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Author(s):  
Dewi Sumaryani Soemarko ◽  
Aditya Agung Prasetyo

Background: Liver cirrhosis is the final pathological result of various chronic liver diseases that characterized by the formation of regenerative nodules and fibrotic tissue. The etiology of liver cirrhosis are hepatitis C, hepatitis B, alcohol, nonalcoholic fatty liver disease, and can also be caused by chemicals in the workplace. The occupational diagnosis of Liver Cirrhosis that exposed by vinyl chloride superimposed with hepatitis B infection with was performed by using The Seven Steps of Occupational Diagnosis, a method that issued by PERDOKI (Indonesian Occupational Medicine Association-IOMA). The aim of this case report is to determine whether liver cirrhosis in this patient is an occupational disease or not.Case Presentation: Fifty years old man came to Emergency Room with complaints of vomiting black blood since 4 hours. Vomiting blood as much as 5 times with a volume of about 200 cc each time. One day before, patient admitted that his defecation is black, watery, and smell bloody. Volume of defecation was unknown. Three months before, patient complainted that the stomach often felt bloated, enlarged, and got full quickly. There was no icteric in eyes and body.This complaints (vomiting black blood and black stools) were often occured since 2017. In 2017, 2018 and 2020, this patient was hospitalized once while in 2019, the patient was hospitalized twice for this complaint. In 2017, when the complaint first appeared, the patient was declared to have hepatitis B and in 2019, the patient underwent an endoscopy and was said to have enlarged blood vessels in the esophagus, and an abdominal ultrasound was performed and was said to be suspected of liver cirrhosis.This patient works as a family owned chemical industry. The chemical produced is called zamitex, a mixture for paints. These chemicals contain formaldehyde, Vinyl Chloride, and CMC (Carboxymethyl Cellulose). This patient had worked in this field for 21 years, and was exposed to these chemicals. In addition, there are also dangers of heat, awkward positions, and psychosocial.Conclusion: Based on The Seven Steps of Occupational Diagnosis, Liver cirrhosis in this patient can be categorized as an occupational disease superimposed with hepatitis B infection. Liver cirrhosis in this patient can be caused by prolonged exposure to Vinyl Chloride. Vinyl Chloride is known to cause damage to the liver, especially to cause carcinoma of the liver. There is a synergistic effect between exposure to Vinyl Chloride and hepatitis B infection, exacerbating the condition of liver damage. However, because the exposure to Vinyl Chloride has been going on for a longer time, compared to hepatitis B infection, the condition of liver cirrhosis in this patient is still categorized as an occupational disease.


2021 ◽  
pp. 1632-1637
Author(s):  
Tomohiro Shidahara ◽  
Shozo Ohsumi ◽  
Yuichiro Miyoshi ◽  
Mina Takahashi ◽  
Seiki Takashima ◽  
...  

Chemotherapy is often difficult to treat human epidermal growth factor receptor 2 (HER2)-positive metastatic recurrent breast cancer in the elderly, and no standard treatment has been established at this point. We experienced a case in which trastuzumab (Tmab) + anastrozole (ANA) was ineffective (progressive disease; PD) in elderly HER2-positive breast cancer with postoperative multiple liver metastases, but T-DM1 was significantly effective (complete response; CR), and treatment could be continued safely. An 82-year-old woman was referred to our department with a right breast mass. A close examination revealed right breast cancer cT1bN0M0 cStage I, and total mastectomy and sentinel lymph node biopsy were performed. The postoperative pathological result was pT1bN0M0 pStage I (luminal HER2 type). The patient was elderly and had no adjuvant treatment after the operation. Approximately 2 years after the operation, multiple liver metastases were observed, and treatment with ANA and Tmab was started. Four months later, MRI showed that the number of multiple liver metastases increased. The patient was diagnosed with PD, and the anti-HER2 drug was changed from trastuzumab to trastuzumab emtansine (T-DM1). The dose was reduced due to vomiting (grade 3). Two months later, MRI showed that the multiple liver metastases shrank and became obscure after 5 months. After that, T-DM1 was continued, and the disease did not worsen. In elderly people with difficulty in administering chemotherapy, T-DM1 may have a safe and sufficient therapeutic effect by adjusting the dose and managing side effects appropriately.


BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e044347
Author(s):  
Jia Wei ◽  
Xiangyi Ma ◽  
Wenwen Wang ◽  
Minli Zhang ◽  
Zhiying Yu ◽  
...  

