Endoscopic diagnosis of early-stage primary esophageal small cell carcinoma: Report of two cases

paythelady.612 shared this article with you from Inoreader Endoscopic diagnosis of early-stage primary esophageal small cell carcinoma: Report of two cases Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 16;9(11):2562-2568. doi: 10.12998/wjcc.v9.i11.2562. ABSTRACT BACKGROUND: Primary esophageal small cell carcinoma (PESCC) is a highly aggressive malignancy, and its detailed clinical behaviors have remained virtually unknown. Because of the rapid tumor progression, the diagnosis of esophageal small cell carcinoma at early stage is extremely difficult in clinical practice. Currently, only a handful of PESCC cases have been reported. CASE SUMMARY: Case 1: A 62-year-old man was diagnosed with an esophageal submucosal tumor by endoscopy. Endoscopic ultrasonography showed a 0.8 cm low echo nodule in the muscularis mucosa. As the patient refused to undergo endoscopic resection, neoplasia was detected by endoscopy 1 year later. Case 2: A 68-year-old woman was diagnosed as having an esophageal submucosal tumor by endoscopy at a local hospital. About 2 wk later, we performed endoscopic ultrasonography and found a 1 cm low echo nodule in the muscularis mucosa; the submucosal was thinner than normal but still continuous; mucosal hyperemia and erosion were found on the surface of the tumor. Endoscopic submucosal dissection (ESD) was performed and the histopathological finding showed a small cell carcinoma invading the submucosal layer. CONCLUSION: Early esophageal small cell carcinoma shows submucosal infiltrating growth with a hypoechoic mass in the muscularis mucosa as diagnosed by endoscopic ultrasonography. It is easily misdiagnosed as submucosal masses. Endoscopic manifestations should be identified and pathological biopsies should be employed. ESD may be performed to provide an opportunity for early treatment of PESCC. PMID:33889621 | PMC:PMC8040171 | DOI:10.12998/wjcc.v9.i11.2562 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Triple administration of osimertinib followed by chemotherapy for advanced lung adenocarcinoma: A case report

paythelady.612 shared this article with you from Inoreader Triple administration of osimertinib followed by chemotherapy for advanced lung adenocarcinoma: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 16;9(11):2627-2633. doi: 10.12998/wjcc.v9.i11.2627. ABSTRACT BACKGROUND: Osimertinib is the recommended first-line treatment for adult patients with epidermal growth factor receptor (EGFR) mutation positive advanced or metastatic non-small cell lung cancer (NSCLC). However, primary or acquired resistance to EGFR-tyrosine kinase inhibitors (EGFR-TKIs) seems inevitable, and when drug-resistance occurs during treatment with osimertinib, the standard of care is to discontinue the TKI. CASE SUMMARY: A 57-year-old female patient with lung adenocarcinoma presented with an irritating cough accompanied by chest distress of one month duration. An enhanced head magnetic resonance imaging scan showed brain metastases. An EGFR mutation (exon 21 L858R) was detected in pleural fluid. The patient was treated with oral osimertinib (80 mg once daily) from January 2018 but developed progressive disease on December 2018. She was then successfully treated with re-challenge and tri-challenge with osimertinib (80 mg once daily) by resensitization chemotherapy twice after the occurrence of drug-resistance to osimertinib, and to date has survived for 31 mo. CONCLUSION: This case may provide some selective therapeutic options for NSCLC patients with acquired drug-resistance who were previously controlled on osimertinib treatment. PMID:33889629 | PMC:PMC8040179 | DOI:10.12998/wjcc.v9.i11.2627 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Current status of radical laparoscopy for treating hepatocellular carcinoma with portal hypertension

