Sarcomatoid carcinoma of the pancreas — a rare tumor with an uncommon presentation and course: A case report and review of literature

BACKGROUNDSarcomatoid carcinoma of the pancreas (SCP) is a rare type of pancreatic neoplasm, and only a few cases have been described in the literature. Histologically, it is composed mostly of atypical spindle cells with apparent sarcomatous features.CASE SUMMARYThis is a report of a 61-year-old Chilean woman who underwent medical investigation for acute abdominal pain. Computed tomography identified a solid tumor in the tail of the pancreas with features suspicious of malignancy. En-bloc distal pancreatectomy and splenectomy were performed to excise the tumor. Histopathology and immunohistochemistry were confirmatory of sarcomatoid carcinoma with lymphovascular invasion. After surgery, the patient did not receive chemotherapy. Previous studies indicate a poor prognosis for this type of malignancy. However, our patient has survived for 35 mo with no recurrence to date.CONCLUSIONThe case presented herein is a patient with an SCP with a rare presentation and long-term survival after surgery despite not receiving adjuvant chemotherapy.     

Small-cell neuroendocrine carcinoma of the rectum — a rare tumor type with poor prognosis: A case report and review of literature

BACKGROUNDSmall-cell neuroendocrine carcinoma (SNEC) of the rectum is a rare tumor associated with poor prognosis.CASE SUMMARYWe report a case of a 77-year-old male who came into our hospital because of blood with his stool. An endoscopy revealed a cauliflower-like neoplasm in his rectum. Imaging examination showed that the lesion in the upper rectum was likely rectal cancer, and there was no evidence of metastasis. The patient was treated with surgery. Pathological examination confirmed SNEC of the rectum and an R0 resection was achieved. However, 1 mo after the operation, the patient developed intestinal and ureteral obstructions due to peritoneal metastases. Finally, the patient died from renal failure.CONCLUSIONSNEC of the rectum is a high-grade carcinoma with an aggressive phenotype, and surgery should be cautiously considered.     

Emergency department initiation of cardiopulmonary bypass: a case report and review of the literature

Background

Out-of-hospital cardiac arrest carries a dismal prognosis. Percutaneous extracorporeal membrane oxygenation (ECMO) has been used with success for in-hospital arrests, and some literature suggests improvement in long-term survival for out-of-hospital arrests as well.

Objectives

This case highlights the use of ECMO in the emergency department.

Case Report

We report a case in which emergency physician-initiated ECMO was used as a bridge to definitive care in an out-of- hospital cardiac arrest in the United States.

Conclusions

ECMO is a novel adjunct for patients in cardiac arrest in whom the usual advanced life support techniques have failed.     

A minimal invasive approach for the treatment of symptomatic post-traumatic splenic cyst—a case report

Splenectomy for symptomatic splenic cyst is curative. The uncertainty regarding the incidence of post-splenectomy overwhelming sepsis has made surgeons re-evaluate the indications for splenectomy. We describe a minimal invasive approach for the treatment of symptomatic splenic cyst with the added benetit of splenic preservation.     

Oral rehabilitation of a Parkinson’s patient: A case report

Parkinson’s disease is an idiopathic disorder of the central nervous system, characterized by resting tremors, muscular rigidity, slow and decreased movements. Oral rehabilitation of these patients requires special care, especially in those cases where the patient’s socioeconomic status is not good and patient cannot come several times for fabrication of a complete denture. This clinical report presents a case of a Parkinson’s patient who was completely rehabilitated in 3 appointments using special techniques. Border molding, final impression and jaw relation procedures were done in one appointment by using a custom tray with detachable handles and occlusal rims.     

Müllerian adenosarcoma of the ovary: case report and review of the literature

Müllerian adenosarcoma is a rare neoplasm that can arise in both uterine and extrauterine locations. This report describes the ultrasound and magnetic resonance imaging findings of one case of ovarian adenosarcoma and reviews the literature as to the previously described imaging findings. Adenosarcoma should be considered in patients with a predominantly solid pelvic mass on imaging, particularly in those with a history of endometriosis or findings compatible with endometriosis on ultrasound or magnetic resonance imaging. A very low resistive index on ultrasound may also be suggestive of this diagnosis.     

