EP.WE.412An unusual case of a 13.8cm Gastric Schwannoma invading into Transverse Mesocolon: A case report and literature review

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Sameera Sharma ◽  
Marika Milani ◽  
Stuart Oglesby ◽  
Shaun Walsh
Keyword(s):  
Smooth Muscle Actin ◽  
Treatment Options ◽  
Transverse Mesocolon ◽  
En Bloc ◽  
Local Invasion ◽  
Gastric Schwannoma ◽  
History Of ◽  
Calcium Deposits ◽  
Greater Curvature ◽  
Enhanced Computed Tomography

Abstract Gastric Schwannomas (GS) are benign, slow-growing, Sub-mucosal tumours (SMT’s) that constitute 0.2% of all gastric tumours. They usually have a homogenous appearance on contrast enhanced computed tomography of the abdomen (CECT Abdomen) and rarely show malignant features such as irregular borders, calcification, local invasion and mucosal ulceration. Due to lack of mucosal changes and poor yield during Oesophago-Gastro-Duodenoscopy (OGD) and biopsy, they are often misdiagnosed as Gastro-Intestinal Stromal tumours (GISTs), a malignant SMT. Treatment options range from conservative management to major open resections and are dependent on the size and clinical presentation. Histologically, GS are spindle cells tumours with lymphoid cuffing. On Immunohistochemistry, they test positive for S100 but negative for DOG1, Smooth muscle actin and Desmin which are markers of GISTs. Here we present the case of a 61-year-old female with a 15-year history of epigastric fullness that turned out to be a 13.8cm GS originating from the greater curvature of the stomach. On CECT Abdomen, the tumour appeared heterogeneous, with multiple calcium deposits and local invasion into the transverse mesocolon. The patient underwent a Sub-total gastrectomy with en-bloc transverse colectomy. Symptoms from GS can be vague and can pose a significant diagnostic and investigative dilemma. Physicians and Surgeons should have a low threshold to investigate prolonged symptoms with CECT Abdomen. Despite their benign nature, if left undiagnosed, GS can grow to significant sizes and mimic malignant gastric tumours on conventional imaging resulting in unconventionally major resections.

Resection of a Thoracic Hemangioblastoma in a Patient With Von Hippel-Lindau: 3-Dimensional Operative Video

2018 ◽  
Vol 16 (3) ◽  
pp. 395-395 ◽  
Author(s):  
Simone E Dekker ◽  
Thomas A Ostergard ◽  
Chad A Glenn ◽  
Berje Shammassian ◽  
Efrem Cox ◽  
...  
Keyword(s):  
Treatment Options ◽  
Spinal Cord Tumor ◽  
Tumor Resection ◽  
En Bloc ◽  
Intramedullary Spinal Cord ◽  
Von Hippel Lindau ◽  
3 Dimensional ◽  
Intramedullary Lesion ◽  
Postoperative Mri ◽  
History Of

Abstract This 3-dimensional operative video illustrates resection of a thoracic hemangioblastoma in a 30-year-old female with a history of Von Hippel-Lindau disease. The patient presented with right lower extremity numbness and flank pain. Magnetic resonance imaging (MRI) demonstrated an enhancing intradural intramedullary lesion at T 7 consistent with a hemangioblastoma. The patient underwent a thoracic laminectomy with a midline dural opening for tumor resection. This case demonstrates the principles of intradural intramedullary spinal cord tumor resection. In this particular case, internal debulking was untenable owing to the vascular nature of hemangioblastomas. The operative video demonstrates en bloc tumor removal. Postoperative MRI demonstrated gross total resection. The postoperative course was uneventful. The natural history of this disease, treatment options, and potential complications are discussed.

Safety of a Clozapine Trial Following Quetiapine-Induced Leukopenia: A Case Report

2019 ◽  
Vol 14 (1) ◽  
pp. 80-83 ◽  
Author(s):  
Asma H. Almaghrebi
Keyword(s):  
Treatment Options ◽  
Young Female ◽  
Similar Reaction ◽  
Careful Monitoring ◽  
Treatment Resistant ◽  
Blood Cell Count ◽  
Antipsychotic Medications ◽  
Case Presentation ◽  
Clozapine Treatment ◽  
History Of

Background: The clozapine-derivative quetiapine has been shown in some cases to cause leukopenia and neutropenia. Case Presentation: We reported on a case of a young female diagnosed with treatment-resistant schizophrenia. After failed trials of three antipsychotic medications and despite a history of quetiapineinduced leukopenia, clozapine treatment was introduced due to the severity of the patient’s symptoms, the limited effective treatment options, and a lack of guidelines on this issue. Result: Over a ten-week period of clozapine treatment at 700 mg per day, the patient developed agranulocytosis. Her white blood cell count sharply dropped to 1.6 &#215; 10<sup>9</sup> L, and her neutrophils decreased to 0.1 &#215; 10<sup>9</sup> L. There had been no similar reaction to her previous medications (carbamazepine, risperidone, and haloperidol). Conclusion: The safety of clozapine in a patient who has previously experienced leukopenia and neutropenia with quetiapine requires further investigation. Increased attention should be paid to such cases. Careful monitoring and slow titration are advisable.

