Orbital myiasis on recurrent undifferentiated carcinoma in the COVID-19 era: a case report and brief review of the literature

Abstract Background Myiasis is defined as the infestation of living tissues by Diptera larvae. Ophthalmic involvement occurs in less than 5% of cases. As the most uncommon type of involvement, orbital myiasis usually affects patients with poor personal hygiene, a low socioeconomic status, a history of surgery, and cancer. Findings In January 2020, an 89-year-old man presented to the Oculoplastic Department of Farabi Eye Hospital (Iran) with a history of left-side progressive orbital mass for six months. A large infiltrative mass of the left orbit with extension to the globe, periorbita, and adnexa was remarkable at the presentation, and its appearance suggested malignancy. Our findings persuaded us to perform exenteration and histopathological evaluation which were reported as “undifferentiated carcinoma”. Regular follow-up visits were recommended. In June 2020, with a 3-month delay, the patient presented with the recurrence of the mass complicated with mobile alive larva. Examinations revealed numerous maggots crawling out of an ulcerative and foul-smelling lesion. He stated that fear of COVID-19 infection postponed his follow-up visit. The patient underwent immediate mechanical removal of larvae, followed by wide local excision of the mass. Conclusion Patients with carcinoma of the adnexal tissues seem to be more prone to myiasis infestation even though it is an uncommon disease. Since COVID-19 is an ongoing pandemic with no end in sight appropriate protocols should be implemented to prevent loss of follow-up in these high risk patients.

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A Comparison of Hospital and Nonhospital Colonoscopy: Wait Times, Fees and Guideline Adherence to Follow-Up Interval

Canadian Journal of Gastroenterology ◽

10.1155/2011/514656 ◽

2011 ◽

Vol 25 (2) ◽

pp. 78-82 ◽

Cited By ~ 2

Author(s):

Noah Ivers ◽

Michael Schwandt ◽

Susan Hum ◽

Danielle Martin ◽

Jill Tinmouth ◽

...

Keyword(s):

Postal Survey ◽

Administrative Databases ◽

Screening Colonoscopy ◽

Wait Times ◽

Multivariable Logistic Regression Analysis ◽

Patient Factors ◽

Risk Patients ◽

History Of ◽

Care Costs

BACKGROUND: Although colonoscopy is increasingly performed in nonhospital facilities, studies to date examining differences between colonoscopy services in hospital and nonhospital settings have been limited, in large part, to administrative databases.OBJECTIVES: To describe the experiences of patients receiving colonoscopy in hospital and nonhospital settings, and to compare these settings with respect to wait times and recommended follow-up interval to the next colonoscopy.METHODS: A postal survey of 2000 patients, 50 to 70 years of age, from an urban academic family practice was conducted. Most recent colonoscopy was classified as either occurring in a hospital or nonhospital setting. Multivariable logistic regression analysis was used to examine the association among wait times, follow-up intervals and patient factors with respect to colonoscopy setting.RESULTS: Patients who underwent their most recent colonoscopy outside of a hospital were more likely to be men (P=0.01) and to have undergone more than one previous colonoscopy (P=0.02). For patients with a normal screening colonoscopy and no family history of colorectal cancer or polyps, nonhospital clinics less often recommended a 10-year follow-up interval (OR 0.13 [95% CI 0.04 to 0.47]). Reported wait times at nonhospital clinics were shorter for patients receiving screening colonoscopy (OR 2.11 [95% CI 1.28 to 3.47]), but not for symptomatic patients (OR 1.74 [95% CI 0.88 to 3.43]). For individuals attending nonhospital clinics, 10% were referred from a hospital by the same specialist performing the procedure; 31.7% reported paying a fee.CONCLUSION: Nonhospital clinics were far less likely to adhere to guidelines regarding follow-up intervals for low-risk patients. Given the implications for both health care costs and patient safety, further study is needed to determine the cause of this disparity.

