Pubic symphysis osteomyelitis with associated vesico-symphyseal fistula: a difficult diagnosis

2021 ◽  
Vol 14 (9) ◽  
pp. e244336
Author(s):  
Brendan Wechsler ◽  
Jonah Devries ◽  
Douglas Yim
Keyword(s):  
Prostate Cancer ◽  
Infectious Complication ◽  
Fistulous Tract ◽  
Disease Process ◽  
Pubic Symphysis ◽  
Laboratory Findings ◽  
Difficult Diagnosis ◽  
Clinical Presentations

Pubic symphysis osteomyelitis is an infectious complication that rarely arises in men who have undergone treatment for prostate cancer. This process may more rarely arise from a fistulous tract between the pubic symphysis and the urinary tract. In this case report, we discuss the most common clinical presentations and laboratory findings that lead to the diagnosis of this disease process, as well as the role of MRI and other imaging modalities in confirmation of the diagnosis. This case serves as a reminder to clinicians to have earlier consideration of pubic symphysis osteomyelitis in their differential diagnosis to reduce the risk of long-term complications associated with undertreatment.

scholarly journals Clinical presentations and long term prognosis of childhood onset polyarteritis nodosa in single centre of Korea

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jeong-Seon Lee ◽  
Joong-Gon Kim ◽  
Soyoung Lee
Keyword(s):  
Polyarteritis Nodosa ◽  
Clinical Manifestations ◽  
Long Term Outcomes ◽  
Childhood Onset ◽  
Laboratory Findings ◽  
Clinical Presentations ◽  
Long Term Prognosis ◽  
Digital Amputation

AbstractChildhood-onset polyarteritis nodosa (PAN) is a rare and systemic necrotising vasculitis in children affecting small- to medium-sized arteries. To date, there have been only a few reports because of its rarity. Thus, we aimed to investigate the clinical manifestations, laboratory findings, treatment, and long-term outcomes in patients with childhood-onset PAN and to evaluate the usefulness of the paediatric vasculitis activity score (PVAS). We retrospectively analysed the data of nine patients with childhood-onset PAN from March 2003 to February 2020. The median ages at symptom onset, diagnosis, and follow-up duration were 7.6 (3–17.5), 7.7 (3.5–17.6), and 7.0 (1.6–16.3) years, respectively. All patients had constitutional symptoms and skin manifestations, while five exhibited Raynaud’s phenomenon. Organ involvement was observed in one patient. The median PVAS at diagnosis was 7 (range: 2–32). Prednisolone was initially used for induction in all patients, and other drugs were added in cases refractory to prednisolone. All patients survived, but three patients with high PVAS at diagnosis experienced irreversible sequelae, including intracranial haemorrhage and digital amputation. In conclusion, early diagnosis and treatment may minimise sequelae in patients with childhood-onset PAN. This study suggests that high PVAS score at diagnosis may be associated with poor prognosis.

scholarly journals Giant parathyroid adenoma: a case report and review of the literature

2019 ◽  
Vol 13 (1) ◽  
Author(s):  
Mohamed S. Al-Hassan ◽  
Menatalla Mekhaimar ◽  
Walid El Ansari ◽  
Adham Darweesh ◽  
Abdelrahman Abdelaal
Keyword(s):  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Parathyroid Adenoma ◽  
Neck Mass ◽  
Rare Type ◽  
Tissue Mass ◽  
Laboratory Findings ◽  
Clinical Presentations ◽  
High Calcium

Abstract Background Giant parathyroid adenoma is a rare type of parathyroid adenoma defined as weighing > 3.5 g. They present as primary hyperparathyroidism but with more elevated laboratory findings and more severe clinical presentations due to the larger tissue mass. This is the first reported case of giant parathyroid adenoma from the Middle East. Case presentation A 52-year-old Indian woman presented with a palpable right-sided neck mass and generalized fatigue. Investigations revealed hypercalcemia with elevated parathyroid hormone and an asymptomatic kidney stone. Ultrasound showed a complex nodule with solid and cystic components, and Sestamibi nuclear scan confirmed a giant parathyroid adenoma. Focused surgical neck exploration was done and a giant parathyroid adenoma weighing 7.7 gm was excised. Conclusions Giant parathyroid adenoma is a rare cause of primary hyperparathyroidism and usually presents symptomatically with high calcium and parathyroid hormone levels. Giant parathyroid adenoma is diagnosed by imaging and laboratory studies. Management is typically surgical, aiming at complete resection. Patients usually recover with no long-term complications or recurrence.

scholarly journals A phase I pilot study of preoperative radiotherapy for prostate cancer: Long-term toxicity and oncologic outcomes.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 60-60
Author(s):  
Noelia Sanmamed ◽  
Rachel Glicksman ◽  
John Thoms ◽  
Alexandre Zlotta ◽  
Antonio Finelli ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Pilot Study ◽  
High Risk ◽  
Phase I ◽  
Oncologic Outcomes ◽  
Gu Toxicity ◽  
Long Term Follow Up