scholarly journals Bloodstream infection with Acinetobacter baumanii in a Plasmodium falciparum positive infant: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Charity Wiafe Akenten ◽  
Kennedy Gyau Boahen ◽  
Kwadwo Sarfo Marfo ◽  
Nimako Sarpong ◽  
Denise Dekker ◽  
...  
Keyword(s):  
Case Report ◽  
Bacterial Infections ◽  
Treatment Options ◽  
Female Child ◽  
Correct Choice ◽  
Blood Cultures ◽  
Microbial Culture ◽  
Acinetobacter Baumanii ◽  
Inappropriate Use ◽  
History Of

Abstract Background The increasing incidence of multi-antibiotic-resistant bacterial infections, coupled with the risk of co-infections in malaria-endemic regions, complicates accurate diagnosis and prolongs hospitalization, thereby increasing the total cost of illness. Further, there are challenges in making the correct choice of antibiotic treatment and duration, precipitated by a lack of access to microbial culture facilities in many hospitals in Ghana. The aim of this case report is to highlight the need for blood cultures or alternative rapid tests to be performed routinely in malaria patients, to diagnose co-infections with bacteria, especially when symptoms persist after antimalarial treatment. Case presentation A 6-month old black female child presented to the Agogo Presbyterian Hospital with fever, diarrhea, and a 3-day history of cough. A rapid diagnostic test for malaria and Malaria microscopy was positive for P. falciparum with a parasitemia of 224 parasites/μl. The patient was treated with Intravenous Artesunate, parental antibiotics (cefuroxime and gentamicin) and oral dispersible zinc tablets in addition to intravenous fluids. Blood culture yielded Acinetobacter baumanii, which was resistant to all of the third-generation antibiotics included in the susceptibility test conducted, but sensitive to ciprofloxacin and gentamicin. After augmenting treatment with intravenous ciprofloxacin, all symptoms resolved. Conclusion Even though this study cannot confirm whether the bacterial infection was nosocomial or otherwise, the case highlights the necessity to test malaria patients for possible co-infections, especially when fever persists after parasites have been cleared from the bloodstream. Bacterial blood cultures and antimicrobial susceptibility testing should be routinely performed to guide treatment options for febril illnesses in Ghana in order to reduce inappropriate use of broad-spectrum antibiotics and limit the development of antimicrobial resistance.

scholarly journals Uterine serous carcinoma: key advances and novel treatment approaches

2021 ◽  
pp. ijgc-2021-002753
Author(s):  
J Stuart Ferriss ◽  
Britt K Erickson ◽  
Ie-Ming Shih ◽  
Amanda N Fader
Keyword(s):  
Endometrial Cancer ◽  
Black Women ◽  
Treatment Options ◽  
Molecular Genetic ◽  
Serous Carcinoma ◽  
Cancer Syndrome ◽  
Her2 Positive ◽  
Incidence And Mortality ◽  
History Of ◽  
Uterine Serous Carcinoma

The incidence and mortality rates from endometrial cancer continue to increase worldwide, while rates in most other cancers have either plateaued or declined considerably. Uterine serous carcinoma represents a fraction of all endometrial malignancies each year, yet this histology is responsible for nearly 40% of all endometrial cancer-related deaths. These deaths disproportionately affect black women, who have higher rates of advanced disease at diagnosis. Molecular genetic analyses reveal major alterations including TP53 mutation, PIK3CA mutation/amplification, ERBB2 amplification, CCNE1 amplification, FBXW7 mutation/deletion, PPP2R1A mutation, and somatic mutations involving homologous recombination genes. Clinical risk factors for uterine serous carcinoma include advancing age, a history of breast cancer, tamoxifen usage, and the hereditary breast–ovarian cancer syndrome. Surgery remains the cornerstone of treatment. Recent advances in our understanding of uterine serous carcinoma molecular drivers have led to development of targeted therapeutics that promise improved outcomes for patients. Overexpression or amplification of HER2 in uterine serous carcinoma carries a poor prognosis; yet this actionable target has led to the incorporation of several anti-HER2 therapies, including trastuzumab which, when added to conventional chemotherapy, is associated with improved survival for women with advanced and recurrent HER2-positive disease. The combination of pembrolizumab and lenvatinib is also a promising targeted treatment strategy for women with uterine serous carcinoma, with a recent phase II study suggesting a 50% response rate in women with recurrent disease. Several trials examining additional targeted agents are ongoing. Despite years of stalled progress, meaningful, tailored treatment options are emerging for patients with this uncommon and biologically aggressive endometrial cancer subtype.

