CS-6 A case of poorly differentiated chordoma with systemic metastasis

A case report: The patient was a 32-year-old man with diplopia. He was diagnosed as sphenoid sinusitis on MRI by a local doctor and visited an otolaryngologist. MRI showed extensive extension of neoplastic lesions from the clivus to the sphenoid sinus to the anterior ethmoid sinuses, bilateral cavernous sinuses, and the right medial and lateral pterygoid muscles. The right Lebiere’s lymph node was enlarged and thought to be a metastatic site. Based on the rapid growth and extension of the tumor, the patient was referred to the Department of Otolaryngology at our hospital on suspicion of sinonasal carcinoma. The possibility of chordoma could not be denied, so the patient was referred to our department. The patient underwent a joint endoscopic extended transsphenoidal tumor resection. The pathological diagnosis showed mitotic and necrotic features, and the majority of the cells showed highly atypical components without mucous substrate. However, brachyury, a marker for chordoma, was diffusely positive, and there was loss of INI1 (SMARCB1) expression. The final diagnosis was poorly differentiated chordoma. Postoperatively, the tumor in the right cavernous sinus grew rapidly, and the right eye became blind due to obstruction of the superior ophthalmic vein. The patient was treated with Gamma Knife as soon as possible in the hope of local control by high-dose irradiation, and after a total of three irradiations, the residual tumor shrank markedly and symptoms improved, but systemic metastasis occurred in a short period of time and the patient died. The number of cases of poorly differentiated chordoma has been reported rarely (more than 50), and it is more common in children and even rarer in adults. We report this case with a review of the literature.

Allogeneic bone marrow transplantation possibly induces a localized type of porokeratosis

A 15-year-old girl underwent allogenic bone marrow transplantation for neuroblastoma. A few years later, she noticed a round lesion on her left buttock. Since the lesion had been asymptomatic and never grown, more than 20 years had passed before she saw a local doctor to consult about it. Although the lesion was suspected to be tinea corporis, no fungi were found on microscopic examination. Subsequently, administered topical corticosteroids were not effective. She was referred to our hospital for further evaluation, and a skin biopsy confirmed the diagnosis of porokeratosis. There was a possibility that chemotherapy, total body radiation, or immunosuppressive therapy associated with allogeneic bone marrow transplantation was involved in the development of porokeratosis. Numerous cases of acquired porokeratosis in immunocompromised status have been observed; as for those after allogenic bone marrow transplantation, 12 cases have been reported in the English literature, 4 of which had only one or a few lesions on a limited area of body surface. Our case was relatively uncommon in that the lesion was solitary and comparatively large. In a localized type of porokeratosis, it was suggested that a malignant skin tumor developed earlier than in other types. Careful follow-up for malignant transformation is especially required.

Questions and answers. Volume 25, No. 11 (1929)

33) a) Are there legal provisions on the right of hypnosis treatment and what? b) Can a local doctor, familiar with the literature of hypnosis, with little independent experience without special training, use psychotherapy as one of the methods of treatment?

Intrathecal baclofen therapy for severe spasticity in an adult with tethered cord syndrome: a case report

Background Patients with tethered cord syndrome often suffer severe spasticity. To the best of our knowledge, intrathecal baclofen (ITB) therapy in a patient with tethered cord syndrome has not been reported previously. We describe a case in which ITB therapy was useful for treating severe spasticity in an adult with tethered cord syndrome. Case presentation We present the case of a 50-year-old Japanese woman with tethered cord syndrome and related conditions suffering from severe spasticity and pain in the lower limbs. She was born with a lumbosacral myelomeningocele, which was closed in the neonatal period. For 4–5 years before this presentation, spasticity in the lower limbs had been exacerbated without any obvious cause. She received rehabilitation and pharmacotherapy from a local doctor, but symptoms were unimproved, and her previous doctor referred her to this department. A test with 50 μg of intrathecally delivered baclofen showed total relief of spasticity and pain, so a pump was implanted for continuous baclofen delivery. During 24 months of follow-up, spasticity has remained under excellent control with baclofen at 38.5–41.0 μg/day. Conclusions ITB therapy proved extremely effective in this adult with severe spasticity from tethered code syndrome.

