SAPHO syndrome associated with a digestive disorder in a ten-year-old girl: Diagnostic difficulties

SAPHO syndrome (acronym for synovitis, acne, pustulosis, hyperostosis, osteitis) is a rare dermato-rheumatic entity usually observed in young adults. The clinical manifestations are proteinaceous and without specificity at the origin of inflammatory diseases of the intestine. Our clinical case is that of a ten-year-old girl who presented with chronic and recurrent osteomyelitis of the pelvic limbs on a febrile background, followed by persistent and recurrent pustular lesions. During the same period, because of an acute abdominal pain syndrome accompanied by fever, a biological inflammatory syndrome, and predominantly neutrophilic hyperleukocytosis, laparotomy was performed and no lesions were found. She subsequently presented with intermittent and recurrent spasmodic abdominal pain. In view of these various symptoms, a multidisciplinary consultation concluded that the patient had SAPHO syndrome associated with a digestive disorder, possibly Crohn’s disease. Our clinical case illustrates the diagnostic difficulties of SAPHO syndrome.

Squamous Cell Rectal Carcinoma: About A Rare and Unusual Case: A Case report

Primary squamous cell rectal carcinoma is a rare malignancy that accounts for 0.3% of rectal tumors. To this date, no sure risk factors have been determined. The etiopathogeny is still unknown, despite the different suggested hypotheses. Specific diagnosis criteria have been set, to identify rectal squamous cell carcinoma from another entity. Moreover, due to its rarity, only few data exist on its management, and no standardized therapeutic regimen was set. We report a very rare case of primary squamous cell rectal carcinoma found in the middle rectum, in a 73-year-old woman. Rectos copy was used to visualize the tumor mass and to take biopsies; their histological study revealed a rectal location of a squamous cell carcinoma. After discussion of the case in a multidisciplinary consultation meeting, management consisted of definitive chemo-radiation.

Hemifacial spasm is not affected by state of consciousness: a case report

Background Hemifacial spasm (HFS) is a movement disorder caused by mechanical compression of the facial nerve after it has left the brainstem and is characterized by brief or sustained twitching of the muscles innervated by that nerve. Often we observe spasm in an awakening situation. Actually contractions persist during sleep. To our knowledge, there were no reports on how HFS manifests under disturbance of consciousness. Here, we report a case of primary HFS in which the patient's symptoms persisted in a coma. Case presentation A 74-year-old female with right-sided primary HFS for 20 years and had received botulinum toxin injections in our hospital. Unfortunately she was carried to emergency department after traumatic right pneumothorax by accident. During the emergency treatment, she lost consciousness due to simultaneous cardiac arrest and respiratory arrest. She was then admitted to the emergency intensive care unit for further treatment. During her hospitalization, she was in a coma with stable vital signs and persisting symptoms of HFS. Thus, a multidisciplinary consultation was requested to identify whether it was focal cortical seizures involving the right-side facial muscles. Physical examination revealed brief involuntary clonic or tonic contractions accompanied with the ‘Babinski-2 sign’. A combination of relevant data, including her past history, clinical presentation and a negative computed tomography scan of the head, led to a diagnosis of right-sided HFS. As the symptoms of HFS are not life-threatening, the use of anticonvulsants is unnecessary. Conclusions For the layperson, it is crucial to seek a multidisciplinary consultation to obtain a correct diagnosis.

Rectal Gastrointestinal Stromal Tumor (GIST): About a Rare and Unusual Case

Rectal gastrointestinal stromal tumors (GIST) are extremely rare, accounting for approximately 0.1% of all rectal tumors. Diagnosis is based on histological and immunohistochemical confirmation. We report the case of a 38-year-old patient with a rectal GIST revealed by chronic rectal bleeding associated with rectal tenesmus, abdominal pain with painful contractions and frequent evacuations evolving in a context of altered general state. Rectoscopy was used to visualize the tumor mass and to take biopsies; their histological and immunohistochemical study revealed a rectal location of a gastrointestinal stromal tumor. The extension assessment was negative. After discussion of the case in a multidisciplinary consultation meeting, management consisted of initially putting the patient on Imatinib given the large tumor size, the degree of local invasion and the location of the mass (lower rectum), with regular follow-up in order to schedule a less invasive surgical resection later. Despite the rarity of rectal GIST, early diagnosis is necessary to avoid progression to locoregional invasion complicating some surgical resections given the anatomical constraints of the pelvic region. Hence the interest of neoadjuvant therapy with tyrosine kinase inhibitors allowing in some cases a decrease in tumor volume, a regression of the degree of local invasion and a decrease in the morbidity of the surgery in order to improve the patient's quality of life.

Microwave ablation of breast pseudoaneurysm

Breast pseudoaneurysm is a very rare complication. In this study, we report a patient with huge breast pseudoaneurysm after ultrasound-guided vacuum-assisted biopsy (UGVAB) of breast nodules. In treatment, we used microwave ablation to treat the pseudoaneurysm, and then used UGVAB again to eliminate the complicated hematoma. The patients obtained good therapeutic effect. From this case, we experience that, before the interventional operations for breast nodules, the systematic ultrasound examination should be performed. In the needle entering channel, the obvious blood vessels should be avoided to reduce the unnecessary vascular injury. When the pseudoaneurysm occurs, the patient’s condition, pseudoaneurysm situation and hematoma size should be comprehensively considered, combined with the multidisciplinary consultation, for selecting the best treatment strategy. doi: https://doi.org/10.12669/pjms.38.1.4930 How to cite this:Cai Z, Ning R, Dong W, Zhang Y. Microwave ablation of breast pseudoaneurysm. Pak J Med Sci. 2022;38(1):---------. doi: https://doi.org/10.12669/pjms.38.1.4930 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Influence of the implementation of a multidisciplinary consultation program on adherence to the first ever course of oral antineoplastic treatment in patients with cancer