paythelady.612 shared this article with you from Inoreader Current status of radical laparoscopy for treating hepatocellular carcinoma with portal hypertension Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 16;9(11):2419-2432. doi: 10.12998/wjcc.v9.i11.2419. ABSTRACT The laparoscopic technique is clinically effective in treating hepatocellular carcinoma (HCC) with portal hypertension (PHT). However, existing studies lack systematic arrangement and induction. Here, we review the latest research advancement in laparoscopic technique for treatment of HCC with PHT, based on published literature and our single-institution experience. Our single-center experience reveals no statistical difference in both short- and long-term prognosis of HCC patients after laparoscopic liver resection (LLR), regardless of whether they suffer from PHT, which is consistent with previous studies on the use of LLR for HCC with PHT. Retrieval outcomes indicate existence of short- and long-term prognostic superiority, following laparoscopic treatment, relative to non-laparoscopic treatment. Besides that, LLR offers long-term prognostic ad vantage compared to laparoscopic radiofrequency ablation. In addition, we review the previous literature and propose corresponding perspectives on the therapy of hypersplenism, the utilization of Pringle maneuver, and the adoption of anatomical hepatectomy during radical laparoscopic treatment. HCC with PHT is not the "forbidden zone" of radical laparoscopic treatment. However, patients' preoperative liver function should be adequately estimated. PMID:33889608 | PMC:PMC8040172 | DOI:10.12998/wjcc.v9.i11.2419 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Anesthetic management of a child with double outlet right ventricle and severe polycythemia: A case report

paythelady.612 shared this article with you from Inoreader Anesthetic management of a child with double outlet right ventricle and severe polycythemia: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 16;9(11):2634-2640. doi: 10.12998/wjcc.v9.i11.2634. ABSTRACT BACKGROUND: Double outlet right ventricle (DORV) is a rare and complex congenital heart defect, and the surgical repairs vary with type and pathophysiology consequences. Due to prolonged progressive hypoxemia, severe polycythemia is common in patients with DORV, which ultimately leads to coagulation dysfunction and increases the risk of thrombosis and infarction. Consequently, the anesthetic management is challenging and how to manage severe polycythemia and avoid hypoxia-related complications in such patients is of great significance. CASE SUMMARY: Herein, we report the anesthetic management of a 10-year-old female patient with a DORV. She lived in the low-oxygen Qinghai-Tibet Plateau, and presented with severe polycythemia (hemoglobin, 24.8 g/dL; hematocrit, 75%). She underwent a modified Fontan surgery, which was satisfactory and without any perioperative complications. Our anesthetic management highlights the importance of perioperative hemodilution in decreasing the risk of thromboembolism and the importance of correcting coagulopathy in preventing hemorrhage. CONCLUSION: Anesthetic management is challenging in rare cyanotic congenital heart disease patients with severe polycythemia. It is important to adopt perioperative hemodilution and correction of coagulopathy in preventing thrombosis and hemorrhage. PMID:33889630 | PMC:PMC8040181 | DOI:10.12998/wjcc.v9.i11.2634 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Possible effect of blonanserin on gambling disorder: A clinical study protocol and a case report

paythelady.612 shared this article with you from Inoreader Possible effect of blonanserin on gambling disorder: A clinical study protocol and a case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 16;9(11):2469-2477. doi: 10.12998/wjcc.v9.i11.2469. ABSTRACT BACKGROUND: Gambling disorder is characterized by excessive and recurrent gambling and can have serious negative social consequences. Although several psychotherapeutic and pharmacological approaches have been used to treat gambling disorder, new treatment strategies are needed. Growing evidence suggests that dopamine D3 receptor plays a specific role in the brain reward system. AIM: To investigate if blonanserin, a dopamine D3 receptor antagonist, would be effective in reducing gambling impulses in patients with gambling disorder. METHODS: We developed a study protocol to measure the efficacy and safety of blonanserin as a potential drug for gambling disorder, in which up to 12 mg/d of blonanserin was prescribed for 8 wk. RESULTS: A 37-year-old female patient with gambling disorder, intellectual disability, and other physical di seases participated in the pilot study. The case showed improvement of gambling symptoms without any psychotherapy. However, blonanserin was discontinued owing to excessive saliva production. CONCLUSION: This case suggests that blonanserin is potentially an effective treatment for patients with gambling disorder who resist standard therapies, but it also carries a risk of adverse effects. Further studies are needed to confirm the findings. PMID:33889612 | PMC:PMC8040182 | DOI:10.12998/wjcc.v9.i11.2469 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Combined immune checkpoint inhibitors of CTLA4 and PD-1 for hepatic melanoma of unknown primary origin: A case report