IntroductionLeiomyoma recurrence is a major concern for long-term myomectomy management, especially for multiple leiomyomas. Gonadotropin-releasing hormone agonist (GnRHa) is one of the most effective medications to reduce the volume of fibroids and the uterus. However, its role in preventing recurrence after conservative surgery remains unclear. At present, there is no randomised clinical trial determining the efficacy of GnRHa treatment for preventing multiple leiomyomas recurrence after myomectomy.Methods and analysisWe are conducting a phase IV randomised controlled trial in women aged 18–45 undergoing myomectomy for multiple leiomyomas. After surgery, women whose pathological result confirms multiple leiomyomas are randomised in a 1:1 ratio into an observation or GnRHa group. The primary outcome is the recurrence of either clinical symptoms or fibroids on imaging. Patients will be assessed for adverse events during the follow-up.Ethics and disseminationThe study was approved by the Medical Ethics Committee of the Tongji Hospital Affiliated with the Tongji Medical College of Huazhong University of Science and Technology (TJ-IRB20180311) according to the submitted study protocol (V.1.0, 10 November 2017) and informed consent (V.1.0, 10 November 2017). The results will be presented at domestic and international conferences and published in peer-reviewed journals.Trial registration numberChiCTR-IPR-17012992.


Author(s):  
Junjie Zhang ◽  
Xiaobo Zhu ◽  
Minyan Jiang ◽  
Yajun Lv

Abstract A female patient with a right-sided encapsulated pleural effusion was misdiagnosed preoperatively as having an encapsulated empyema. However, a giant mass in the anterior mediastinum was found via thoracoscopy, and a mature teratoma was detected based on the pathological result. Herein we report this case and provide lessons for cardiothoracic surgeons.


BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xintao Cai ◽  
Zhixiang Sun ◽  
Yu Li ◽  
Dongqi Shao ◽  
Xialin Zheng ◽  
...  

Abstract Background Craniopharyngioma (CP) is a slow-growing, benign tumor of the central nervous system located within the sellar and suprasellar regions. The tumor may extend from the suprasellar region to other areas. CPs are generally believed to originate from squamous remnants of an incompletely involuted craniopharyngeal duct that also develops from Rathke’s pouch. Primary parasellar craniopharyngioma is a relatively rare tumor, and nasal endoscopy, computed tomography, and enhanced magnetic resonance imaging can be applied to better evaluate the invasiveness and characteristics of these tumors. Case presentation We report a case of right parasellar craniopharyngioma in a 49-year-old female patient with a 10-day history of dizziness and blurred vision. Preoperative imaging examination revealed right parasellar space-occupying lesions, and the patient underwent transnasal neuroendoscopic resection of the right parasellar space-occupying lesion. The postoperative pathological result confirmed craniopharyngioma. Conclusions Primary ectopic parasellar craniopharyngioma is a relatively rare tumor, and preoperative imaging examination can assist in the evaluation of tumor characteristics. However, the final diagnosis continues to depend on the histopathological results.


2021 ◽  
pp. 20210078
Author(s):  
Yun Bai ◽  
Jun Lin ◽  
An Chen ◽  
Min Bai ◽  
Chunxiao Li ◽  
...  

Objective: To compare the diagnostic value of contrast-enhanced ultrasonography (CEUS) with baseline ultrasound (B-US) in ureteral neoplasms. Methods: Retrospective analysis, comprising clinical presentation, image appearances, and diagnostic results on B-ultrasound and CEUS, considering pathological result as a gold-standard, was conducted on the clinical information of 39 patients with ureteral neoplasms. CT urography was used to detect and confirm the presence of ureteral neoplasms. Both B-ultrasound and CEUS investigations of those 39 patients under study were performed by a senior radiologist. Results: Pathological outcomes established 27 ureteral malignancies and 12 ureteral benignancies. Ureteral malignancies were observed to occur in older patients than benignancies (p = 0.002). Only the morphological indicator of the ureteric wall on B-ultrasound was different in ureteral malignancies and benignancies (p = 0.030). Tumors with hyperenhancement, larger width, and hyperenhanced ureteric wall were easily diagnosed as malignant on CEUS, whereas iso-/hypoenhanced, narrower, and iso-/hypoenhanced ureteric wall indicated benign tumors. Moreover, the lesion widths, enhanced morphologies of the ureteric wall, and the ureteral wall’s linear boundaries on CEUS were different between high- and low-stage ureteral urothelial carcinomas (p = 0.012, 0.002, 0.001, respectively). Conclusion: The display of microvessels in ureteral neoplasms was significantly enhanced by CEUS, thus contributing to the differential diagnosis of ureteral neoplasms while assisting the staging of ureteral urothelial carcinoma. Advances in knowledge: The imaging features of different ureteral neoplasms on CEUS were analyzed in this study. The diagnostic performances of CEUS and B-ultrasound in ureteral urothelial carcinomas were also explored.


