terminal ileum. A third diagnostic laparoscopy was performed. The small collection was not identified and conversion to midline laparotomy revealed a second necrotic friable appendix leading to a retrocaecal and retroileal cavity (abscess). This was confirmed on histopathology to be a gangrenous appendix with secondary peritonitis. He was discharged from hospital several days post-operatively. A year later he represented to our services with an incisional hernia which was repaired laparoscopically.</p></div><div><h3>Conclusions</h3><p>Dual appendix is a well described but rare congenital abnormality that is well described by the Cave-Wellbridge classification. This congenital abnormality is often recognised incidentally at surgery or on post-mortem examination. Radiological studies are often not useful aids in making the diagnosis of duplicate appendix. Hence the possibility of a duplex appendix should be considered and sought during diagnostic laparoscopy performed in patients presenting with recurrent right iliac fossa symptoms.</p></div>","PeriodicalId":100954,"journal":{"name":"New Horizons in Clinical Case Reports","volume":"2 ","pages":"Page 30"},"PeriodicalIF":0.0,"publicationDate":"2017-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.nhccr.2017.10.026","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74929845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-union of paediatric carpal fractures: A case report and current concepts review","authors":"Scarlet Nazarian *,&nbsp;Ashley Simpson,&nbsp;Gavin Schaller,&nbsp;Rajiv Bajekal","doi":"10.1016/j.nhccr.2017.10.009","DOIUrl":"10.1016/j.nhccr.2017.10.009","url":null,"abstract":"<div><h3>Introduction</h3><p>Paediatric carpal bone fractures are rare, and usually secondary to significant direct trauma. Diagnosis can commonly be missed or the significance of the injury not completely recognised on presentation. During development, the ossification centre of each individual carpal bone is surrounded by a spherical growth plate. This acts as a protective barrier against injury. As the child reaches adolescence the critical bone-to-cartilage ratio is reached, and so, carpal bone fractures start to become more common.</p></div><div><h3>Case description</h3><p>A 12 year-old boy presented to the emergency department with right wrist pain following a fall from his bicycle while travelling at speed. The impact was sustained directly on to an outstretched hand, resulting in a closed injury. Radiographs demonstrated a dorsally displaced Salter-Harris III fracture of the distal radius with associated displaced fractures of the ulna styloid and lunate. The patient reported reduced sensation and tingling in the thumb, index and radial aspect of middle finger consistent with the distribution of the median nerve. Motor supply was intact. The fracture was initially mobilised with a dorsal plaster slab. The patient was taken to theatre the following morning for manipulation under anaesthetic and plaster immobilisation. Satisfactory reduction of the distal radius fracture was achieved with the lunate and ulnar styloid fractures not addressed. Median nerve symptoms improved somewhat following the procedure but did not completely resolve. At 10 days post-operatively check radiographs demonstrated the distal radius fracture reduction to be maintained and the plaster cast was changed to a lightweight below elbow full cast which remained in situ for 6 weeks. Radiographs at 6 weeks demonstrated union of the distal radius fracture but no signs of healing of the ulnar styloid or lunate fractures. Median nerve sensory symptoms had improved. The cast was removed and range of motion exercises begun. An MRI was performed showing a non-united fracture of the lunate without signs of avascular necrosis. The patient is now 6 months post-op and currently asymptomatic with a full painless range of motion. He has returned to his pre-morbid level of function being actively involved in physical education at school and reports no pain in the wrist or functional deficit. Radiographs continue to demonstrate a lunate non-union.</p></div><div><h3>Results and Conclusions</h3><p>Paediatric lunate fractures are very rare, and as a result there is very little published literature available. Previous case reports have demonstrated good long-term results from both conservative and operative management of paediatric carpal fractures. A case report by Bhatnagar et al. highlighted a good clinical outcome with non-operative treatment of an active 11-year old boy with multiple carpal fractures. They demonstrated asymptomatic full range of motion of the wrist at 3 years follow-u","PeriodicalId":100954,"journal":{"name":"New Horizons in Clinical Case Reports","volume":"2 ","pages":"Pages 23-24"},"PeriodicalIF":0.0,"publicationDate":"2017-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.nhccr.2017.10.009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74210323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Twisted \"appendix epiploica\" as extraordinary cause of discomfort at the right lower abdomen and rare differential diagnosis of acute appendicitis - a representative case","authors":"Stefan Schäfer * ,&nbsp;Benjamin Garlipp ,&nbsp;Cora Wex ,&nbsp;Inken Häusler ,&nbsp;Stephan Arndt ,&nbsp;Björn Friebe ,&nbsp;Dörthe Jechorek ,&nbsp;Frank Meyer","doi":"10.1016/j.nhccr.2017.10.035","DOIUrl":"10.1016/j.nhccr.2017.10.035","url":null,"abstract":"<div><h3>Introduction</h3><p>Appendicitis can be considered the most frequent cause of discomfort at the right lower abdomen. Simultaneously, it is the most frequent indication for a surgical intervention. In addition, there is a broad spectrum of differential diagnoses, which can lead to a very challenging finding-specific management in good time as found out in the presented case.