Pub Date : 2022-10-31Epub Date: 2022-09-22DOI: 10.31579/2692-9392/147
Elizabeth Klaas, Shahd Mohamed, Jordan Poe, Ramya Reddy, Abeer Dagra, Brandon Lucke-Wold
Breast cancer metastasis is a continued concern for patients with recent development in our understanding of disease progression. In this paper, we highlight the pathophysiology behind breast cancer metastasis. Blood brain barrier disruption plays a critical component in progression. We then investigate the current treatment strategies and recommended guidelines. This focuses on radiation and medical management. Finally, we address the role of surgical intervention. The data is organized into tables and figures to highlight key components. Finally, we address emerging treatments and pre-clinical data. The paper will serve as a user-friendly guide for clinicians and researchers to help formulate a strategy to manage breast cancer metastasis patients sufficiently.
{"title":"Innovative Approaches for Breast Cancer Metastasis to the Brain.","authors":"Elizabeth Klaas, Shahd Mohamed, Jordan Poe, Ramya Reddy, Abeer Dagra, Brandon Lucke-Wold","doi":"10.31579/2692-9392/147","DOIUrl":"10.31579/2692-9392/147","url":null,"abstract":"<p><p>Breast cancer metastasis is a continued concern for patients with recent development in our understanding of disease progression. In this paper, we highlight the pathophysiology behind breast cancer metastasis. Blood brain barrier disruption plays a critical component in progression. We then investigate the current treatment strategies and recommended guidelines. This focuses on radiation and medical management. Finally, we address the role of surgical intervention. The data is organized into tables and figures to highlight key components. Finally, we address emerging treatments and pre-clinical data. The paper will serve as a user-friendly guide for clinicians and researchers to help formulate a strategy to manage breast cancer metastasis patients sufficiently.</p>","PeriodicalId":72284,"journal":{"name":"Archives of medical case reports and case study","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35345738","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}
A patient in the sixth decade of life presented to the Emergency Department (ED) with an apparent suicide attempt as well as with abdominal pain. The patient appeared to be inebriated. The prehospital emergency medicine service (EMS) providers suggested that the presentation may have been due to diabetic ketoacidosis. A chest x-ray finding showed possible pneumoperitoneum, but was read by radiology has having been seen on a chest x-ray from a year prior. Repeat physical examination continued to show abdominal tenderness, leading to a CT scan of the abdomen that demonstrated a large pneumo-peritoneum with a mild ileus and chronic surgical findings. The patient was transferred to a tertiary level of care for exploratory laparotomy after broad spectrum antibiotics and additional pain medication given. A bowel perforation was identified and was repaired. He had an uncomplicated clinical course and was discharged from the hospital 8 days later. The critical thinking skill of iterative reconsideration of a diagnosis along with iterative testing can avoid the pitfalls that can attend to such biases of cognition as anchoring and premature closure of thinking.
{"title":"Case Report: The Value of Vigilance and Iterative Evaluations with an Uncooperative Patient in the Emergency Department","authors":"J. Espinosa","doi":"10.31579/2692-9392/139","DOIUrl":"https://doi.org/10.31579/2692-9392/139","url":null,"abstract":"A patient in the sixth decade of life presented to the Emergency Department (ED) with an apparent suicide attempt as well as with abdominal pain. The patient appeared to be inebriated. The prehospital emergency medicine service (EMS) providers suggested that the presentation may have been due to diabetic ketoacidosis. A chest x-ray finding showed possible pneumoperitoneum, but was read by radiology has having been seen on a chest x-ray from a year prior. Repeat physical examination continued to show abdominal tenderness, leading to a CT scan of the abdomen that demonstrated a large pneumo-peritoneum with a mild ileus and chronic surgical findings. The patient was transferred to a tertiary level of care for exploratory laparotomy after broad spectrum antibiotics and additional pain medication given. A bowel perforation was identified and was repaired. He had an uncomplicated clinical course and was discharged from the hospital 8 days later. The critical thinking skill of iterative reconsideration of a diagnosis along with iterative testing can avoid the pitfalls that can attend to such biases of cognition as anchoring and premature closure of thinking.","PeriodicalId":72284,"journal":{"name":"Archives of medical case reports and case study","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44374048","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}
Extramammary Paget’s disease (EMPD) is a rare form of primary or secondary intraepithelial adenocarcinoma typically presenting within the fifth through seventh decades of life. Though cases of EMPD localized to the scrotum are typically not associated with underlying malignancy, evaluation of dermal and angiolymphatic invasion in conjunction with pertinent laboratory investigations, e.g., serum CEA, is essential to rule out malignancy and metastatic disease. We present a case of EMPD in an elderly male that presented with a history of a longstanding asymptomatic scrotal lesion that was ultimately managed with excision and skin grafting.