scholarly journals Large intraperitoneal lipoleiomyoma in a pre-menopausal woman: a case report

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Sara L. Schaefer ◽  
Amy L. Strong ◽  
Sheena Bahroloomi ◽  
Jichang Han ◽  
Michella K. Whisman ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Smooth Muscle ◽  
Case Report ◽  
Smooth Muscle Actin ◽  
Abdominal Mass ◽  
Histopathological Analysis ◽  
Menopausal Woman ◽  
En Bloc ◽  
Cross Sectional

Abstract Background Lipoleiomyoma is a rare, benign variant of the commonplace uterine leiomyoma. Unlike leiomyoma, these tumors are composed of smooth muscle cells admixed with mature adipose tissue. While rare, they are most frequently identified in the uterus, but even more infrequently have been described in extrauterine locations. Case presentation We describe a case report of a 45-year-old woman with a history of in vitro fertilization pregnancy presenting 6 years later with abdominal distention and weight loss found to have a 30-cm intra-abdominal lipoleiomyoma. While cross-sectional imaging can narrow the differential diagnosis, histopathological analysis with stains positive for smooth muscle actin, desmin, and estrogen receptor, but negative for HMB-45 confirms the diagnosis of lipoleiomyoma. The large encapsulated tumor was resected en bloc. The patients post-operative course was uneventful and her symptoms resolved. Conclusions Lipoleiomyoma should be considered on the differential diagnosis in a woman with a large intra-abdominal mass. While considered benign, resection should be considered if the mass is symptomatic, and the diagnosis is unclear or there is a concern for malignancy.

scholarly journals History of the Military Nurse Corps and the 1918 Influenza Pandemic: Lessons for the 2019 Coronavirus Pandemic

2020 ◽  
Author(s):  
Laura A Talbot ◽  
E Jeffrey Metter ◽  
Heather King
Keyword(s):  
World War I ◽  
Patient Outcomes ◽  
Influenza Pandemic ◽  
Treatment Options ◽  
Primary Therapy ◽  
World War ◽  
Military Nursing ◽  
History Of ◽  
1918 Influenza ◽  
The Military

ABSTRACT During World War I, the 1918 influenza pandemic struck the fatigued combat troops serving on the Western Front. Medical treatment options were limited; thus, skilled military nursing care was the primary therapy and the best indicator of patient outcomes. This article examines the military nursing’s role in the care of the soldiers during the 1918 flu pandemic and compares this to the 2019 coronavirus pandemic.

Episodic versus Chronic Dizziness: An Analysis of Predictive Factors

2021 ◽  
pp. 000348942110254
Author(s):  
Eric J. Formeister ◽  
Ricky Chae ◽  
Emily Wong ◽  
Whitney Chiao ◽  
Lauren Pasquesi ◽  
...  
Keyword(s):  
Multivariate Regression ◽  
Treatment Options ◽  
Depression And Anxiety ◽  
Imaging Studies ◽  
Comorbid Depression ◽  
Cross Sectional ◽  
Tertiary Center ◽  
Chronic Dizziness ◽  
Associated Symptoms ◽  
History Of

Objectives: To elucidate differences in demographic and clinical characteristics between patients with episodic and chronic dizziness. Methods: A cross-sectional, observational study of 217 adults referred for dizziness at 1 tertiary center was undertaken. Subjects were split into a chronic dizziness group (>15 dizzy days per month) and an episodic dizziness group (<15 dizzy days per month). Results: 217 adults (average age, 53.7 years; 56.7% female) participated. One-third (n = 74) met criteria for chronic dizziness. Dizziness handicap inventory (DHI) scores were significantly higher in those with chronic dizziness compared to those with episodic dizziness (53.9 vs 40.7; P < .001). Comorbid depression and anxiety were more prevalent in those with chronic dizziness (44.6% and 47.3% vs 37.8% and 35.7%, respectively; P > .05). Abnormal vestibular testing and abnormal imaging studies did not differ significantly between the 2 groups. Ménière’s disease and BPPV were significantly more common among those with episodic dizziness, while the prevalence of vestibular migraine did not differ according to chronicity of symptoms. A multivariate regression that included age, sex, DHI, history of anxiety and/or depression, associated symptoms, and dizziness triggers was able to account for 15% of the variance in the chronicity of dizziness (pseudo- R2 = 0.15; P < .001). Conclusions: Those who suffer from chronic dizziness have significantly higher DHI and high comorbid rates of depression and anxiety than those with episodic dizziness. Our findings show that factors other than diagnosis alone are important in the chronification of dizziness, an observation that could help improve on multimodal treatment options for this group of patients.