</p></div><div><h3>Case description</h3><p>A 44-year old female patient was transfered to the surgical department because of discomfort of the right lower abdomen with changing intensity which had persisted since the day before. Patient showed a reduced but stable clinical status (normosomic nutritional status; no relevant accompanying diseases). Previous oral nutrition was normal. Clinical examination revealed pain by palpation at the right lower abdomen. Laboratory parameters: White blood cell count, 8.2Gpt/L; CrP, 10.4mg/L; urine with no pathological finding; no increased serum β-HCG level. Transabdominal ultrasound as orienting initial imaging detected free fluid around the cecum and along the right iliac vessels (appendiceal diameter, approximately 6.5mm) – in summary, no sign of appendicitis with certainty. Because of a persisting symptomatology, indication for a surgical intervention was derived (intraoperatively, laparoscopic appendectomy and partial resection of the greater omentum). Postoperative course was uneventful (no general/specific complications, wound healing was properly, initiation of oral nutrition and mobilization were well tolerated). Pathohistological investigation revealed lipofibromatosis of the appendage of the cecum with attached necrotic fat tissue and hemostasis, which can be associated with the diagnosis of a twisted appendix epiploica (no hint for malignant tumor growth).</p></div><div><h3>Results and Conclusions</h3><p>The finding as presented occurs very rarely (approximately, 0.2%), which was initially misinterpreted as appendicitis with regard to symptomatology, ultrasound and laboratory findings. A definite diagnosis became only possible during the postoperative course by pathohistological investigation (suspicion already raised by intraoperative inspection aspects). Taking the final diagnosis into account, the question of a necessary indication for surgical intervention can be brought up, which can not be circumvented in case of unclear findings and medical history according to the surgical policy (“case of doubt“). However, as a consequence a more intense and extended diagnostic including a well developed clinical experience level as well as the clinical suspicion can be derived and concluded. This was an exciting and instructive case from a didactic point of view (relevant also for medical students) with rare occurrence in daily clinical practice, which includes the whole spectrum of differential diagnoses of i) unclear discomfort at the right lower abdomen in general and ii) acute appendicitis specifically.</p></div>","PeriodicalId":100954,"journal":{"name":"New Horizons in Clinical Case Reports","volume":"2 ","pages":"Page 34"},"PeriodicalIF":0.0,"publicationDate":"2017-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.nhccr.2017.10.035","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83672322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case report of metastatic renal oncocytoma","authors":"Gionathan Amante *,&nbsp;Yan Mei Goh,&nbsp;Henry Andrews","doi":"10.1016/j.nhccr.2017.10.014","DOIUrl":"10.1016/j.nhccr.2017.10.014","url":null,"abstract":"<div><h3>Introduction</h3><p>Renal oncocytomas are renal tumours that are largely considered to be benign. They represent 5.5% of all renal tumours and the age-standardised incidence is 0.3 per 100,000/year in men and women.¹ Despite this, there have been reported cases where these tumours have developed metastases. We report the case of a patient who had a right radical nephrectomy for renal oncocytoma who then presents nine years later with a pathological neck of femur (NOF) fracture secondary to metastases, suggesting malignant behaviour of the tumour.</p></div><div><h3>Case description</h3><p>A 62-year-old lady presented in December 2010 with shortness of breath on exertion, frontal headache and malignant hypertension. She was treated with Ramipril and her blood pressure subsided. On discharge she underwent further investigations, including 24hour urine catecholamine test – (normal), and abdominal ultrasound which revealed a mass in the right kidney. Computerized tomography (CT) confirmed a well-defined lower pole right renal solid mass measuring 7.5x5.7cm, extending to the renal pelvis with compression of the vascular pedicle. There was no evidence of extrarenal extension. Renal cell carcinoma stage T2 was suggested. She underwent a right laparoscopic nephrectomy and recovered well from the operation. Histology confirmed oncocytoma with atypical features of extrarenal invasion, absence of Hale’s colloidal blue staining, negativity for cytokeratin 7 and positive vimentin staining. This patient had yearly follow-up CT. Four years after her first surgery, a nodule was noted in the right nephrectomy bed. Surgical excision confirmed recurrent oncocytoma. Two years after this she presented with pathological fracture of her right neck of femur. A bone biopsy confirmed metastatic disease. She had a dynamic hip screw fixation.