Genetic and phenotypic analysis of a rare asymptomatic case of a homozygous Chinese Gγ+(Aγδβ)0-thalassemia deletion in a Chinese family

ObjectiveThe clinical and hematologic features of thalassemia are due to different factors, and patients with identical genotypes may regularly exhibit variable severity. In the present work, one homozygous Chinese ^Gγ⁺(^Aγδβ)⁰-thalassemia case with an asymptomatic phenotype, which is contrary to traditional views, was identified. Analysis of the underlying causes of this rare clinical phenotype involved accurate genetic diagnosis and detection of several genetic modifications.MethodsSix members of the proband’s family were enrolled in the study. Hematological parameters and hemoglobin analysis results were recorded. A suspension-array system, multiplex gap-polymerase chain reaction (gap-PCR) and multiplex ligation-dependent probe amplification (MLPA) were used together to characterize genotypes. Sanger sequencing was utilized to examine the KLF1 gene and four primary fetal hemoglobin (Hb F)-associated single-nucleotide polymorphisms (SNPs).ResultsFour family members carried the Chinese ^Gγ⁺(^Aγδβ)⁰-thalassemia mutation, and a homozygous state was ultimately diagnosed for the proband. All of the Chinese ^Gγ⁺(^Aγδβ)⁰ mutation-positive cases were coinherited with the Southern Asian α-thalassemia deletion (– – ^SEA/αα). Two SNP variants, rs7776054 and rs9399137, in the HBS1L-MYB locus were detected in the proband.ConclusionsThus far, this is the first study to describe the molecular characterization of a homozygous Chinese ^Gγ⁺(^Aγδβ)⁰-thalassemia patient who exhibits no clinical symptoms. Our findings suggest that coinheritance of α-thalassemia or HBS1L-MYB locus variants may affect the clinical severity of Chinese ^Gγ⁺(^Aγδβ)⁰-thalassemia. We conclude that the molecular examination of genetic determinants known to be associated with clinical outcomes in Chinese ^Gγ⁺(^Aγδβ)⁰-thalassemia should be emphasized.     

Use of the INDEPENDENCE 3000 IBOT™ transporter at home and in the community: A case report

The INDEPENDENCE? 3000 IBOT? Transporter (IBOT), as an electronically stabilized mobility device for people with disabilities. The purpose of this study was to gain experience with the IBOT? at home and in the community using an expert wheelchair user, who used the device as his primary mobility device for 1 week. This case report is based upon observations by trained clinicians, and a diary recorded by the primary author a male manual wheelchair user with traumatic spinal cord injury at the T7/8 level. The subject was 41 years of age and 21 years post SCI at the time of the study. The participant was employed and lived in a ranch style accessible home. The subject used the devices to perform a variety of activities including holding eye-level discussions with colleagues and shopping by balancing on two wheels, going up and down steep ramps, traversing outdoor surfaces (e.g., grass, dirt trails) and climbing curbs. The balance and four-wheel drive functions were helpful and worked well. The IBOT was somewhat difficult to control in standard function. The seat height was too high for most tables and desks encountered, and transfers were notably more difficult than with other wheelchairs. It was difficult to use the IBOT in the bathroom, and the subject preferred to use his personal wheelchairs for transfers into the shower. The IBOT was a functional mobility device, its greatest strengths are outdoors and in circumstances where there is space to use balance function.     

Primary primitive neuroectodermal tumor in the pericardium—a focus on imaging findings: A case report

BACKGROUNDPrimitive neuroectodermal tumors (PNETs) are rare, sporadic malignant tumors of the peripheral nervous system, bone, or soft tissues. However, to the best of our knowledge, only three cases of PNET in the pericardium have been reported in the English literature, and their magnetic resonance imaging findings have not previously been described.CASE SUMMARYA 3-year-old boy was hospitalized with a 1-wk history of recurrent vomiting and weakness. Detailed history-taking revealed no evidence of heart disease. Computed tomography demonstrated a soft tissue mass in the left pericardial cavity with heterogeneous contrast enhancement. The border between the mass and the heart was poorly defined. Thoracotomy revealed a mass invading the left ventricle, with a high risk of bleeding. The mass was considered inoperable. A biopsy was performed, and the histological and immunohistochemical findings confirmed the diagnosis of primary PNET of the pericardium. The patient received four cycles of standard chemotherapy. Chest magnetic resonance imaging 3 mo after the initiation of chemotherapy revealed that the tumor in the pericardium still existed, but its volume had slightly decreased. The patient was lost to follow-up, and the final outcome was therefore unknown.CONCLUSIONMedical imaging plays an important role in defining the pericardial origin of PNET and understanding its characteristics. Magnetic resonance imaging can provide more information on the tumor than computed tomography and may thus aid therapeutic planning.     

