Pub Date : 2024-01-31DOI: 10.33137/utmj.v101i1.41240
Sangyang Jia, Nicholas Lao, R. G. Boldt, Amol Mujoomdar, Ronald Chow, Charles B Simone, Michael Lock
Introduction: There are currently limited data comparing the efficacy of stereotactic body radiation therapy (SBRT) to transarterial chemoembolization (TACE) for the treatment of hepatocellular carcinoma (HCC). The aim of this systematic review and meta-analysis was to report on the summary effect estimate of overall survival and local control at 1-year based on available evidence. Methods: A literature search was conducted in PubMed from database inception until April 2020. Articles were independently screened by two reviewers and included if they reported on a propensity-matched study design comparing SBRT to TACE for the treatment of HCC with at least 1 year follow up. Event data of overall survival and local control at 1-year were extracted. A random-effects model was applied to generate summary odds ratio and corresponding 95% confidence intervals (CI). Results: Four studies with 606 patients were identified and included. SBRT (73.6%) and TACE (67.0%) had similar 1-year rates of OS, with an OR of 0.87 (0.56, 1.37). SBRT (88.4%) had greater local control at 1 year compared to TACE (71.7%); OR of 0.34 (0.13, 0.86). Conclusion: SBRT is comparable to TACE in terms of 1-year survival for the treatment HCC and may provide an advantage in terms of local control. Future controlled trials are necessary to determine the clinical advantages and best indications for each treatment.
{"title":"Stereotactic Body Radiation Therapy (SBRT) Versus Transarterial Chemoembolization (TACE) for Treatment Of Hepatocellular Carcinoma: a Meta-Analysis of Propensity Matched Studies","authors":"Sangyang Jia, Nicholas Lao, R. G. Boldt, Amol Mujoomdar, Ronald Chow, Charles B Simone, Michael Lock","doi":"10.33137/utmj.v101i1.41240","DOIUrl":"https://doi.org/10.33137/utmj.v101i1.41240","url":null,"abstract":"Introduction: There are currently limited data comparing the efficacy of stereotactic body radiation therapy (SBRT) to transarterial chemoembolization (TACE) for the treatment of hepatocellular carcinoma (HCC). The aim of this systematic review and meta-analysis was to report on the summary effect estimate of overall survival and local control at 1-year based on available evidence. \u0000Methods: A literature search was conducted in PubMed from database inception until April 2020. Articles were independently screened by two reviewers and included if they reported on a propensity-matched study design comparing SBRT to TACE for the treatment of HCC with at least 1 year follow up. Event data of overall survival and local control at 1-year were extracted. A random-effects model was applied to generate summary odds ratio and corresponding 95% confidence intervals (CI). \u0000Results: Four studies with 606 patients were identified and included. SBRT (73.6%) and TACE (67.0%) had similar 1-year rates of OS, with an OR of 0.87 (0.56, 1.37). SBRT (88.4%) had greater local control at 1 year compared to TACE (71.7%); OR of 0.34 (0.13, 0.86). \u0000Conclusion: SBRT is comparable to TACE in terms of 1-year survival for the treatment HCC and may provide an advantage in terms of local control. Future controlled trials are necessary to determine the clinical advantages and best indications for each treatment.","PeriodicalId":41298,"journal":{"name":"University of Toronto Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140473483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-31DOI: 10.33137/utmj.v101i1.40751
Stephanie Dephoure
Maternal-fetal conflict is a complex bioethical issue that evolves through the distinction of the fetus as a separate patient to the pregnant individual. The conflict is characterized by differences in best interest that may be competing between the developing fetus and the pregnant individual, particularly when respecting the autonomy of the pregnant patient may place the fetus at harm. When these conflicts take place within adolescent medicine, novel challenges arise due to factors unique to adolescence, including evolving autonomy, and balancing inherent vulnerability. This commentary explores some of these factors and how they uniquely shape adolescent maternal-fetal conflict. Further, it explores microethics, a field of bioethics that centers around the physician-patient relationship, as a mitigation tool that can be applied in cases of adolescent maternal-fetal conflict.