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Bilateral giant inguinoscrotal hernia with hydrocele. A case report

Journal of Surgical Arts ◽

10.14717/jsurgarts-210206 ◽

2021 ◽

pp. 82-85

Keyword(s):

Greater Omentum ◽

High Morbidity ◽

Bilateral Hernia ◽

Hernia Sac ◽

Inguinoscrotal Hernia ◽

Giant Inguinoscrotal Hernia ◽

Uncommon Disease ◽

History Of

Giant inguinoscrotal hernia (GIH) is a high morbidity and mortality disease. Giant inguinoscrotal hernia containing omentum, intestinal segments or urinary bladder is a challenging surgical disease. The patient was diagnosed with bilateral giant inguinoscrotal hernia at the age of 81. The case had 22 years history of this uncommon disease. Ultrasound revealed a voluminous hernia sac containing bowel loops, greater omentum, and hydrocele. According the new classification of GIH, the patient was type II. He underwent complete surgical hernioplasty involving omentectomy and orchiectomy. After the surgery, any emerging complications were closely monitored. When giant inguinoscrotal hernia is diagnosed, operation should be recommended immediately. Treatment procedure of hernia should be according the classification of GIH. The Lichtenstein tension-free technique seems to be the best surgical procedure for the patient who have bilateral hernia. It should be used whenever possible in such cases. The patients should be carefully follow up postoperative in terms of abdominal compartment syndrome and respiratory insufficiency.

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Utility of quantitative fluorescent in situ hybridization (FISH) to predict non-muscle-invasive bladder cancer (NMIBC) recurrence.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.7_suppl.286 ◽

2011 ◽

Vol 29 (7_suppl) ◽

pp. 286-286

Author(s):

H. M. Rosevear ◽

A. J. Lightfoot ◽

M. A. O'Donnell

Keyword(s):

High Risk ◽

First Year ◽

Fish Analysis ◽

High Grade ◽

Intermediate Risk ◽

Binary Variable ◽

Risk Patients ◽

History Of ◽

Abnormal Cells

286 Background: Urovysion's (Abbot Laboratories, Downers Grove, IL) FISH analysis is used to monitor bladder cancer recurrence in patients with a history of NMIBC and is often reported as a binary variable (normal/abnormal). We investigated whether the percentage of abnormal cells as determined by FISH analysis in patients with a history of NMIBC correlated with risk of recurrence. Methods: At our institution, barbotage FISH analysis is routinely done along with cystoscopy and cytology on both high risk (Ta/T1 high grade or CIS) and low or intermediate risk patients (all others) at every 3-month follow-up for the first year post-resection. We retrospectively reviewed 241 consecutive NMIBC patients and identified 399 FISH analyses for which we had one year follow-up. Normal FISH analyses were defined as 2 or fewer abnormal cells per sample. We calculated the percentage of abnormal cells and correlated that to the number of patients who had a recurrence of NMIBC as defined by positive high grade cytology or tumor on cystoscopy during the first year of follow-up. Results: The sensitivity, specificity, and positive and negative predictive values of FISH analysis if reported as a binary variable was 55, 43, 16 and 89%, respectively. Considering only those patients with abnormal FISH, the average percentage of abnormal cells for patients who were found to have NMIBC recurrence at 1 year was 38% (range 6–100) compared to 21% (range 6–100) for patients who were recurrence-free at 1 year (p<0.0001). High risk patients who recurred within 1 year had a statistically higher percentage of abnormal cells as compared to those who did not recur within 1 year (50% [range 6–100] vs. 25% [range 6– 100], respectively p=0.001). There was no difference in the percentage of abnormal cells for those patients with low or intermediate risk disease based on recurrence within 1 year (22% [range 6–100] vs. 20% [range 6–100], respectively p=0.25). Conclusions: The percentage of abnormal cells in FISH analysis correlates with risk of recurrence for patients with high risk disease and can be used to guide surveillance interval decisions in patients with no other evidence of recurrence. [Table: see text]

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Giant squamous cell carcinoma of the scalp

Our Dermatology Online ◽

10.7241/ourd.20221.25 ◽

2022 ◽

Vol 13 (1) ◽

pp. 99-100

Author(s):

Soumaya Hamich ◽

Fatima Zahra El Gaitibi ◽

Kaoutar Znati ◽

Meriem Meziane ◽

Nadia Ismaili ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Squamous Cell ◽