{"title":"Extramammary Paget’s Disease Arising in the Scrotum of an Elderly Male","authors":"Nada Shaker","doi":"10.31579/2692-9392/141","DOIUrl":"https://doi.org/10.31579/2692-9392/141","url":null,"abstract":"Extramammary Paget’s disease (EMPD) is a rare form of primary or secondary intraepithelial adenocarcinoma typically presenting within the fifth through seventh decades of life. Though cases of EMPD localized to the scrotum are typically not associated with underlying malignancy, evaluation of dermal and angiolymphatic invasion in conjunction with pertinent laboratory investigations, e.g., serum CEA, is essential to rule out malignancy and metastatic disease. We present a case of EMPD in an elderly male that presented with a history of a longstanding asymptomatic scrotal lesion that was ultimately managed with excision and skin grafting.","PeriodicalId":72284,"journal":{"name":"Archives of medical case reports and case study","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45191456","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}
Hemophilia A is an X-linked recessive hereditary bleeding illness that manifests as increased bleeding after moderate trauma and spontaneous bleeding. It is caused by a deficiency of the clotting factor VIII (FVIII). We report a video assisted-thoracoscopy in a 48-year-old patient with Hemophilia A. Hemophilia shouldn't be a barrier to invasive surgery, but there are a few conditions that must be met to ensure a straightforward intraoperative and postoperative course. Understanding the disease, a multidisciplinary team approach, and appropriate anesthetic management can result in a successful surgical outcome.
{"title":"Anesthetic Management of a Video-Assisted Thoracoscopy and Pulmonary Biopsy in a Hemophilic Patient. a Case Report","authors":"Marina Delgado","doi":"10.31579/2692-9392/149","DOIUrl":"https://doi.org/10.31579/2692-9392/149","url":null,"abstract":"Hemophilia A is an X-linked recessive hereditary bleeding illness that manifests as increased bleeding after moderate trauma and spontaneous bleeding. It is caused by a deficiency of the clotting factor VIII (FVIII). We report a video assisted-thoracoscopy in a 48-year-old patient with Hemophilia A. Hemophilia shouldn't be a barrier to invasive surgery, but there are a few conditions that must be met to ensure a straightforward intraoperative and postoperative course. Understanding the disease, a multidisciplinary team approach, and appropriate anesthetic management can result in a successful surgical outcome.","PeriodicalId":72284,"journal":{"name":"Archives of medical case reports and case study","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47670935","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}
This article is a sequel to other previous articles entitled “Diabetic foot in Algeria” in which the technique is extensively described. To avoid the redundancy effect, we invite you to refer to them. In addition, in this article, we share our experience concerning a precise lesion localization of the diabetic foot.
{"title":"Diabetic Foot in Algeria Illustration V – Case Report","authors":"N. Boudjenah","doi":"10.31579/2692-9392/144","DOIUrl":"https://doi.org/10.31579/2692-9392/144","url":null,"abstract":"This article is a sequel to other previous articles entitled “Diabetic foot in Algeria” in which the technique is extensively described. To avoid the redundancy effect, we invite you to refer to them. In addition, in this article, we share our experience concerning a precise lesion localization of the diabetic foot.","PeriodicalId":72284,"journal":{"name":"Archives of medical case reports and case study","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45475302","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}
We present the case of a 32-year-old patient with a known history of Gitelman syndrome who presented with hypokalemia and hypomagnesemia. The patient was treated with supplemental potassium, magnesium and intravenous fluids in the ED. The patient required hospital admission for further electrolyte correction. An awaremess of Gitelman syndrome is important for the emergency physician. Some patients have a known history of Gitelman Syndrome. In such cases, it is imperative to be aware of what electrolyte abnormalities to expect. Some new diagnoses of GS can be made in patients presenting with hypotension, or myalgias along with hypokalemia and hypomagnesemia.