scholarly journals Gastric Schwannoma: A Rare but Important Differential Diagnosis of a Gastric Submucosal Mass

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
William Yoon ◽  
Kari Paulson ◽  
Paul Mazzara ◽  
Sweety Nagori ◽  
Mohammed Barawi ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Surgical Resection ◽  
Treatment Options ◽  
Partial Gastrectomy ◽  
Preoperative Imaging ◽  
Mesenchymal Tumors ◽  
Gastric Schwannoma ◽  
Gastric Mass ◽  
Submucosal Mass ◽  
Slow Growing

Schwannomas are generally slow growing asymptomatic neoplasms that rarely occur in the GI tract. However, if found, the most common site is the stomach. Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract, and 60–70% of them occur in the stomach. Owing to their typical presentation as submucosal neoplasms, gastric schwannomas and GISTs appear grossly similar. Accordingly, the differential diagnosis for a gastric submucosal mass should include gastric schwannomas. Furthermore, GI schwannomas are benign neoplasms with excellent prognosis after surgical resection, whereas 10–30% of GISTs have malignant behavior. Hence, it is important to distinguish gastric schwannomas from GISTs to make an accurate diagnosis to optimally guide treatment options. Nevertheless, owing to the paucity of gastric schwannomas, the index of suspicion for this diagnosis is low. We report a rare case of gastric schwannoma in 53-year-old woman who underwent laparoscopic partial gastrectomy under the suspicion of a GIST preoperatively but confirmed to have a gastric schwannoma postoperatively. This case underscores the importance of including gastric schwannomas in the differential diagnosis when preoperative imaging studies reveal a submucosal, exophytic gastric mass. For a gastric schwannoma, complete margin negative surgical resection is the curative treatment of choice.

Pharmacoeconomic Considerations in Treatment Options for Acute Seizures

1998 ◽  
Vol 13 (1_suppl) ◽  
pp. S27-S29 ◽  
Author(s):  
Nina Graves
Keyword(s):  
Treatment Options ◽  
Emergency Department Visits ◽  
Event Management ◽  
Pharmacoeconomic Data ◽  
Acute Seizures ◽  
Rectal Diazepam ◽  
Adverse Event Management ◽  
History Of ◽  
Cluster Seizures ◽  
The Cost

Two pharmacoeconomic studies on the treatment of acute seizures have been conducted. In 1991, Kriel and colleagues surveyed parents of children with a history of cluster seizures, prolonged seizures, or status epilepticus who had been instructed in the use of rectal diazepam. A comparison of data before instruction with data after instruction showed a reduced need for emergency department visits with rectal diazepam. Instruction thus provided a pharmacoeconomic benefit, despite the cost of the product. In 1996, Marchetti and coworkers found that intravenous fosphenytoin was associated with fewer adverse events than intravenous phenytoin. Fosphenytoin thus reduced the need for adverse event management and provided a substantial pharmacoeconomic benefit, despite its higher cost, compared with phenytoin. This study had a number of limitations, however, and hospital pharmacists remain resistant to the use of fosphenytoin. Additional studies may provide more pharmacoeconomic data to support the greater use of fosphenytoin in the treatment of acute pediatric seizures. (J Child Neurol 1998;13(Suppl 1):S27-S29).

Vanishing tumour of the internal auditory meatus

2008 ◽  
Vol 123 (5) ◽  
pp. 563-565 ◽  
Author(s):  
A Jain ◽  
M Ablett ◽  
P Wardrop
Keyword(s):  
World Literature ◽  
Cerebellopontine Angle ◽  
Renal Carcinoma ◽  
Treatment Options ◽  
Internal Auditory Meatus ◽  
Radiological Investigation ◽  
Urological Symptoms ◽  
History Of ◽  
The Common ◽  
Rare Report

AbstractObjectives:We report a very rare case of prostatic metastasis in the internal auditory meatus, which disappeared with treatment.Case report:An elderly man presented with a history of hearing loss, dizzy spells and, more recently, facial palsy. He also complained simultaneously of urological symptoms, which on investigation revealed advanced, metastatic prostate cancer. Radiological investigation, in the form of magnetic resonance imaging, revealed an internal auditory meatus mass which resembled an acoustic neuroma. The patient was treated with hormone injections.Tumours of the internal auditory meatus and cerebellopontine angle are mostly primary. Rarely, metastatic deposits have been described in this region, from squamous cell carcinoma, malignant melanoma, malignant parotid oncocytoma, renal carcinoma, and lung and thyroid primaries.Conclusion:To our knowledge, this is a very rare report in the world literature of prostatic metastasis to the internal auditory meatus. We discuss the common presenting features, investigations and treatment options for metastatic prostatic tumours of the internal auditory meatus and cerebellopontine angle.

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