Low Socioeconomic Status ◽

Sun Exposure ◽

Biological Assessment ◽

Personal Hygiene ◽

Surgical Removal ◽

Anatomical Location ◽

History Of

We report the case of a 43-year-old male with a history of pulmonary tuberculosis cured one year previously and a 25-year-old history of smoking. The patient presented with a tumor of the scalp that had been evolving since the age of thirteen years, gradually increasing in size, neglected by the patient. An examination revealed a giant tumor of the occipital area (Fig. 1), 15 × 8 cm in size, which was protruded and ulcerated, with thick, hard edges. On biological assessment, a hemogram revealed microcytic hypochromic anemia at 2.9 g/dL. Ferritin was at 4 ng/mL. HIV serology was negative. A skin biopsy revealed a mature, well-differentiated, infiltrating squamous cell carcinoma (Fig. 2). A CT scan of the brain revealed a poorly limited subgalactic parietooccipital lesion process, with bone lysis and endocranial extension and invasion of the upper longitudinal sinus. Ultrasonography of the lymph node area revealed bilateral axillary and inguinal adenopathies with an infracentimetric fatty hilum. The immediate management was to transfuse the patient with three red blood cells. Control hemoglobin was 7.7 g/dl. The patient, then, received external radiotherapy but was lost to follow-up. Squamous cell carcinoma is the second most common skin cancer [1], occurring in elderly patients with a clear phototype on sun-exposed areas. Its frequency is increasing and correlates with sun exposure [1]. It may reach enormous sizes if neglected and not treated in its early stages. The most common causes of a delayed diagnosis are low socioeconomic status, poor personal hygiene, and fear of the diagnosis and of its possible consequences [2]. Giant carcinomas are defined by a diameter exceeding 5 cm [3]. They pose a higher risk of complication and mortality. The invasiveness of these tumors depends on the size, anatomical location, and histological subtype. Their treatment is difficult because, even with extensive surgical removal, recurrence and metastasis are frequent [3].

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Risk factors of recurrence and major bleeding in patients with intermediate-risk for recurrence of venous thromboembolism: from the COMMAND VTE Registry

European Heart Journal ◽

10.1093/eurheartj/ehab724.1937 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

Y Yamashita ◽

H Amano ◽

T Morimoto ◽

T Kimura ◽

Keyword(s):

Risk Factors ◽

Major Bleeding ◽

Independent Risk Factor ◽

Anticoagulation Therapy ◽

Intermediate Risk ◽

Risk Patients ◽

History Of ◽

Independent Risk Factors ◽

Recurrent Vte

Abstract Background/Introduction Patients with venous thromboembolism (VTE), including pulmonary embolism (PE), have a long-term risk of recurrence, and anticoagulation therapy is recommended for the prevention of recurrence. The latest 2019 European Society of Cardiology (ESC) guideline classified the risks of recurrence into low- (<3%/year), intermediate- (3–8%/year), and high- (>8%/year) risk, and recommended the extended anticoagulation therapy of indefinite duration for high-risk patients as well as intermediate-risk patients. However, extended anticoagulation therapy of indefinite duration for all of intermediate-risk patients have been a matter of active debate. Thus, additional risk assessment of recurrence in intermediate-risk patients might be clinically relevant in defining the optimal duration of anticoagulation therapy. Furthermore, bleeding risk during anticoagulation therapy should also be taken into consideration for optimal duration of anticoagulation therapy. However, there are limited data assessing the risk of recurrence as well as bleeding in patients with intermediate-risk for recurrence based on the classification in the latest 2019 ESC guideline. Purpose The current study aimed to identify the risk factors of recurrence as well as major bleeding in patients with intermediate-risk for recurrence, using a large observational database of VTE patients in Japan. Methods The COMMAND VTE Registry is a multicenter registry enrolling consecutive 3027 patients with acute symptomatic VTE among 29 centers in Japan. The current study population consisted of 1703 patients with intermediate-risk for recurrence. The primary outcome measure was recurrent VTE during the entire follow-up period, and the secondary outcome measures were recurrent VTE and major bleeding during anticoagulation therapy. Results In the multivariable Cox regression model for recurrent VTE incorporating the status of anticoagulation therapy as a time-updated covariate, off-anticoagulation therapy was strongly associated with an increased risk for recurrent VTE (HR 9.42, 95% CI 5.97–14.86). During anticoagulation therapy, the independent risk factor for recurrent VTE was thrombophilia (HR 3.58, 95% CI 1.56–7.50), while the independent risk factors for major bleeding were age ≥75 years (HR 2.04, 95% CI 1.36–3.07), men (HR 1.52, 95% CI 1.02–2.27), history of major bleeding (HR 3.48, 95% CI 1.82–6.14) and thrombocytopenia (HR 3.73, 95% CI 2.04–6.37). Conclusions Among VTE patients with intermediate-risk for recurrence, discontinuation of anticoagulation therapy was a very strong independent risk factor of recurrence during the entire follow-up period. The independent risk factors of recurrent VTE and those of major bleeding during anticoagulation therapy were different: thrombophilia for recurrent VTE, and advanced age, men, history of major bleeding, and thrombocytopenia for major bleeding. FUNDunding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Research Institute for Production Development, Mitsubishi Tanabe Pharma Corporation