Purpose To evaluate adherence (as measured by the medication possession ratio) to the first ever course of oral antineoplasic treatment in cancer patients before and after the implementation of a multidisciplinary consultation program (involving an oncologist, a pharmacist, and a nurse) and to investigate the program's impact on adverse events and drug-related problems. Patients and Methods In a retrospective single-center study, we compared the medication possession ratio 2 months after treatment initiation in a control group (before multidisciplinary consultation program implementation) versus an interventional group (after multidisciplinary consultation program implementation). Results Two months after oral antineoplasic treatment initiation, the mean ± standard deviation medication possession ratio did not differ significantly when comparing the interventional (multidisciplinary consultation program) group ( n = 33; 0.99 ± 0.06) with the control group ( n = 64; 0.94 ± 0.16) ( p = 0.062). Patients in the multidisciplinary consultation program group had fewer adverse events in general (41, vs 109 in the control group; p = 0.048) and digestive adverse events in particular (6 vs 29, respectively; p = 0.007). A total of 53 and 40 drug-related problems were identified in the control and multidisciplinary consultation program groups, respectively ( p = 0.074). Conclusions Implementation of an multidisciplinary consultation program was not associated with a significant difference in drug adherence (as assessed by the medication possession ratio), which was good before and after implementation. The multidisciplinary consultation program was associated with a lower incidence of adverse events.

Case Report: Efficiency of Embolization Microcoils for the Repair of Brachiocephalic Vein Perforation During Hemodialysis Catheter Placement

Background: The cuff catheter is one of the most common routes of vascular access in hemodialysis patients, while severe complications can occur during cuff catheter placement, such as bleeding, hematoma, and artery or vein damage. During catheterization, brachiocephalic vein perforation associated with a mediastinal lesion is rare. Open chest repair is effective for brachiocephalic vein perforation during catheter placement, but it entails a risk of potentially lethal trauma. Interventional treatment can be considered to reduce injury in this context, but relevant reports are limited.Case report: Herein, we describe our experience with a 68-year-old male hemodialyzed patient in whom cuff catheter vascular access was required for regular hemodialysis. He complained of mild pain in the left side of his chest during cuff catheter placement. The surgeon immediately checked the location of the catheter. Digital subtraction angiography revealed that the hemodialysis cuff catheter had punctured the mediastinal area from the left brachiocephalic vein. The patient was diagnosed with left brachiocephalic vein perforation (d ≈ 5 mm). Fortunately, the brachiocephalic vein perforation was successfully repaired with two embolization microcoils after comprehensive assessment and multidisciplinary consultation.Conclusion: Brachiocephalic vein perforation can be repaired with embolization microcoils during hemodialysis catheter placement, and this method of interventional treatment is safe and effective.

AGGRAVATION OF COVID 19 INFECTION SECONDARY TO SURGERY

Patients with COVID-19 who have underwentsurgery have high rates of mortality and complications includingincreasedrespiratorydistress, bacterialinfections, pneumothorax and multi-visceralfailure. Pneumomedistinis a rare complication. Surgical indications in COVID-19 patients shouldbediscussed in a multidisciplinary consultation meeting, considering the presenceof comorbidities and the availability of therapeutic alternatives. We report the case ofa 43-year-old womanpresentingwith COVID-19 infection, whounderwent a cholecystectomywith post-operative complications.

Small Bowel Adenocarcinoma Simulating Superior Mesenteric Artery Syndrome (SMAS): A Case Report

The adenocarcinoma of the small intestine is a rare tumor of all gastrointestinal cancers often occurs on a predisposing ground we report the case of a 40-year-old patient chronic smoker has 1 pack year weaned 2 years ago, alcoholic weaned 5 years ago whose symptomatology dates back to 3 months by the appearance of epigastralgia and vomiting post prandial, Complicated by a high occlusive syndrome made of post prandial vomiting with abdominal pain all evolving in a context of alteration of general state made the patient was addressed to the service of digestive cancer surgery and liver transplantation of CHU Ibn Rochd Casablanca. The patient had an abdominal CT scan which showed duodenojejunal distension with incarceration of an undistended loop at the level of the aorto-mesenteric clamp. The patient was sent to the operating room in emergency, he underwent a segmental Greco-Resection of 15 cm taking away a jejunal mass under laparoscopy with extra corporal anastomosis latero-lateral jejuno-jejunal with at the exploration one notes the presence of a tumoral mass of 3cm mobile at the level of the 2nd loop jejunal stenosing responsible for a jejunal distension upstream measuring 4cm in diameter. The anatomopathological study of the specimen showed a moderately differentiated and invasive adenocarcinoma, classified as pT3N1Mx. The postoperative follow-up was marked by a deep venous thrombosis involving the ileo-femoral-popliteal axis of the ilio-femoral-popliteal trunk on day 2 postoperatively, for which the patient was put on low molecular weight Heparin at a curative dose with compression stockings and monitoring. The patient had resumed transit in the form of gas on postoperative day 3, with a correct assessment, and was declared discharged on postoperative day 6. The patient's file was discussed in a multidisciplinary consultation meeting and the decision was to undergo adjuvant chemotherapy and oesogastroduodal fibroscopy (FOGD) and colonoscopy to look for predisposing diseases.