paythelady.612 shared this article with you from Inoreader Combined immune checkpoint inhibitors of CTLA4 and PD-1 for hepatic melanoma of unknown primary origin: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 16;9(11):2641-2648. doi: 10.12998/wjcc.v9.i11.2641. ABSTRACT BACKGROUND: Melanoma is uncommonly found in lymph nodes, subcutaneous tissue, or visceral organs without a primary lesion, where it is identified as metastatic melanoma with unknown primary (MUP). Hepatic MUP is extremely rare and has a poor prognosis. There is limited information on its pathogenesis, clinical and imaging features, and pathological findings. There are no guidelines for the use of immune checkpoint inhibitors (ICIs) in hepatic MUP, and the treatment outcome has rarely been reported. CASE SUMMARY: A 42-year-old woman presented to our hospital with hepatic tumors found incidentally during a routine check-up. Contrast-enhanced abdominal com-puterized tomography showed multiple mass lesions in the liver. Pathological results revealed melanoma, which was confirmed by immunohistochemical staining for HMB-45(+), Melan-A(+), S-100(+) , and SOX10(+). There was no evidence of primary cutaneous, ocular, gastrointestinal, or anal lesion on a comprehensive examination. The patient was diagnosed with hepatic MUP. She received combined antibodies against cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4, ipilimumab) and programmed death protein-1 (PD-1, nivolumab). She died of hepatic failure 9 mo after hepatic MUP was diagnosed. This the first case of hepatic MUP treated with combined ipilimumab and nivolumab, who showed better outcome than previous cases. CONCLUSION: Combined ICIs of PD-1 and CTLA-4 may be considered as the first-line therapy for patients with hepatic MUP. PMID:33889631 | PMC:PMC8040165 | DOI:10.12998/wjcc.v9.i11.2641 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Cerebellar artery infarction with sudden hearing loss and vertigo as initial symptoms: A case report

paythelady.612 shared this article with you from Inoreader Cerebellar artery infarction with sudden hearing loss and vertigo as initial symptoms: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 16;9(11):2519-2523. doi: 10.12998/wjcc.v9.i11.2519. ABSTRACT BACKGROUND: Sudden hearing loss (SHL) is associated with serious systematic conditions such as neoplasms, vascular events, autoimmune diseases, infections, and iatrogenic injury. Some authors report that SHL can be an early warning sign of impending vertebrobasilar ischemic stroke. It is important to distinguish stroke from benign disease. CASE SUMMARY: A 48-year-old male patient presented with SHL and vertigo as first symptoms. Diffusion-weighted imaging revealed high signal intensity in the left posterior inferior cerebellar artery territory of the cerebellar hemisphere and high signal intensity in the right pons and bridge cerebellar arm, confirming that the patient had cerebral infarction. Treatment with antiplatelet drugs, steroid anti-inflammatory drugs, and neurotrophic nerve therapy promoted blood circulation and removed blood stasis , and the symptoms of the patient were significantly improved. CONCLUSION: SHL and vertigo could be the initial symptoms of vertebrobasilar ischemic stroke. PMID:33889616 | PMC:PMC8040184 | DOI:10.12998/wjcc.v9.i11.2519 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Cholangiojejunostomy for multiple biliary ducts in living donor liver transplantation: A case report