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Challenges of Hemodialysis Access for High Risk Patients: Impact of Mesenteric Vein Bioprosthetic Graft

The Journal of Vascular Access ◽

10.1177/112972980300400208 ◽

2003 ◽

Vol 4 (2) ◽

pp. 73-80 ◽

Cited By ~ 10

Author(s):

M.H. Glickman ◽

J.H. Lawson ◽

H.E. Katzman ◽

A.F. Schild ◽

R.M. Fujitani

Keyword(s):

High Risk ◽

African Americans ◽

Patency Rate ◽

Primary Patency ◽

Secondary Patency ◽

Hemodialysis Access ◽

Primary Patency Rate ◽

Risk Patients ◽

History Of

Objective The purpose of this study is to compare in a prospective fashion the performance of a new bioprosthesis, the mesenteric vein bioprosthesis (MVB), in patients who have had multiple failed ePTFE grafts. Performance measures include primary patency rates, assisted-primary patency rates, secondary patency rates, complications, and the number of interventions required to maintain graft patency. Study: From October 1999 to February 2002, 276 hemodialysis access grafts were implanted in a multicenter study. Of those grafts, 74 were placed in patients with a prior history of ≥ 3 failed prosthetic grafts (mean = 3.5 grafts, range = 3–6 grafts). Fifty-nine grafts were constructed with MVB, and 15 grafts with ePTFE as a concomitant control. Mean follow-up was 11.5 months. In the MVB group, 79.7% were African-Americans, 61% were females, and 23.7% were hypercoagulable. Of the ePTFE group, 86.7% were African-Americans, 46.7% were female, and 13.2% were hypercoagulable. Results Per Kaplan-Meier curves, the primary patency rate of the MVB group at 12 months was 33% vs the ePTFE group of 18% (p=0.120); the assisted-primary patency rates at 12 months were 45% MVB vs 18% ePTFE (p=0.011). The secondary patency rates at 12 and 24 months for the MVB group were 67% and 59%, respectively, vs 45% and 15% for the ePTFE group (p=0.006). During the follow-up time period, 80% of the ePTFE grafts were abandoned compared to 34% of the MVB group. Infection and thrombosis rates in the MVB group were lower than the ePTFE group. The infection rate for the MVB group requiring intervention was 0.07 events/graft year (gt/y) compared to 0.30 events/gt-y for ePTFE (p=0.04). A thrombosis rate of 0.69 events/gt-y occurred in the MVB group whereas 2.50 events/gt-y presented in the ePTFE group (p<0.01). Conclusion: In this study, high-risk patients (defined as those having multiple failed prosthetic grafts for hemodialysis) in whom the MVB conduit for hemoaccess was implanted, showed significant improvement in assisted-primary and secondary patency rates compared to the ePTFE cohort. The MVB group, however, did not have a statistically better primary patency rate compared to the ePTFE group. The MVB patient also had fewer thrombotic and infectious events and an overall reduction in the number of interventions while maintaining a permanent access site. This new bioprosthesis should be the conduit of choice in the complex group of patients as it offers assisted-primary and secondary patency rates similar to those commonly experienced by patients without a history of multiple graft failures.