60 Background: Pre-operative radiotherapy (PreORT) improves local control in various cancer types, and has become an established oncologic treatment strategy. During 2001-2004, we conducted a phase I pilot study assessing the role of short-course PreORT for men with unfavourable intermediate- and high-risk localized prostate cancer (PCa). We present long-term follow-up toxicity and oncologic outcomes. Methods: Eligible patients had histologically proven PCa, cT1-T2N0M0, PSA > 15-35 ng/ml with any Gleason score, or PSA 10-15 ng/ml with Gleason score ≥7. Patients received 25 Gy in five consecutive daily fractions to the prostate, followed by radical prostatectomy (RadP) within 14 days after RT completion. Primary outcomes were intra-operative morbidity, and late genitourinary (GU) and gastrointestinal (GI) toxicities. Acute toxicity was assessed during radiotherapy treatment on daily basis using RTOG grade scoring scale. Patients were assessed post-RadP clinically and with PSA at 1 and 6 months, and every 6 months. Intra- and Post-RadP toxicity was documented prospectively and scored as per Common Terminology Criteria for Adverse Events v4.0. Biochemical failure (BF) was determined based on two consecutive post-RadP PSA > 0.2 ng/ml. Results: Fifteen patients were enrolled; 14 patients completed PreORT followed by RadP, which also included bilateral lymph node dissections in 13 cases. Median follow-up was 12.2 years (range 6.7-16.3 years). Late GU toxicity was common, with 2 patients (14.3%) experiencing G2 toxicity, and 6 patients (42.8%) G3 toxicity. There were no G4-5 late GU toxicity. Late GI toxicity was infrequent, with only 1 patient (7.1%) experiencing transient G2 proctitis. At last follow-up, 8 (57.1%) and 6 (42.8%) patients experienced BF and metastatic disease recurrence, respectively. Conclusions: The use of PreORT in men with high-risk PCa is associated with unexpected high-rates of late GU toxicity. Future studies examining the role of RT pre-RadP must cautiously select RT technique and dose schedule. Importantly, long-term follow-up data is essential to fully determine the therapeutic index of PreORT in the management of localized PCa. Clinical trial information: NCT00252447.

scholarly journals The role of resection of pulmonary metastases from prostate cancer: a case report and literature review

2013 ◽  
Vol 5 (6) ◽  
pp. 104
Author(s):  
Christopher J.D. Wallis ◽  
John C. English ◽  
S. Larry Goldenberg
Keyword(s):  
Prostate Cancer ◽  
Pulmonary Metastases ◽  
Specific Antigen ◽  
Lower Lobe ◽  
Lung Nodules ◽  
Lower Lung ◽  
Long Term Prognosis ◽  
Solitary Metastases

We report a case of a 53-year-old man who presented with twonodules in the lower lobe and one nodule in the upper lobe of theright lung almost 7 years after radical prostatectomy for pT3aN0M0,Gleason 4+5 disease, without evidence of osseous or lymphaticspread. Surgical resection of the lower lung nodules confirmedmetastases, but prostate-specific antigen did not drop to undetectablelevels. Isolated pulmonary metastases from prostate cancerare rare with only 33 previously described cases in the Englishlanguageliterature, 18 of which were solitary metastases. Wereview the principles of management, including metastasectomyand long-term prognosis.

scholarly journals Robotic-Assisted Laparoscopic Radical Prostatectomy: An Objective Assessment and Review of the Literature

2006 ◽  
Vol 6 ◽  
pp. 2589-2061 ◽  
Author(s):  
Lester S. Borden Jr. ◽  
Paul M. Kozlowski
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Objective Assessment ◽  
Cancer Control ◽  
Laparoscopic Radical Prostatectomy ◽  
Robotic Assisted ◽  
Open Radical Prostatectomy ◽  
Term Data

Robotic-assisted laparoscopic radical prostatectomy (RLRP) has become an accepted treatment option for men with prostate cancer. A search of the available literature through January 2006 was performed to analyze the surgical technique, outcomes data, and other unique issues regarding RLRP. While prospective, randomized trials and long-term data are lacking, short-term data from single institution series have demonstrated outcomes for RLRP that appear to be equivalent to those for open radical prostatectomy (ORP). Although not yet proven, some encouraging data suggest that RLRP may be able to achieve improved cancer control, postoperative urinary control, and erectile function compared to open surgery for prostate cancer. Definite advantages of RLRP over ORP are not yet established. Future studies will determine the role of RLRP in the surgical treatment of men with prostate cancer.

scholarly journals Prophylactic Catheter Ablation for Ventricular Tachycardia: Are We There Yet?

2017 ◽  
Vol 6 (3) ◽  
pp. 125 ◽  
Author(s):  
Rahul K Mukherjee ◽  
Louisa O’Neill ◽  
Mark D O’Neill ◽  
◽  
◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Catheter Ablation ◽  
Disease Process ◽  
Sufficient Evidence ◽  
Optimal Timing ◽  
Success Rates ◽  
Randomised Controlled ◽  
Contemporary Practice

Ventricular tachycardia (VT), often degenerating into ventricular fibrillation, is the leading cause of sudden cardiac death. Catheter ablation of VT is associated with relatively low, long-term success rates, while the optimal timing of ablation in patients with ischaemic and nonischaemic cardiomyopathy remains unclear. Contemporary practice in most centres is to consider ablation late in the disease process following the failure of anti-arrhythmic medications and/or following recurrent implantable cardioverter-defibrillator shocks. Three major randomised, controlled trials have been published investigating the role of prophylactic catheter ablation for VT. In the present review, we assess the evidence from these and other related trials in VT ablation to understand if there is sufficient evidence to advocate prophylactic catheter ablation in patients with VT.

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