2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kimberly Sánchez ◽  
Juan Valls

Objective: To correlate the clinical lymph node classification with the pathological result of neck dissections performed in patients with head and neck cancer at the Otorhinolaryngology Department of the Hospital Universitario de Caracas from January 1, 2011 to December 31, 2016. Method: Descriptive, quantitative and retrospective study, which evaluated 27 patients, who underwent classical radical, modified radical and selective neck dissection. Results: average age 56 years, 77.8% male. The most frequent histological type was squamous carcinoma 81.5%. The most used type of dissection was selective 53.3%, followed by the classical radical 26.7% and the modified radical 20.0%, of these 36% presented local or cervical recurrence. Of the 16 patients with positive lymph nodes, 13 had patology confirmation, and all the negative nodes also had negative patology confirmation; regarding cervical recurrence, of the 7 cases where it was present, all positive nodes, and in the 11 patients negative nodes, all negative cervical recurrence. Conclusion: The relationship between the pathological and clinical classification, as well as the presence of positive lymph nodes in cervical recurrences are statistically significant and are related to the decrease in survival. Neck palpation continues to be a useful tool in therapeutic decision making, which has shown higher than average sensitivity and specificity.


BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Juan Tang ◽  
Zhen Zeng ◽  
Senyi Deng ◽  
Feng Lin

Abstract Background Bronchogenic cysts can be caused by errors in the growth of the ventral foregut. Localization of the bronchogenic cyst (BC) varies depending on the level of the abnormal budding. They are usually located in the lungs and mediastinum. BCs of the diaphragm are a rare form of this abnormality. Case presentation A 66-year-old woman coughs and expectorates. CT scan evaluation revealed a soft tissue shadow of 6 × 5 cm in the left lung. Under thoracoscopic surgery, we found that the mass originated from the diaphragm away from the lung tissue, we completely removed the mass and the pathological result was diagnosed as BC. Conclusions The prognosis of ectopic BC is usually optimistic for benign tumors, as long as the tumor is completely removed.


2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Qiping Liu ◽  
Huiling Gong ◽  
Hui Zhu ◽  
Chunyan Yuan ◽  
Bin Hu

Objective. To discuss the clinical application value of contrast-enhanced ultrasound (CEUS) in testicular occupied lesions. Methods. Nine conventional-ultrasound-found testicular occupied lesions which underwent CEUS meantime were analyzed retrospectively. The CEUS perfusion pattern was compared with the surgical pathological result or follow-up findings. Results. Among all the 9 testicular occupied lesions, there were 5 testicular malignant tumors, 1 testicular benign tumor, 1 testicular tuberculosis, and 2 testicular hematomas. CEUS diagnosed 6 testicular malignant tumors, 1 testicular benign tumor, and 2 testicular hematomas, and its diagnostic accuracy was about 88.9%. Conclusion. CEUS has high clinical application value in the differential diagnoses of benign and malignant testicular occupied lesions.


2021 ◽  
Author(s):  
Marina Martin Pereda ◽  
Maria Amores Vergara ◽  
Lorena Sabonet Morente ◽  
Ernesto Gonzalez Mesa ◽  
Pilar Espejo Reina ◽  
...  

Abstract Background Testosterone replacement treatment as part of gender reassignment therapy has repercussions on the final pathological result of the hysterectomies that are performed. The objective of this review is to analyze the surgical pieces of hysterectomies performed on FTM patients (female-to-male) and to describe possible changes related to testosterone. There are few studies and with a low number of patients where this possible repercussion is addressed. Methods A retrospective study was carried out, which included 117 patients between the ages of 21 and 56, operated on between 2010 and 2019, with at least an average duration of treatment of 5 years before gender reassignment surgery. Main outcome measure were changes in follicle stimulating hormone (FSH), luteinizin hormone (LH), testosterone (TST) and estradiol in blood, both preoperatively and postoperatively. Also the differente types of endometrium and ovaries found in histerectomy pieces. Results the pathological study revealed that 95 (80.3%) cases showed an atrophic endometrium, 7 (6%) cases an endometrium with secretory-type changes, and 15 (13.7%) cases with weakly proliferating endometrium. Conclusions Our data revealed that the most frequent histology after chronic administration of parenteral testosterone was such compatible with atrophic endometrium, coinciding with what has been published in the literature up to now. More long-term studies on the effects of parenteral testosterone are still needed.


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