First-trimester treatment of cesarean scar pregnancy using a cervical ripening—double-balloon catheter: A case report

Cesarean scar pregnancies are relatively rare. In the first trimester, if the decision is made to terminate the pregnancy, it should be done as soon as possible to avoid complications. We report a successful termination of a live, 6 weeks and 4 days cesarean scar pregnancy using a double-balloon cervical ripening catheter in a patient with two previous cesarean deliveries.     

Hyperlipoproteinaemia(a): which is the optimal therapy? A case report

This case report presents the clinical history of a patient with elevated lipoprotein(a) and small size isoform, associated with mixed hyperlipaemia, which was probably familial combined hyperlipaemia. After premature myocardial infarction, the subject was treated with fibrates. Niacin was started after recurrence. One year ago, after another episode of acute coronary syndrome, rosuvastatin was added to niacin. The atherogenicity of this lipid disorder, along with the different options for therapy is discussed.     

Acupuncture and Kinesio Taping for the acute management of Bell’s palsy: A case report

BackgroundBell’s palsy is an idiopathic, acute peripheral palsy of the facial nerve that supplies the muscles of facial expression. Despite an expected 70% full recovery rate, up to 30% of patients are left with potentially disfiguring facial weakness, involuntary movements, or persistent lacrimation. The most frequently used treatment options are corticosteroids and antiviral drugs. However, accompanying clinical conditions, such as uncontrolled diabetes, hypertension, gastrointestinal disturbances, polypharmacy of geriatric patients, and significant sequelae ratios, indicate the need for safe and effective complementary therapies that would enhance the success of the conventional interventions.Case summaryA 26-year-old female presented with numbness and earache on the left side of the face; these symptoms had been ongoing for 8–10 h. Physical examination revealed peripheral facial paralysis of House-Brackmann grade III and corticosteroid-valacyclovir treatment was initiated. On the same day, Kinesio Taping was applied to the affected nerve and muscle area with the aim of primarily neurofacilitation and edema-pain relief. On the fifth day, acupuncture treatment was started and was continued for 3 consecutive days. A physical therapy program was administered for the subsequent 10 days. At the 3-week follow-up examination, Bell’s palsy was determined as grade I, and the treatment was stopped.ConclusionAcupuncture and Kinesio Taping, in conjunction with physical therapy modalities, are safe and promising complementary therapies for the acute management of Bell's palsy. However, further large scale and randomized controlled studies are necessary to assess whether these complementary interventions have significant additive or synergistic effect for complete recovery of patients with Bell’s palsy.     

Aortic dissection and turner’s syndrome: case report and review of the literature

Cardiovascular abnormalities are frequently encountered in patients with Turner’s syndrome. These include coarctation of the aorta, aortic root dilatation, bicuspid aortic valve, atrial and ventricular septal defects. Aortic dissection is a rare but devastating complication of Turner’s syndrome that usually occurs in adulthood. We report a case of Turner’s syndrome with coarctation of the aorta and chronic aortic dissection, and review the relevant literature. There have been 21 prior reported cases of aortic dissection in patients with Turner’s syndrome. Possible etiologic factors contributing to the occurrence of aortic dissection in this syndrome are protean. They include the presence of cystic medial necrosis, coarctation of the aorta, bicuspid aortic valve, aortic root dilatation, and hypertension, although cases of aortic dissection and Turner’s syndrome have been described in patients without any risk factors. As our knowledge of the natural history of congenital heart defects and risk factors for aortic dissection in Turner’s syndrome is limited, periodic cardiac evaluation of these patients may be warranted. Early recognition and treatment of this potentially lethal complication of Turner’s syndrome is essential.