New Horizons in Clinical Case Reports最新文献

We report a case of functionally independent and cognitively intact 88-year-old male, suffering from anemia with suspicion for UGI bleeding. Diagnostic evaluation revealed a small bowel tumor as the source of bleeding. Our presentation will include a discussion about small bowel tumors as a relatively rare entity. The patient was operated on and the tumor was diagnosed as a distant metastasis of melanoma. Further evaluation revealed a relatively small primary melanoma tumor on the posterior part of right heel. The patient was not aware of the tumor until the diagnostic investigation. Radical Surgery was proposed as the choice of treatment with high probability of wheelchair-bound state as the functional outcome. Further discussion is related to the dilemma of choosing between aggressive treatments versus preserving quality of life in elderly persons. Modern options of melanoma treatment and their suitability to the elderly patient are presented together with a review of the literature.

Objectives

The nucleoside reverse transcriptase inhibitors (NRTI) have been an important 'back-bone' of an antiretroviral therapy (ART) for HIV-1 infected patients. However, these agents have been associated with both short and long-term toxicity. Therefore, there has been growing interest in evaluating NRTI-sparing regimens. Now we have administered dolutegravir (DTG) and rilpivirine (RPV) to HIV-1 infected patients as a new NRTI-sparing regimen. However, there are few data on the outcome of ART regimen consisting of DTG and RPV. In this study, we examined treatment outcome for this NRTI-sparing regimen in HIV-1 infected patients.

Method

We examined 27 HIV-1 infected patients treated with NRTI-sparing regimen consisting of DTG and RPV in Nagoya Medical Center, Japan. We checked efficacy and safety for this regimen from 2014 to 2015, retrospectively.

Results

Median duration of this NRTI-sparing regimen for 27 Japanese HIV-1 infected patients (26 males, 1 female; mean age 57 years) was 323 days. The reasons for changing to this regimen were pill burden (n=13), lipodystrophy related to NRTI (n=7), myelopathy (n=2), renal dysfunction (n=1), dyslipidemia (n=1), respectively. Finally, 25 patients have continued this regimen. After starting this regimen, HIV viral load were soon less than the detection limit for all patients. Virologic failure and regimen discontinuations by severe adverse reactions were not confirmed for individuals. In addition, abnormal laboratory data (ALT, AST, etc) were not shown for all patients.

Conclusions

Current UK and US treatment guidelines do not recommend NRTI-sparing regimens for people starting ART due to concerns about toxicity, treatment discontinuation, and drug resistance. In this study, 12 patients had been already treated with NRTI-sparing regimen (Raltegravir + RPV). As these patients were elder, it was essential to reduce pill burden. Therefore, a new NRTI-sparing regimen, DTG + RPV, will be available in the future because of reducing pill burden, few drug interactions and low toxicity.

Introduction

Inflammatory local recurrence after breast-conserving therapy is very rare and these patients always have poor prognosis.¹ In common, the recurrence happens in a median of 65 months for lymph node negative patients. Fast recurrence is usually be considered correlated with ER status, lymph node status and tumor size.

Case description

A 70-year-old female patient had left breast conserving surgery in PUMCH on 2016-4-19, pathological results showed an IDC (triple negative) and the margins of the tumor were clear. Then she began chemotherapy (Taxol+CTX, 3 week regimen) on 5-22. At the end of June, she had a skin lesion on the left breast. We continued chemotherapy to 7-22, TC*4 in total. During this, the patient's skin lesion turned bigger and the therapy had no effect on this. We took the skin for biopsy and the skin and lymphatic was filled with breast cancer metastases.

Conclusion

Locally recurrence can happen in patients having had breast-conserving surgery. However, in our case, the patient has rare inflammatory local recurrence after breast conserving surgery very rapidly, even during chemotherapy. Just 2 months after surgery. So we think that the inflammatory skin lesion on breast cancer patients must be taken seriously and do biopsy as soon as possible.

In Poland, sarcomas represent about 1% of all cancer diseases. Every year about 800 new cases are diagnosed. Osteosarcoma is the most frequently recognized primary malignant bone tumor.

Osteosarcomas are diagnosed more frequently in children and adolescent males, whereas in pregnant women they are extremely rare. We present a case of a 29-year-old pregnant woman with a highly diverse osteosarcoma. A patient which was in 23rd week of pregnancy was treated with multiple doses of chemotherapy while fetal health was being monitored.

The plan for a therapeutic process included inducing a pregnancy solution at the moment of the fetus reaching maturity, then continuing oncological treatment.

According to the established protocol of treatment in 34 week pregnancy was completed via cesarean section. The woman gave birth to a daughter in good condition. Surgical treatment was conducted after delivery until complete post-pregnancy healing. There was no reduction of dose or quantity of planned and conducted courses of chemotherapy due to pregnancy.

The paper offers an analysis of diagnosis and therapy of pregnant women with osteosarcoma based on own experience and on the basis of a relevant literature.

With the first recorded medical application of a robot - a CT-based orientation of a needle guide for biopsy of the brain - occurring in 1985, a number of research groups in Asia, Europe, and the USA began investigating other medical applications of robotics. Beside of a big number of research prototypes and scientific outcome, a relatively small number of commercial ventures were resulting from these efforts.

Now, after more than 30 years of activities and compared to many other fields of medical technology, medical robotics still can be considered as of being in its infant state. The number of commercially available setups actually could be increased, but only few of them really have created significant impact. Many research questions have been addressed in order to improve the technology, but the gap between research in laboratories and real use in surgical routine seems to get even bigger. If one looks to the main reasons for this slow adoptation of new technology, it turns out to mostly not being related to technical functioning, but to other factors such as:

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  cumbersome use of robots (complexity, size, missing integration into clinical workflow) which hinders application in clinical routine,

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  high cost for robot system and operational cost (i.e. cost/benefit ratio is not satisfactory in most cases),

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  high setup time and effort (e.g. additional person for operating robot system),

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  limitation in portability and/or mobility,

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  unsolved safety issues.

The presentation will include a short introduction into medical robot systems for surgical applications. Topics include issues such as kinematic configurations, interfaces to existing surgical equipment, but also matters related to standards and regulations. One key aspect for (future) medical robots is related to its main operation principle. Current commercial robot systems are either directly controlled by a human operator or strictly follow a pre-defined path. Automated systems are limited to setups where no direct contact between robot and/or the guided tool takes place, e.g. to compensate (to a certain degree) breathing motion in external radiotherapy or for imaging purposes. On the cognitive side, a long thought-after feature is to estimate what the surgeon would like to do next. This could be taken into account when planning and executing the next movement of the robotized tool or camera. Addition of cognitive capabilities to the robot also has the potential to take a further step toward surgical automation, e.g. for the awareness of the current medical situation and the ability to react in a suitable way. Concrete robot applications - such as for percutaneous placement of needles for tumor