</p></div><div><h3>Results and Conclusions</h3><p>The World Health Organization classifies renal oncocytoma as benign neoplasm.² Nevertheless there are case reports of metastatic disease in these tumours. Studies have revealed a classical pattern with typical features of benign neoplasia in 57.5-67% of cases. Malignant features such as atypical histological pattern, focal necrosis, multinucleation, mitotic activity, degenerative atypia and invasion of extrarenal fat have been described in others. Despite this, not all patients with such features progress to developing metastatic disease at 5-year follow-up. In fact only 2 patients out of 42 with atypical features developed metastatic disease.³ This suggests that there is a potential for metastatic transformation of this tumour, especially in the group with features of atypia. There is a however, paucity of information in published literature regarding this. The risk stratification of these atypical features will be a good start. Clearly, further research by way of genetic assessment, including chromosomal and tumour markers is required, as part o","PeriodicalId":100954,"journal":{"name":"New Horizons in Clinical Case Reports","volume":"2 ","pages":"Pages 25-26"},"PeriodicalIF":0.0,"publicationDate":"2017-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.nhccr.2017.10.014","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91040489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraosseous lipoma of the calcaneus: The non-stereotypic lesion of the bone","authors":"A. Sani,MH,&nbsp;MY Bajuri,&nbsp;MH Shukur","doi":"10.1016/j.nhccr.2017.03.001","DOIUrl":"10.1016/j.nhccr.2017.03.001","url":null,"abstract":"<div><h3>Background</h3><p>Intraosseous lipoma is one of the rarest benign bone tumour. They have been identified in the tibia, fíbula, metatarsals, and calcaneal. They are easily misdiagnosed as the clinical presentation is nonspecific and can mimic other ligamentous or soft tissue injury.</p></div><div><h3>Case presentation</h3><p>We described a 40-year-old patient with a chronic dull pain at sole of foot without significant physical findings apart from minimal swelling over the lateral ankle and local tenderness over the anterior talofibular ligament, lateral talocalcaneal joint and minimal pain at the base of left heel. MRI revealed features of suggestive of anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) sprain with incidental finding of calcaneal intraosseous lipoma. Intraosseous calcaneal lipoma was treated with surgical curettage and bone graft due to the non-resolving nature of the pain despite conservative effort. Patient was symptom free and bony consolidation was visible in radiographs. No evidence of local recurrence seen and patient able to return to normal daily activities without any restrictions. Intraosseous lipoma of the calcaneus is an even rarer subset of osteolipoma and is often identified incidentally during radiologic examination, having no specific symptoms besides heel pain at the worst. Diagnosis is usually made accidentally on radiographs images. CT or MRI scans are used to confirm the fatty nature of the lipoma.</p></div><div><h3>Conclusions</h3><p>Intraosseous lipoma of the calcaneal is very infrequent benign tumour-like lesion that can appear with pain but can also be asymptomatic and discovered incidentally by imaging investigation. To reach the diagnosis it is usually enough to have simple x-ray and CT or MRI. It has good prognosis, usually it improves with rest and analgesia. On occasions, excision and curettage of tumour and bone grafting, or cementation can be necessary as treatment modalities in cases that failed conservative management.</p></div>","PeriodicalId":100954,"journal":{"name":"New Horizons in Clinical Case Reports","volume":"2 ","pages":"Pages 1-3"},"PeriodicalIF":0.0,"publicationDate":"2017-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.nhccr.2017.03.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79270684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perianal mucinous adenocarcinoma presenting as recurrent perianal sepsis","authors":"Zulfiqar Hanif *,&nbsp;Kumaran Shanmugarajah,&nbsp;Simon Middleton","doi":"10.1016/j.nhccr.2017.10.036","DOIUrl":"10.1016/j.nhccr.2017.10.036","url":null,"abstract":"<div><h3>Introduction</h3><p>Mucinous adenocarcinoma can rarely present as recurrent perianal sepsis and may be defined by specific neoplastic involvement of perianal tissue in the absence of rectal mucosal carcinoma. It accounts for less than 5% of tumours in this region. These tumors are usually well-differentiated and present late because of their insidious slow growing nature. These lesions are often mistaken for a benign condition like perianal fistula and abscess. Neoadjuvant radiotherapy and radical resection of mucinous adenocarcinoma with abdominoperineal resection is the treatment of choice. We present such a case along with a review of literature concerning its etiopathology.