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Clinical Characteristics and Outcome of Staphylococcus aureus Prostate Abscess From Ten Years of Experience at a Tertiary Care Center

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz372 ◽

2019 ◽

Vol 6 (10) ◽

Cited By ~ 1

Author(s):

Bryan Walker ◽

Eric Heidel ◽

Mahmoud Shorman

Keyword(s):

Staphylococcus Aureus ◽

Rare Complication ◽

Care Center ◽

Tertiary Care ◽

Care Hospital ◽

Risk Patients ◽

History Of ◽

A Site ◽

Lost To Follow Up

Abstract Objective Prostatic abscess (PA) is an uncommon infection that is generally secondary to Escherichia coli and other members of the Enterobacteriaceae family. In recent years, although rare, more reports of Staphylococcus aureus (S. aureus) PA have been reported, especially with increasing reports of bacteremia associated with injection drug use (IDU). Method This was a retrospective review of adult patients admitted to a tertiary care hospital between 2008 and 2018 and who had a diagnosis of S. aureus PA. Results Twenty-one patients were included. The average age was 46 years. Fourteen (67%) patients presented with genitourinary concerns. Main risk factors included concurrent skin or soft tissue infections (52%), history of genitourinary disease or instrumentation (48%), IDU (38%), and diabetes mellitus (38%). Methicillin-resistant Staphylococcus aureus (MRSA) was identified in 57% and concomitant bacteremia in 81% of patients. Surgical or a radiologically guided drainage was performed in 81% of patients. Antibiotic treatment duration ranged from 3 to 8 weeks. Six patients were lost to follow-up. Clinical resolution was observed in the remaining 15 (81%) patients who had follow-up. Conclusions S. aureus PA continues to be a rare complication of S.aureus infections. In most published reports, MRSA is the culprit. In high risk patients with persistent bacteremia, physicians need to consider the prostate as a site of infection.

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Peripherally Embolizing Aortic Thrombus: The Work-Up, Management, and Outcome of Primary Aortic Thrombus

Case Reports in Cardiology ◽

10.1155/2019/8132578 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6

Author(s):

Ramy Mando ◽

Robert Gemayel ◽

Ashish Chaddha ◽

Julian J. Barbat ◽

Elvis Cami

Keyword(s):

Filling Defect ◽

Sudden Onset ◽

Low Grade ◽

Unique Case ◽

Descending Aorta ◽

Aortic Thrombus ◽

Risk Patients ◽

History Of ◽

Work Up

Background. Primary aortic thrombus is an uncommon entity and not frequently reported in the literature. Herein, we discuss the presentation and management of a patient with a primary thoracic mural thrombus. Case Summary. A 46-year-old female with past medical history of tobacco dependence presented for low-grade fever and sudden onset, severe right upper quadrant abdominal pain with associated nausea and vomiting. Computed tomography (CT) revealed an intraluminal polypoid filling defect arising from the isthmus of the aorta projecting into the proximal descending aorta and findings consistent with infarction of the spleen and right kidney. Infectious, autoimmune, hematologic, and oncologic work-up were all unyielding. The patient was started on heparin and later transitioned to apixaban 5 mg twice a day and 81 mg of aspirin daily. She was also counseled regarding smoking cessation. Two months follow-up CT revealed resolution of the thrombus. Patient had no further thromboembolic complications. Discussion. We present a unique case of primary aortic thrombus. To our knowledge, this is the first reported case managed successfully with a NOAC. This diagnosis is one of exclusion and through work-up should be completed. Our aim is to raise awareness of this condition and successful management with apixaban in low-risk patients.

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Neurological outcomes of untreated brainstem cavernous malformations in a prospective observational cohort and literature review

Stroke and Vascular Neurology ◽

10.1136/svn-2020-000608 ◽

2021 ◽

pp. svn-2020-000608

Author(s):

Da Li ◽

Jing-Jie Zheng ◽

Jian-Cong Weng ◽

Pan-Pan Liu ◽

Ze-Yu Wu ◽

...