paythelady.612 shared this article with you from Inoreader Cholangiojejunostomy for multiple biliary ducts in living donor liver transplantation: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 16;9(11):2649-2654. doi: 10.12998/wjcc.v9.i11.2649. ABSTRACT BACKGROUND: Laparoscopic living donor hepatectomy (LLDH) has been successfully carried out in several transplant centers. Biliary reconstruction is key in living donor liver transplantation (LDLT). Reliable biliary reconstruction can effectively prevent postoperative biliary stricture and leakage. Although preoperative magnetic resonance cholangiopancreatography and intraoperative indocyanine green cholangiography have been shown to be helpful in determining optimal division points, biliary variability and limitations associated with LLDH, multiple biliary tracts are often encountered during surgery, which inhibits biliary reconstruction. A reliable cholangiojejunostomy for multiple biliary ducts has been utilized in LDLT. This procedure provides a reference for multiple biliary reconstructions after LLDH. CASE SUMMARY: A 2-year-old girl dia gnosed with ornithine transcarbamylase deficiency required liver transplantation. Due to the scarcity of deceased donors, she was put on the waiting list for LDLT. Her father was a suitable donor; however, after a rigorous evaluation, preoperative magnetic resonance cholangiopancreatography examination of the donor indicated the possibility of multivessel variation in the biliary tract. Therefore, a laparoscopic left lateral section was performed on the donor, which met the estimated graft-to-recipient weight ratio. Under intraoperative indocyanine green cholangiography, 4 biliary tracts were confirmed in the graft. It was difficult to reform the intrahepatic bile ducts due to their openings of more than 5 mm. A reliable cholangiojejunostomy was, therefore, utilized: Suture of the jejunum to the adjacent liver was performed around the bile duct openings with 6/0 absorbable sutures. At the last follow-up (1 year after surgery), the patient was complication-free. CONCLUSION: Int rahepatic cholangiojejunostomy is reliable for multiple biliary ducts after LLDH in LDLT. PMID:33889632 | PMC:PMC8040162 | DOI:10.12998/wjcc.v9.i11.2649 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Extraosseous spinal epidural plasmocytoma associated with multiple myeloma: Two case reports

paythelady.612 shared this article with you from Inoreader Extraosseous spinal epidural plasmocytoma associated with multiple myeloma: Two case reports Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 16;9(11):2555-2561. doi: 10.12998/wjcc.v9.i11.2555. ABSTRACT BACKGROUND: Multiple myeloma is a malignant hematological disease characterized by proliferation of monoclonal plasma cells mainly in the bone marrow. Extraosseous epidural plasmacytoma associated with myeloma arises from lymphoid tissue in the epidural space without focal vertebral involvement, and is rare. CASE SUMMARY: A 52-year-old woman was diagnosed with kappa subtype nonsecretory multiple myeloma and presented with bilateral arm weakness 11 mo after completing multiple courses of chemotherapy. Spinal magnetic resonance imaging (MRI) showed a posterior C7-T3 epidural mass with spinal cord compression. After five courses of chemotherapy, follow-up MRI showed resolution of cord compression. A 54-year-old man presented with paraplegia 15 mo after a diagnosis of IgD kappa subtype multiple myeloma and completing multiple courses of chemothe rapy. He underwent Th11 and L1 laminectomies for tumor resection because MRI showed an epidural mass causing cord compression. His-topathologic examination was consistent with IgD multiple myeloma. The patients have currently survived for 33 mo and 19 mo, respectively. CONCLUSION: Isolated extraosseous epidural plasmacytoma associated with multiple myeloma without bony involvement is difficult to diagnose by imaging. Definitive diagnosis requires pathological and immunohistochemical examination. PMID:33889620 | PMC:PMC8040174 | DOI:10.12998/wjcc.v9.i11.2555 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Surgical therapy for hemangioma of the azygos vein arch under thoracoscopy: A case report