Totally endoscopic surgical resection for a blood cyst originated from mitral valve: a case report

Background Intracardiac blood cysts are very rare primary cardiac tumors. Blood cysts originated from the mitral valve represent a minority of cases, and previous cases have been mainly treated with conventional surgery through median sternotomy. When the tumor involves heart valves and histopathological diagnosis remains unknown preoperatively, minimally invasive surgical resection of an intracardiac tumor can be challenging, especially through an endoscopic approach. We herein present the first case of successful surgical resection for a rare mitral valve originated blood cyst in a minimally invasive, totally thoracoscopic approach. Case presentation An apparently healthy 38-year-old male presented to his local hospital with six months history of palpitation and exertional dyspnea. Transthoracic echocardiography showed a mobile round cystic mass inside the left ventricle, attached to the anterolateral papillary muscle and chordae tendineae of the mitral valve. The local doctor diagnosed an intracardiac tumor and suggested a surgical resection through median sternotomy. However, the patient refused to have a sternotomy. He was then referred to us seeking minimally invasive surgery. We assessed the location, appearance and relationship to nearby structures of the tumor with echocardiography, and made a diagnosis of a suspected primary cystic intracardiac tumor. Since we had enough experience of totally endoscopic mitral surgery, our surgical plan was to resect the tumor in the aid of thoracoscopy, and manage the possible deformation and dysfunction of the cardiac structure if necessary. Using femoro-femoral cannulation and cardiopulmonary bypass, we successfully resected the tumor through a thoracoscopic approach in a closed chest, and well preserved the subvalvular structure and valvular function. Postoperative recovery was quick and uneventful. Pathologic diagnosis confirmed a simple blood cyst. Conclusions Surgical resection is warranted for symptomatic cases of intracardiac blood cysts. With prudent preoperative diagnosis and comprehensive surgical plan, we believe the thoracoscopic approach is a safe, curative and viable alternative for complete resection of cardiac valvular tumors.

LOCAL EXPERIENCE OF TELEMEDICINE: EXAMPLES OF CASES IN YEMEN

Background: The benefits of establishing a web-based telemedicine service in a resource-stressed society, linking health professionals in order to improve the quality and accessibility of healthcare and facilitate a further method of medical education through exchange of knowledge and experiences. Sub-standard communication facilities within a strained medical service across limited sites, combined with an inadequate understanding of the service further reduces provision. The on-going military campaign within the country exacerbates the problems facing medical staff, yet despite the difficult situation in the country there is a drive towards an increase in health facilities. Objective: The aim of this research is to explore one of the first experiences in the use of telemedicine in Yemen by clarifying cases that have benefited from telemedicine and further exploring the potential for development of a network of TM to serve areas which lack sub-specialty services. Methods: We carried out a review of both the first and second phases of our experience of TM services in Yemen. The first phase began in 1997 when we joined a newly established international company based in the USA with several offices in different countries. We got a huge, expensive digitizer that was supposed to transfer medical reports to second opinion sites in USA, UK, Jordan etc. The second phase began a few years later utilizing a free service, namely The Swinfen Charitable Trust, based in the UK; in which 300 cases in the first stage with 1-3 responses and about 80 cases with 5-50 responses and more in the second stage were involved and benefited from TM services. Results: During the study period the process was seen to be generally very useful to patients helping the local doctor to give the correct decision on management and treatment; added to that cases had reduced travel and the specialist advice proved educational for the doctors who received their guidance. Conclusion and recommendation: This study revealed that telemedicine services are generally underutilized in Yemen despite the good results achieved in many of the cases. Technical, administrative, and legal issues should be discussed in Yemen. Factors such as on-going problems with internet connectivity and consequent system reliability must also be considered. Knowing and identifying these factors is vital for considering any future in-depth studies and assessing the appropriate measures to fix the technological problems that face TM in Yemen are an on-going concern. Peer Review History: Received 3 January 2021; Revised 11 February; Accepted 1 March, Available online 15 March 2021 UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency. Received file: Reviewer's Comments: Average Peer review marks at initial stage: 5.5/10 Average Peer review marks at publication stage: 7.0/10 Reviewer(s) detail: Dr. George Zhu, Tehran University of Medical Sciences, Tehran, Iran, [email protected] Dr. Evren Alğin Yapar, Turkish Medicines and Medical Devices Agency, Turkiye, [email protected] Similar Articles: USE OF COLCHICINE TO COUNTERACT THE STRONG HYPERINFLAMMATORY STATE INDUCED BY SARS-COV-2