{"title":"Case Report: A Hidden Cause for Electrolyte Derangement in the ED: Gitelman Syndrome","authors":"James Espinosa","doi":"10.31579/2692-9392/134","DOIUrl":"https://doi.org/10.31579/2692-9392/134","url":null,"abstract":"We present the case of a 32-year-old patient with a known history of Gitelman syndrome who presented with hypokalemia and hypomagnesemia. The patient was treated with supplemental potassium, magnesium and intravenous fluids in the ED. The patient required hospital admission for further electrolyte correction. An awaremess of Gitelman syndrome is important for the emergency physician. Some patients have a known history of Gitelman Syndrome. In such cases, it is imperative to be aware of what electrolyte abnormalities to expect. Some new diagnoses of GS can be made in patients presenting with hypotension, or myalgias along with hypokalemia and hypomagnesemia.","PeriodicalId":72284,"journal":{"name":"Archives of medical case reports and case study","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49072645","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}
Introduction: Weekend admission has been related to worse outcomes. The aim of this study is to assess the impact of the “weekend effect” in patients with nonvariceal uppergastrointestinal bleeding (NVUGIB). Methods: Retrospective analysis of clinical and endoscopic data of patients admitted to Centro Hospitalar Universitário do Porto, from January/2016 to December/2018 for upper gastrointestinal bleeding (UGIB). The association between weekend admission and the timing of endoscopy; level of hospitalisation; surgery need; rebleeding and mortality was evaluated. Results: Atotal of 545 patients were included. No significant association between weekday and weekend admissions was observed in any of the outcomes. The majority of patients underwent upper endoscopy up to 12 hours afteradmission (62.0% vs. 57.2%, weekday vs. weekend admission, respectively), with similar timings of endoscopy between both groups (p=0.607). Hospitalization in intensive and/or intermediate care units (41.6% vs. 42.8%, p=0.869) was not related to the day of admission. Also, no differences were assessed in the following outcomes: surgery need (5.8% vs. 6.3%, p=0.843), rebleeding (9.3% vs. 6.2%, p=0.289) and mortality rates (6.2% vs. 2.4%, p=0.103). Discussion and Conclusion: In this sample of patients with NVUGIB, clinical management and results were independent of the day of admission. The absence of “weekend effect” seems to be related to the gastroenterology emergency model evaluated and its continuous access to endoscopic resources.
{"title":"Weekend Hospitalization in Nonvariceal Upper Gastrointestinal Bleeding – an Additional Risk?","authors":"D. Falcão","doi":"10.31579/2692-9392/125","DOIUrl":"https://doi.org/10.31579/2692-9392/125","url":null,"abstract":"Introduction: Weekend admission has been related to worse outcomes. The aim of this study is to assess the impact of the “weekend effect” in patients with nonvariceal uppergastrointestinal bleeding (NVUGIB). Methods: Retrospective analysis of clinical and endoscopic data of patients admitted to Centro Hospitalar Universitário do Porto, from January/2016 to December/2018 for upper gastrointestinal bleeding (UGIB). The association between weekend admission and the timing of endoscopy; level of hospitalisation; surgery need; rebleeding and mortality was evaluated. Results: Atotal of 545 patients were included. No significant association between weekday and weekend admissions was observed in any of the outcomes. The majority of patients underwent upper endoscopy up to 12 hours afteradmission (62.0% vs. 57.2%, weekday vs. weekend admission, respectively), with similar timings of endoscopy between both groups (p=0.607). Hospitalization in intensive and/or intermediate care units (41.6% vs. 42.8%, p=0.869) was not related to the day of admission. Also, no differences were assessed in the following outcomes: surgery need (5.8% vs. 6.3%, p=0.843), rebleeding (9.3% vs. 6.2%, p=0.289) and mortality rates (6.2% vs. 2.4%, p=0.103). Discussion and Conclusion: In this sample of patients with NVUGIB, clinical management and results were independent of the day of admission. The absence of “weekend effect” seems to be related to the gastroenterology emergency model evaluated and its continuous access to endoscopic resources.","PeriodicalId":72284,"journal":{"name":"Archives of medical case reports and case study","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49467514","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}
Sudden cardiac death (SCD) is defined as a sudden and unexpected death secondary to a cardiovascular cause. In many cases, cardiopulmonary resuscitation (CPR) maneuvers can achieve recovery of the patient, which is then called resuscitated SCD. We present the case of an adolescent with resuscitated SCD, who finally died of refractory cardiogenic shock, secondary to fibromuscular dysplasia of the coronary arteries.