{"title":"An Exploration of Ethical Considerations in Adolescent Maternal-Fetal Conflict – Balancing of Ethical Principles and Factors Unique to Adolescence Through Applications of Microethics","authors":"Stephanie Dephoure","doi":"10.33137/utmj.v101i1.40751","DOIUrl":"https://doi.org/10.33137/utmj.v101i1.40751","url":null,"abstract":"Maternal-fetal conflict is a complex bioethical issue that evolves through the distinction of the fetus as a separate patient to the pregnant individual. The conflict is characterized by differences in best interest that may be competing between the developing fetus and the pregnant individual, particularly when respecting the autonomy of the pregnant patient may place the fetus at harm. When these conflicts take place within adolescent medicine, novel challenges arise due to factors unique to adolescence, including evolving autonomy, and balancing inherent vulnerability. This commentary explores some of these factors and how they uniquely shape adolescent maternal-fetal conflict. Further, it explores microethics, a field of bioethics that centers around the physician-patient relationship, as a mitigation tool that can be applied in cases of adolescent maternal-fetal conflict.","PeriodicalId":41298,"journal":{"name":"University of Toronto Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140474527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-31DOI: 10.33137/utmj.v101i1.40965
Tony Abdelmaseeh, Rakesh Shah, John Sobuto, Renee Frank, Steven Archambault
A miliary nodular pattern of the lungs is an unusual presentation of sarcoidosis. Diagnosis of this condition can be challenging and requires exclusion of other lung pathology. A 47-year-old African American male presented to his doctor with a complaint of unintentional weight loss, exertional dyspnea and cough. The patient had a history of chronic smoking as well as recent incarceration. A miliary nodular pattern was found on CT scan of the lungs in a random distribution (with prominent peri-lymphatic distribution). HIV was ruled out. Tuberculosis (TB) and fungal infections were ruled out by tissue specimens and cultures from bronchoalveolar washings. Non-caseating granulomas on tissue specimens, peripheral smear lymphopenia and an elevated angiotensin converting enzyme (ACE) level were the positive findings on pathology and labs. The patient responded to a tapering course of oral steroids. This case demonstrates one of the unusual clinical presentations of sarcoidosis. Sarcoidosis is an autoimmune condition with predilection for middle aged African American patients.
{"title":"Sarcoidosis Masquerading as Miliary Tuberculosis: A Case Report","authors":"Tony Abdelmaseeh, Rakesh Shah, John Sobuto, Renee Frank, Steven Archambault","doi":"10.33137/utmj.v101i1.40965","DOIUrl":"https://doi.org/10.33137/utmj.v101i1.40965","url":null,"abstract":"A miliary nodular pattern of the lungs is an unusual presentation of sarcoidosis. Diagnosis of this condition can be challenging and requires exclusion of other lung pathology.\u0000A 47-year-old African American male presented to his doctor with a complaint of unintentional weight loss, exertional dyspnea and cough. The patient had a history of chronic smoking as well as recent incarceration. A miliary nodular pattern was found on CT scan of the lungs in a random distribution (with prominent peri-lymphatic distribution). HIV was ruled out. Tuberculosis (TB) and fungal infections were ruled out by tissue specimens and cultures from bronchoalveolar washings. Non-caseating granulomas on tissue specimens, peripheral smear lymphopenia and an elevated angiotensin converting enzyme (ACE) level were the positive findings on pathology and labs. The patient responded to a tapering course of oral steroids.\u0000This case demonstrates one of the unusual clinical presentations of sarcoidosis. Sarcoidosis is an autoimmune condition with predilection for middle aged African American patients.","PeriodicalId":41298,"journal":{"name":"University of Toronto Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140475392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-31DOI: 10.33137/utmj.v101i1.41619
Fatin Syahirah Sulaiman, N. Mohamad, Mohd Hafizuddin Husin@Mohd Hussin, Chiew Chea Lau, K. A. Sayuti
Renal artery thrombosis is a rare condition that requires early diagnosis and urgent intervention to prevent renal infarction and permanent renal damage. Possibility of renal artery thrombosis should be considered in patients with underlying hypercoagulable state presented with acute unremitting flank pain, nausea and vomiting. We report a case of a 35-year-old man with underlying nephrotic syndrome who presented with three days history of acute non-localized and non-resolving abdominal pain and vomiting. He was initially referred to general surgery for acute intestinal obstruction. Contrast-enhanced computed tomography (CECT) abdomen revealed acute left renal infarction secondary to total thrombotic occlusion of the left renal artery. The patient was treated with endovascular manual aspiration thrombectomy resulting in partial revascularization of left renal artery with restoration of renal function, complete resolution of symptom and good clinical outcomes. This case report serves as a reminder for physicians to include renal infarction in the differential diagnosis when evaluating a patient with acute abdomen, particularly in patient with hypercoagulable state. This case also aligns with other experiences demonstrating positive outcomes after endovascular thrombectomy, even in the presence of prolonged renal ischemia time of more than 72 hours.