</p></div><div><h3>Case description</h3><p>A 68-year-old man presented with 6 episodes of perianal sepsis over the course of a year. He had no history of previous perianal sepsis, diabetes or Crohns disease. His past medical history included ischaemic heart disease. He was a previous smoker, with a 20-pack year smoking history. The patient underwent examination under anaesthetic and incision and drainages of perianal abscesses on multiple occasions. A pelvic MRI scan demonstrated the fistulous tract and a chronic abscess. Initial biopsies taken from the rectal mucosa and fistula tract were unremarkable. However, biopsies taken during his sixth examination under anaesthetic revealed mucinous adenocarcinoma.</p></div><div><h3>Results</h3><p>Patient had neoadjuvant radiotherapy followed by curative abdominoperineal resection (APR) with satisfactory outcome.</p></div><div><h3>Take home message</h3><p>Expeditious identification and management is associated with favourable outcomes. In patients presenting with ongoing perianal sepsis, one should have high index of suspicion and the diagnosis of mucinous adenocarcinoma should be considered.</p></div>","PeriodicalId":100954,"journal":{"name":"New Horizons in Clinical Case Reports","volume":"2 ","pages":"Page 34"},"PeriodicalIF":0.0,"publicationDate":"2017-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.nhccr.2017.10.036","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79206347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emphysematous pyelonephritis - Is surgery necessary?","authors":"Joseph Butler,&nbsp;Ree'Thee Bhatt,&nbsp;Gionathan Amante *","doi":"10.1016/j.nhccr.2017.10.024","DOIUrl":"10.1016/j.nhccr.2017.10.024","url":null,"abstract":"<div><h3>Introduction</h3><p>Emphysematous pyelonephritis is a rare, life threatening acute suppuration of the kidney, characterised by the presence of air in the renal parenchyma, sometimes extending to the surrounding tissue. <em>E. Coli</em> and <em>Klebsiella</em> are the most common causative organisms, but the exact pathogenesis is poorly understood. It carries a high mortality, cited up to 50% and therefore requires prompt diagnosis and management.</p></div><div><h3>Case description</h3><p>A 52-year old woman presented to A&amp;E with a two day history of severe left-sided abdominal pain, rigors, vomiting and increased urinary frequency. Her past medical history was significant for non-insulin dependent Type 2 diabetes mellitus, a well-established risk factor that is present in 90% of cases. On examination, she had marked left flank tenderness, tachycardia and pyrexia. Bloods showed raised inflammatory markers with a severe AKI.</p></div><div><h3>Results and Conclusions</h3><p>A CT KUB carried out in A&amp;E showed air bubbles in the parenchyma and calyceal system of the left kidney, which confirmed emphysematous pyelonephritis. As there was no obstruction, the decision was made to manage conservatively. She was started on intravenous empiric metronidazole and tazocin, aggressive fluid resuscitation and close monitoring of her blood glucose. On day 3, initial blood cultures grew ESBL and tazocin was switched to meropenem and amikacin. A repeat CT scan on day 4 showed complete resolution of the parenchymal gas. Nonetheless, she continued to have recurrent pain and pyrexia. She stayed in hospital for a total of 16 days, with conservative management alone significantly improving her AKI and pyelonephritis. She was discharged with analgesia for residual loin tenderness.</p></div><div><h3>Take home message</h3><p>As portrayed in this case, young diabetic women are predisposed to developing emphysematous pyelonephritis. Nephrectomy remains the treatment of choice in most patients, whilst nephrostomy drainage is required in patients with urinary obstruction. Systematic reviews have indicated that antibiotic therapy with nephrostomy carries a reduced mortality risk in comparison to antibiotic therapy with emergency nephrectomy, though there are currently no guidelines available to optimally manage the condition. Prompt CT diagnosis and targeted antibiotic therapy in the initial assessment of this patient were crucial in preventing her from having to undergo an invasive surgical procedure.</p></div>","PeriodicalId":100954,"journal":{"name":"New Horizons in Clinical Case Reports","volume":"2 ","pages":"Page 30"},"PeriodicalIF":0.0,"publicationDate":"2017-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.nhccr.2017.10.024","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89872877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}