paythelady.612 shared this article with you from Inoreader Surgical therapy for hemangioma of the azygos vein arch under thoracoscopy: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 16;9(11):2655-2661. doi: 10.12998/wjcc.v9.i11.2655. ABSTRACT BACKGROUND: Azygos vein aneurysms are extremely rare, and their pathogenesis is not clear. The overwhelming majority of patients have no obvious clinical symptoms and are found to have the disease by physical examination or by chance. There are few reports on the diagnosis of and treatment strategy for this disease. Moreover, the choice of therapeutic schedule and the treatment window are controversial. CASE SUMMARY: We report a case of azygos vein arch aneurysm in a 53-year-old woman. The patient had symptoms of back pain, chest tightness, and choking. Enhanced chest computed tomography showed a soft-tissue mass in the right posterior mediastinum, which was connected to the superior vena cava. The enhancement degree in the venous phase was the same as that of the superior vena cava. The patient received video-assisted thoracoscopic surgery. After the operation, her back pain disappeared, and her dysphagia and chest tightness were also significantly relieved. The postoperative pathology confirmed hemangioma. The patient was discharged on the seventh day after surgery without any comp-lications. CONCLUSION: Some patients with hemangioma of the azygos vein arch may experience dysphagia and chest tightness caused by the tumor compressing the esophagus and trachea. Enhanced computed tomography scanning is vital for the diagnosis of azygos vein aneurysms. In addition, despite the difficulty and risk of surgery, thoracoscopic surgery for azygos vein aneurysms is completely feasible. PMID:33889633 | PMC:PMC8040170 | DOI:10.12998/wjcc.v9.i11.2655 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Early colonoscopy and urgent contrast enhanced computed tomography for colonic diverticular bleeding reduces risk of rebleeding

paythelady.612 shared this article with you from Inoreader Early colonoscopy and urgent contrast enhanced computed tomography for colonic diverticular bleeding reduces risk of rebleeding Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 16;9(11):2446-2457. doi: 10.12998/wjcc.v9.i11.2446. ABSTRACT BACKGROUND: Colonoscopy within 24 h of hospital admission for colonic diverticular bleeding (CDB) is recommended. However, little is known about rates of rebleeding within 30 d. We posited that a group of patients who underwent contrast-enhanced computed tomography (CT) within 4 h of the last hematochezia and colonoscopy within 24 h would experience fewer incidences of rebleeding. AIM: To evaluate the outcomes of early colonoscopy for CDB among different groups of patients. METHODS: Data from 182 patients with CDB who underwent contrast-enhanced CT and colonoscopy between January 2011 and December 2018 at the study site were retrospectively reviewed. Patients were divided into groups based on the timing of the CT imaging, within or at 4 h were defined as urgent CTs (n = 100) and those performed after 4 h were defined as elective CTs (n = 82). Main outcomes included rebleeding within 30 d and the identification of stigmata of recent hemorrhage (SRH) (i.e., active bleeding, non-bleeding visible vessels, or adherent clots). RESULTS: In total, 182 patients (126 men and 56 women) with median ages of 68.6 (range, 37-92) and 73.7 (range, 48-93) years, respectively, underwent CT imaging and colonoscopy within 24 h of the last hematochezia. Patients for whom CT was performed within 4 h of the last hematochezia were included in the urgent CT group (n = 100) and patients for whom CT was performed after 4 h were included in the elective CT group (n = 82). SRH were identified in 35.0% (35/100) of the urgent CT cases and 7.3% (6/82) of the elective CT cases (P < 0.01). Among all patients with extravasation-positive images on CT, SRH was identified in 31 out of 47 patients (66.0%) in the urgent CT group and 4 out of 20 patients (20.0%) in the elective CT group (P < 0. 01). Furthermore, rates of rebleeding within 30 d were significantly improved in the urgent CT and extravasation-positive cases (P < 0.05). Results from the evaluation of early colonoscopy did not show a difference in the ability to detect SRH identification or rebleeding rates. Only cases by urgent CT reduced risk of rebleeding due to the evidence of active bleeding on the image. CONCLUSION: To improve rates of rebleeding, colonoscopy is recommended within 24 h in patients with extravasation-positive CT images within 4 h of the last hema-tochezia. Otherwise, elective colonoscopy can be performed. PMID:33889610 | PMC:PMC8040177 | DOI:10.12998/wjcc.v9.i11.2446 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.