{"title":"Rare Case of Acute Renal Artery Thrombosis in Nephrotic Syndrome: The Unusual Presentations and Outcomes of Endovascular Manual Aspiration Thrombectomy","authors":"Fatin Syahirah Sulaiman, N. Mohamad, Mohd Hafizuddin Husin@Mohd Hussin, Chiew Chea Lau, K. A. Sayuti","doi":"10.33137/utmj.v101i1.41619","DOIUrl":"https://doi.org/10.33137/utmj.v101i1.41619","url":null,"abstract":"Renal artery thrombosis is a rare condition that requires early diagnosis and urgent intervention to prevent renal infarction and permanent renal damage. Possibility of renal artery thrombosis should be considered in patients with underlying hypercoagulable state presented with acute unremitting flank pain, nausea and vomiting. We report a case of a 35-year-old man with underlying nephrotic syndrome who presented with three days history of acute non-localized and non-resolving abdominal pain and vomiting. He was initially referred to general surgery for acute intestinal obstruction. Contrast-enhanced computed tomography (CECT) abdomen revealed acute left renal infarction secondary to total thrombotic occlusion of the left renal artery. The patient was treated with endovascular manual aspiration thrombectomy resulting in partial revascularization of left renal artery with restoration of renal function, complete resolution of symptom and good clinical outcomes. This case report serves as a reminder for physicians to include renal infarction in the differential diagnosis when evaluating a patient with acute abdomen, particularly in patient with hypercoagulable state. This case also aligns with other experiences demonstrating positive outcomes after endovascular thrombectomy, even in the presence of prolonged renal ischemia time of more than 72 hours.","PeriodicalId":41298,"journal":{"name":"University of Toronto Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140472676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-31DOI: 10.33137/utmj.v101i1.41242
Saiful Islam BIN AHMAD HUSNI, Mawaddah Binti Azman, Timothy Wong Leong Wei
Background: Foreign bodies in the upper aerodigestive tract are frequently seen in otolaryngological practice, but migration of foreign body and oesophageal penetration are rare occurrences. Most reported cases of migration in literature involve fish bones, which are usually found in the lateral neck soft tissue or thyroid lobule. This can cause serious complications if left untreated. In most cases, fish bones can be removed safely by endoscopy, but they may migrate extraluminally to the skin in rare cases. Computed tomography (CT) neck with contrast is the investigation of choice to confirm migration. Case presentation: We present a case of an elderly lady with fish bone ingestion which migrated and embedded itself over the right thyroid cartilage region that required open surgery for removal. In this case, the patient underwent two open surgeries to locate the presence of the foreign body despite the CT neck done to aid in mapping intraoperatively. We used surgical clips in the first unsuccessful operation in locating the foreign body, and later performed a repeat CT scan and the clips were used to pinpoint the exact location of the foreign body during second surgery. By doing so, we successfully managed to remove the foreign body and patient was discharged well. Conclusion: This case has illustrated how versatile surgical clips are in helping us to locate the position of the foreign body rather than blindly exploring and causing further iatrogenic injury. With supplementation from a thorough repeat CT scan, we do think that in a presenting case of foreign body migration with difficulty locating the exact foreign body location, imaging adjunct such as C arm fluoroscopy and ultrasound guidance as reported in the literature can be used to avoid unnecessary iatrogenic injury and cause more harm to the patient.