{"title":"Fibromuscular Dysplasia of the Coronary Arteries: An Infrequent Cause of Sudden Death","authors":"C. Niño-Taravilla","doi":"10.31579/2692-9392/131","DOIUrl":"https://doi.org/10.31579/2692-9392/131","url":null,"abstract":"Sudden cardiac death (SCD) is defined as a sudden and unexpected death secondary to a cardiovascular cause. In many cases, cardiopulmonary resuscitation (CPR) maneuvers can achieve recovery of the patient, which is then called resuscitated SCD. We present the case of an adolescent with resuscitated SCD, who finally died of refractory cardiogenic shock, secondary to fibromuscular dysplasia of the coronary arteries.","PeriodicalId":72284,"journal":{"name":"Archives of medical case reports and case study","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44173787","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}
A dental surgeon had sudden onset of massive hemoptysis with hypovolemic shock during COVID-19 epidemic; her nasopharyngeal swab for SARS-CoV-2 PCR was positive. She noticed 2 days history of fever and cough; however, she had poor appetite for nearly two weeks. Resuscitation was done successfully with fluids and blood transfusion. Chest radiograph showed opacities in left lower zone; and, NECT chest revealed consolidation in left lower lobe and patchy opacities in right upper lobe with areas of bronchiectasis. Sputum for gene expert for drug resistant tuberculosis, Ziehl Neelsen stain for acid fast bacilli and Lowenstein Jensen media for culture could not be done as microbiological services were limitted in the peak of COVID-19 pandemics. Therefore, anti-tubercular therapy (isoniazid, rifampicin, ethambutol and pyrazinamide) was initiated mainly based on NECT chest without sputum confirmation; the patient made dramatic improvement. Two months later, she gained 10 lbs weight; and radiological improvement.
{"title":"A 32-Year-Old Dental Surgeon Presented with Massive Hemoptysis, Fever and Hypotension As A Result of Bleeding from Bronchiectasis due to Pulmonary Tuberculosis (New Case) with Concurrent Covid-19 Infection Successfully Treated with Anti-Tubercular Th","authors":"K. Phyu Pyar","doi":"10.31579/2692-9392/129","DOIUrl":"https://doi.org/10.31579/2692-9392/129","url":null,"abstract":"A dental surgeon had sudden onset of massive hemoptysis with hypovolemic shock during COVID-19 epidemic; her nasopharyngeal swab for SARS-CoV-2 PCR was positive. She noticed 2 days history of fever and cough; however, she had poor appetite for nearly two weeks. Resuscitation was done successfully with fluids and blood transfusion. Chest radiograph showed opacities in left lower zone; and, NECT chest revealed consolidation in left lower lobe and patchy opacities in right upper lobe with areas of bronchiectasis. Sputum for gene expert for drug resistant tuberculosis, Ziehl Neelsen stain for acid fast bacilli and Lowenstein Jensen media for culture could not be done as microbiological services were limitted in the peak of COVID-19 pandemics. Therefore, anti-tubercular therapy (isoniazid, rifampicin, ethambutol and pyrazinamide) was initiated mainly based on NECT chest without sputum confirmation; the patient made dramatic improvement. Two months later, she gained 10 lbs weight; and radiological improvement.","PeriodicalId":72284,"journal":{"name":"Archives of medical case reports and case study","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47752633","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}
It seemed interesting to us to share this observation because it reflects our management of the diabetic patient with a wound and suffering from a severe disabling Neuropathy. Our clinical case today is a 55-year-old male. A patient with type 2 diabetes, on insulin therapy and oral anti-diabetics and being treated for high blood pressure. He came to our consultation on August 05, 2020, with an infection of the right foot, of which the starting point is the second and third toes. These ones being ischemic
{"title":"Diabetic Foot in Algeria Illustration IV – Clinical Case Report","authors":"N. Boudjenah","doi":"10.31579/2692-9392/137","DOIUrl":"https://doi.org/10.31579/2692-9392/137","url":null,"abstract":"It seemed interesting to us to share this observation because it reflects our management of the diabetic patient with a wound and suffering from a severe disabling Neuropathy. Our clinical case today is a 55-year-old male. A patient with type 2 diabetes, on insulin therapy and oral anti-diabetics and being treated for high blood pressure. He came to our consultation on August 05, 2020, with an infection of the right foot, of which the starting point is the second and third toes. These ones being ischemic","PeriodicalId":72284,"journal":{"name":"Archives of medical case reports and case study","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47298825","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}
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