Keyword(s):

Neurological Status ◽

Neurological Deficits ◽

Developmental Venous Anomaly ◽

Cavernous Malformations ◽

Neurological Outcomes ◽

Scale Scores ◽

Risk Patients ◽

History Of ◽

Lost To Follow Up

BackgroundHaemorrhages of brainstem cavernous malformations (CMs) can lead to neurological deficits, the natural history of which is uncertain. The study aimed to evaluate the neurological outcomes of untreated brainstem CMs and to identify the adverse factors associated with worsened outcomes.MethodsFrom 2009 to 2015, 698 patients (321 women) with brainstem CMs were entered into the prospective cohort after excluding patients lost to follow-up (n=43). All patients were registered, clinical data were collected and scheduled follow-up was performed.ResultsAfter a median follow-up of 60.9 months, prospective haemorrhages occurred in 167 patients (23.9%). The mean modified Rankin Scale scores at enrolment and at censoring time were 1.6 and 1.2. Neurological status was improved, unchanged and worsened in 334 (47.9%), 293 (42.0%) and 71 (10.2%) patients, respectively; 233 (33.4%) recovered to normal levels. Lesions crossing the axial midpoint (relative risk (RR) 2.325, p=0.003) and developmental venous anomaly (DVA) (RR 1.776, p=0.036) were independently significantly related to worsened outcomes. The percentage of worsened outcomes was 5.3% (18 of 337) in low-risk patients (neither DVA nor crossing the axial point) and increased to 26.0% (13 of 50) in high-risk patients (with both DVA and crossing the axial point). The percentage of worsened outcomes significantly increased as the number of prospective haemorrhages increased (from 1.5% (8 of 531, if 0 prospective ictus) to 37.5% (48 of 128, if 1 ictus) and 38.5% (15 of 39, if >1 ictus)).ConclusionsThe neurological outcomes of untreated brainstem CMs were improved/unchanged in majority of patients (89.8%) with a fatality rate of 1.7% in our cohort, which seemed to be favourable. Radiological features significantly predicted worsened outcomes. Our results provide evidence for clinical consultation and individualised treatment. The referral bias of our cohort was underlined.

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Factors Influencing Failure to Undergo Interval Cholecystectomy After Percutaneous Cholecystostomy Among Patients With Acute Cholecystitis: a Retrospective Study

10.21203/rs.3.rs-640058/v1 ◽

2021 ◽

Author(s):

Yao Peng ◽

Zhihui Chang ◽

Zhaoyu Liu

Keyword(s):

Acute Cholecystitis ◽

Acalculous Cholecystitis ◽

Albumin Level ◽

Percutaneous Cholecystostomy ◽

Factors Influencing ◽

Effective Treatment Modality ◽

Risk Patients ◽

History Of ◽

Grade Iii

Abstract Background: Percutaneous cholecystostomy (PC) with interval cholecystectomy is an effective treatment modality in high-risk patients with acute cholecystitis. However, some patients still fail to undergo interval cholecystectomy after PC, with the reasons rarely reported. Hence, this study aimed to explore the factors that prevent a patient from undergoing interval cholecystectomy.Methods: Data from patients with acute cholecystitis who had undergone PC from January 1, 2017, to December 31, 2019, in our hospital were retrospectively collected. The follow-up endpoint was the patient undergoing cholecystectomy. Patients who failed to undergo cholecystectomy were followed up every three months until death. Univariate and multivariate analyses were performed to analyze the factors influencing failure to undergo interval cholecystectomy. A nomogram was used to predict the numerical probability of non-interval cholecystectomy.Results: In total, 205 participants were identified, and 67 (32.7%) patients did not undergo cholecystectomy during the follow-up period. Multivariate analysis revealed that Tokyo guidelines 2018 (TG18) grade III status (odds ratio [OR]: 3.83; 95% confidence interval [CI]: 1.27–11.49; p=0.017), acalculous cholecystitis (OR: 4.55; 95% CI: 1.59–12.50; p=0.005), albumin level <28 g/L (OR: 4.15; 95% CI: 1.09–15.81; p=0.037), and history of malignancy (OR: 4.65; 95% CI: 1.62–13.37; p=0.004) were independent risk factors for a patient’s failure to undergo interval cholecystectomy. Among them, history of malignancy showed the highest predictor point on the nomogram for predicting non-interval cholecystectomy.Conclusions: TG18 grade III status, acalculous cholecystitis, severe hypoproteinemia, and history of malignancy are the factors influencing failure to undergo cholecystectomy after PC in patients with acute cholecystitis.

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