背景：上消化道异物是耳鼻喉科的常见病，但异物移位和食道穿透却很少见。文献报道的大多数移位病例涉及鱼骨，通常发现于颈部外侧软组织或甲状腺小叶。如果不及时治疗，可能会引起严重的并发症。在大多数情况下，鱼骨可以通过内窥镜安全取出，但在极少数病例中，鱼骨可能会向皮肤外移位。使用造影剂进行颈部计算机断层扫描（CT）是确认移位的首选检查方法：我们介绍了一例老年女性摄入鱼骨的病例，鱼骨移位并嵌入右侧甲状软骨区域，需要开刀切除。在本病例中，尽管术中做了颈部 CT 辅助测绘，但患者还是接受了两次开放手术来确定异物的位置。我们在第一次手术中使用了手术夹定位异物，但没有成功，后来我们再次进行了 CT 扫描，并在第二次手术中使用手术夹精确定位了异物的位置。这样，我们成功地取出了异物，患者也顺利出院：本病例说明了手术夹的多功能性，它可以帮助我们找到异物的位置，而不是盲目探查并造成进一步的先天性损伤。我们认为，对于难以准确定位异物位置的异物移位病例，可以通过文献报道的 C 臂透视和超声引导等影像辅助手段来避免不必要的先天性损伤，给患者造成更大的伤害。
{"title":"Chronic Neck Swelling: A Case Report of Migrating Fish Bone","authors":"Saiful Islam BIN AHMAD HUSNI, Mawaddah Binti Azman, Timothy Wong Leong Wei","doi":"10.33137/utmj.v101i1.41242","DOIUrl":"https://doi.org/10.33137/utmj.v101i1.41242","url":null,"abstract":"Background: Foreign bodies in the upper aerodigestive tract are frequently seen in otolaryngological practice, but migration of foreign body and oesophageal penetration are rare occurrences. Most reported cases of migration in literature involve fish bones, which are usually found in the lateral neck soft tissue or thyroid lobule. This can cause serious complications if left untreated. In most cases, fish bones can be removed safely by endoscopy, but they may migrate extraluminally to the skin in rare cases. Computed tomography (CT) neck with contrast is the investigation of choice to confirm migration.\u0000Case presentation: We present a case of an elderly lady with fish bone ingestion which migrated and embedded itself over the right thyroid cartilage region that required open surgery for removal. In this case, the patient underwent two open surgeries to locate the presence of the foreign body despite the CT neck done to aid in mapping intraoperatively. We used surgical clips in the first unsuccessful operation in locating the foreign body, and later performed a repeat CT scan and the clips were used to pinpoint the exact location of the foreign body during second surgery. By doing so, we successfully managed to remove the foreign body and patient was discharged well.\u0000Conclusion: This case has illustrated how versatile surgical clips are in helping us to locate the position of the foreign body rather than blindly exploring and causing further iatrogenic injury. With supplementation from a thorough repeat CT scan, we do think that in a presenting case of foreign body migration with difficulty locating the exact foreign body location, imaging adjunct such as C arm fluoroscopy and ultrasound guidance as reported in the literature can be used to avoid unnecessary iatrogenic injury and cause more harm to the patient.","PeriodicalId":41298,"journal":{"name":"University of Toronto Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140470796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-31DOI: 10.33137/utmj.v100i2.39276
John-Peter Bonello, Claire Sethuram
Canada continues to struggle with wait times for patients transitioning from primary to specialized care. Since 2019, wait times for speciality consultation and time to specialty treatment have increased significantly throughout Canada, with Ontario ranking third overall among the provinces for the longest wait times. In addition to Ontario having the largest population among the provinces, musculoskeletal (MSK) based issues make up approximately 30% of all primary care reasons for visits and ranks among the longest wait times by specialty. Thus, a large proportion of patients seeking MSK based health care in Ontario are experiencing significant delays. This commentary discusses the burden of wait times for MSK patients requiring specialized care and offers a guide on how to assess, interpret, and possibly challenge the current care model. Essentially, this commentary suggests further studies be conducted through a qualitative lens to gather and assess information about patients’ perspectives on access, feasibility, and patient-provider alignment of care. Through this subjective lens, a better understanding may be gained regarding how patients interact with the current model of care for MSK health, and this knowledge can be applied in creating patient-education resources, guiding continuing medical education, and most importantly, increasing awareness for prominent systemic impacts such as wait times.