Cervical Cancer- Care Delayed-Care Denied and Death Invited

With about 78 billion global population, in 2020, 19 million new cancers and nearly 1 million deaths due to all types estimated to occur. Cervical cancer does not figure in top 5 most common cancers in both sexes globally, but with 6.5% incidence it forms the fourth top among women worldwide. The cancer registry data across the country in India with simple average of the most recent local rates applied to 2020 population estimates a figure of 1324413 cases and 851678 in 2020 and cumulative prevalence around 2.7 million cases in last 5 years of all categories of cancers in India. Cervical cancers in India account for 10% of all cancers in both sexes and about 18% of cancers among women in India as per the international agency for Cancer Research. Nearly one-third of the global cervical cancer deaths occur in India. It is a preventable condition as it has a long precancerous stage amenable for screening and treating. Cervical cancer Cervix uteri is no 3 with about 123 907 cases (9.45) next only to Breast and Oral cancers with a 2.01 cumulative risk. Cervical cancer death risk as 60000 women die annually. While the incidence and mortality rates of cervical cancer in the world are 13.1/ and 6.9/ per lakh population, in India, it is estimated to be 14.7/and 9.2/ per lakh population. Resulting in about 96,922 new cervical cancer cases and 60,078 deaths ranking second among women cancers. The incidence varies within Indian population basically due to ggeographical and socio-economic disparities in screening practices and care seeking practices across the districts of India. Epidemiologically the symptoms are mild and mimic a venereal disease of low infectiousness and therefore delay in seeking care and reporting at a time when the prognosis is poor. The 5-year survival rate is around 76.0% for those aged ≤50 years with much poorer survival among cases with involvement lymph nodes. We present one such case of a 45 year’s old rural women reporting on 4th May 2021 with symptoms vaginal bleeding, back pain, urine leakage & pelvic pain since 2 months to a gynecologic oncology service at a cancer hospital & research center, Bangalore. She had the history of taking treatment for another 2 months earlier from a traditional healer with no progress. She had consulted a family doctor first who referred her to the Cancer hospital. After an evaluation for abnormal vagina bleeding, cervical biopsies that demonstrated invasive adenocarcinoma of the cervix (Stage IV B CA Cervix) the diagnosis was confirmed. Since it was in an advanced stage, a palliative management including radiation therapy for control of bleeding & pain, and systemic chemotherapy for disseminated disease was opted. After 22 days of treatment she got discharged along with medications prescribed Inj. Amikacin 100mg IV OD, Inj. Pantoprazole 40mg IV OD, DNS which was given by the local doctor. But there was no progress and finally she died on 17th June 2021 after 23 days of discharge. This case emphasizes the need for early care seeking behavior, regular screening for all women over 35-45 years and HPV vaccination for adolescent girls in India.

Catatonia

Karl Login, Latvian, peasant-farmer, 22 years old; the closest relatives of the patient are healthy; nothing is known about distant relatives. K.L. in childhood he endured scarlet fever, but generally enjoyed good health, studied well in the village school, lingering actively helped his father in village work; character was good-natured, apathetic, played the violin well and was considered a good musician. He led a correct lifestyle, did not drink and, as far as is known, did not have sexual intercourse. I got sick in December 1895; according to the opinion of the patient's brother, the disease developed as a result of two reasons; K.L. was a witness of how the worker got into the car and was taken out dead; this circumstance seemed to have made a heavy impression on K. L; the second reason: he wanted to get married, but the father did not allow this the son must learn some trade, get a job and then get married. Around Christmas 1895 K.L. I was extremely apathetic, "quiet", slept a lot; sometimes complained about the feeling of pressure in the head and chest. At the end of January, he stopped talking, working and playing the violin, and slept almost all day long. The patient was used by a local doctor, but without any success; all manifestations of the disease progressively intensified. Before admission to the clinic, he almost continuously merged for two or three weeks, occasionally smiling: except for yes and no, he did not say a word. He himself went up to the table and ate, was clean; if he is taken somewhere, he resists. There was no deception of feelings, no inclination to destruction.

Pleomorphic carcinoma of the trachea after chemoradiotherapy for laryngeal cancer

A 66-year-old male patient who had received chemoradiotherapy (CRT) for laryngeal cancer 2 years ago visited a local doctor complaining of dyspnoea and wheezing. CT scan showed narrowing of the trachea caused by a tumour. We intubated the trachea over the tumour using a bronchoscope. A week later, the truncated tracheal tumour obstructed the tracheal tube, compromising the patient’s breathing. We removed the obstructed tube and inserted a new one. We submitted the tissue from the tube to a pathologist. Histopathological diagnosis was pleomorphic carcinoma, a subtype of sarcomatoid carcinoma. The mechanism of epithelial–mesenchymal transition (EMT) occurring after CRT was detected in the tumour. Because he had undergone CRT for laryngeal cancer, surgery was not indicated, and we started radiation therapy. Sarcomatoid carcinomas including pleomorphic carcinoma of the trachea are extremely rare, with few reported cases, and EMT is associated with this histological type and CRT.

Conflict in migrant doctor–local doctor communication in public healthcare institutions in Chile

When investigating intercultural communication in healthcare settings, interprofessional communication has received very little scholarly attention compared to doctor–patient interactions. Interactions among doctors, however, are an important locus for the organizational life of a hospital as the way these professionals communicate will promote (or hinder) professional effectiveness and efficiency. This paper presents the findings of a study that explores the perceptions concerning the degree and frequency of communicative conflict of 61 migrant doctors working in public healthcare institutions in the central region of El Maule in Chile. Drawing on data from a survey on communicative conflicts, the study analyses the perceptions of the migrant doctors in relation to one particular style of conflict management, namely, adaptability. Findings show that although communicative conflicts seem to occur only occasionally, moderate scores are reported for how such perceptions are believed to affect work performance. Also, the demands of communicative adaptability are perceived to be met largely by migrant doctors alone. The paper then offers considerations about the possible impact that these adaptability efforts could have on migrant doctors’ integration processes.