{"title":"Navigating long wait times for rheumatological health issues and suggestions for further investigations","authors":"John-Peter Bonello, Claire Sethuram","doi":"10.33137/utmj.v100i2.39276","DOIUrl":"https://doi.org/10.33137/utmj.v100i2.39276","url":null,"abstract":"Canada continues to struggle with wait times for patients transitioning from primary to specialized care. Since 2019, wait times for speciality consultation and time to specialty treatment have increased significantly throughout Canada, with Ontario ranking third overall among the provinces for the longest wait times. In addition to Ontario having the largest population among the provinces, musculoskeletal (MSK) based issues make up approximately 30% of all primary care reasons for visits and ranks among the longest wait times by specialty. Thus, a large proportion of patients seeking MSK based health care in Ontario are experiencing significant delays. This commentary discusses the burden of wait times for MSK patients requiring specialized care and offers a guide on how to assess, interpret, and possibly challenge the current care model. Essentially, this commentary suggests further studies be conducted through a qualitative lens to gather and assess information about patients’ perspectives on access, feasibility, and patient-provider alignment of care. Through this subjective lens, a better understanding may be gained regarding how patients interact with the current model of care for MSK health, and this knowledge can be applied in creating patient-education resources, guiding continuing medical education, and most importantly, increasing awareness for prominent systemic impacts such as wait times.","PeriodicalId":41298,"journal":{"name":"University of Toronto Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75615040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-31DOI: 10.33137/utmj.v100i2.41464
Pascal Tyrrell
The field of healthcare has witnessed remarkable advancements in recent years, particularly in the care and management of persons with hemophilia. With the advent of artificial intelligence (AI) and the growing importance of ultrasonography in medicine, the future of hemophilia care holds great promise. These developments not only improve the delivery of healthcare but also empower patients, leading to better outcomes and enhanced quality of life. In this article, I will explore the recent developments in hemophilia care, the impact of AI on healthcare delivery, and the significance of ultrasonography in digital health for persons with hemophilia.
{"title":"Infusing artificial intelligence into hemophilia care: taking the next step","authors":"Pascal Tyrrell","doi":"10.33137/utmj.v100i2.41464","DOIUrl":"https://doi.org/10.33137/utmj.v100i2.41464","url":null,"abstract":"The field of healthcare has witnessed remarkable advancements in recent years, particularly in the care and management of persons with hemophilia. With the advent of artificial intelligence (AI) and the growing importance of ultrasonography in medicine, the future of hemophilia care holds great promise. These developments not only improve the delivery of healthcare but also empower patients, leading to better outcomes and enhanced quality of life. In this article, I will explore the recent developments in hemophilia care, the impact of AI on healthcare delivery, and the significance of ultrasonography in digital health for persons with hemophilia.","PeriodicalId":41298,"journal":{"name":"University of Toronto Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83151181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-31DOI: 10.33137/utmj.v100i2.37765
Victoria Phooi Khei Tan, W. Teng, Fong Juen Kiew, N. Azizan, F. Hayati
Colorectal cancer in pregnancy is an infrequent phenomenon. It is estimated to occur in 1 in 13,000 pregnancies, with 80% representing rectal cancer. We report a rare case of a young pregnant female presenting with primary sigmoid colon adenocarcinoma metastasizing to the breast, ovaries, and stomach. Diagnosing colorectal malignancy in pregnancy is challenging, given the similarities in symptoms. Cancer in pregnancy may take on a more malignant course with rapid progression. Physicians must recognise the potential of this deadly disease lurking undetected in patients of this vulnerable population.
{"title":"A unique case report of sigmoid colon cancer metastasising to the breasts, ovaries and stomach in pregnancy","authors":"Victoria Phooi Khei Tan, W. Teng, Fong Juen Kiew, N. Azizan, F. Hayati","doi":"10.33137/utmj.v100i2.37765","DOIUrl":"https://doi.org/10.33137/utmj.v100i2.37765","url":null,"abstract":"Colorectal cancer in pregnancy is an infrequent phenomenon. It is estimated to occur in 1 in 13,000 pregnancies, with 80% representing rectal cancer. We report a rare case of a young pregnant female presenting with primary sigmoid colon adenocarcinoma metastasizing to the breast, ovaries, and stomach. Diagnosing colorectal malignancy in pregnancy is challenging, given the similarities in symptoms. Cancer in pregnancy may take on a more malignant course with rapid progression. Physicians must recognise the potential of this deadly disease lurking undetected in patients of this vulnerable population.","PeriodicalId":41298,"journal":{"name":"University of Toronto Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80130665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-31DOI: 10.33137/utmj.v100i2.37887
Mohd Azzahi Mohamed Kamel, I. A. Ismail, Jazlan Jamaluddin, M. F. Hamdan
Subclavian artery occlusion is an uncommon condition affecting approximately 2% of the general population. Only 8.7% of patients with total occlusion of subclavian artery are asymptomatic. It has the potential to cause significant morbidity as it could contribute to the ischemic complications affecting the upper extremities, brain, and heart. We present a case of asymptomatic total occlusion of left subclavian artery which was found following investigations for discrepancy in blood pressure readings from the patient’s right and left arm. The difference was noted due to the clinic’s furniture arrangement. The patient was treated with stent insertion via percutaneous transluminal angioplasty. After three years of follow ups, she remains asymptomatic and free of cardiovascular-related complications.
{"title":"Clinic furniture arrangements leading to patient self-reported blood pressure discrepancy: a rare case of total occlusion of left subclavian artery","authors":"Mohd Azzahi Mohamed Kamel, I. A. Ismail, Jazlan Jamaluddin, M. F. Hamdan","doi":"10.33137/utmj.v100i2.37887","DOIUrl":"https://doi.org/10.33137/utmj.v100i2.37887","url":null,"abstract":"Subclavian artery occlusion is an uncommon condition affecting approximately 2% of the general population. Only 8.7% of patients with total occlusion of subclavian artery are asymptomatic. It has the potential to cause significant morbidity as it could contribute to the ischemic complications affecting the upper extremities, brain, and heart. We present a case of asymptomatic total occlusion of left subclavian artery which was found following investigations for discrepancy in blood pressure readings from the patient’s right and left arm. The difference was noted due to the clinic’s furniture arrangement. The patient was treated with stent insertion via percutaneous transluminal angioplasty. After three years of follow ups, she remains asymptomatic and free of cardiovascular-related complications.","PeriodicalId":41298,"journal":{"name":"University of Toronto Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85603176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-31DOI: 10.33137/utmj.v100i2.40384
Muna Alkhaifi, Emily Peircell, Stephanie Mooney, Adam Clayton, J. Simpson
Background: Family medicine residents should be prepared to address the psychosocial issues that breast cancer survivors may experience. Objectives: Our study aimed to implement a patient-centred approach model into the family medicine residency program and evaluate the impact of such a program on residents. Methods: An interactive virtual session (75 minutes), was integrated into the academic half-day of the family medicine residency program at St. Michael’s Hospital. The session was led by a cancer survivor and her partner. They discussed how illness has impacted their lives and reflect on their experiences with the health care system. The session was facilitated by a trained facilitator in health care. A qualitative approach was used to evaluate the impact of this program. Two focus groups for residents was conducted to evaluate the delivery mode, recommendations and impact of the proposed program. The focus group discussions were recorded, transcribed and thematically analyzed. Results: This program has had positive influences on residents by improving therapeutic relationships and enhancing the residents' understanding of the experience of illness. This program allowed residents to appreciate the importance of understating patients’ perspectives and values. Additionally, adding the partner perspective to the program was appreciated and valued by residents. Conclusions: Based on the school’s specific curriculum, this program can be integrated into the residents’ academic activities. This can improve important competencies for family medicine residents including confidence in communication and increased empathy. Family medicine residency programs wishing to enhance such humanism skills by family physicians might consider this model.
背景:家庭医学住院医师应该准备好解决乳腺癌幸存者可能遇到的社会心理问题。目的:本研究旨在将以患者为中心的方法模型引入家庭医学住院医师计划，并评估该计划对住院医师的影响。方法:在St. Michael 's Hospital的家庭医学住院医师半天的学术课程中加入一个互动式的虚拟会议(75分钟)。会议由一位癌症幸存者和她的伴侣主持。他们讨论了疾病如何影响他们的生活，并反思了他们在医疗保健系统中的经历。会议由一位在保健方面受过训练的调解人主持。采用定性方法评估该项目的影响。针对居民进行了两个焦点小组，以评估拟议计划的交付模式、建议和影响。对焦点小组讨论进行了记录、转录和专题分析。结果:本项目对住院医师产生了积极的影响，改善了治疗关系，提高了住院医师对疾病体验的理解。这个项目让住院医生认识到低估病人的观点和价值观的重要性。此外，在项目中加入合作伙伴的视角也受到了居民的赞赏和重视。结论:根据学校的具体课程设置，该项目可以融入到住客的学术活动中。这可以提高家庭医学住院医师的重要能力，包括沟通的信心和增加的同理心。希望提高家庭医生人文主义技能的家庭医学住院医师项目可以考虑这种模式。
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