Unresectable esophageal cancer treated with multiple chemotherapies in combination with chemoradiotherapy: A case report

paythelady.612 shared this article with you from Inoreader Unresectable esophageal cancer treated with multiple chemotherapies in combination with chemoradiotherapy: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 26;9(12):2801-2810. doi: 10.12998/wjcc.v9.i12.2801. ABSTRACT BACKGROUND: Definitive chemoradiotherapy (dCRT) using cisplatin plus 5fluorouracil (CF) with radiation is considered the standard treatment for unresectable locally advanced T4 esophageal squamous cell carcinoma (ESCC). Recently, induction chemotherapy has received attention as an effective treatment strategy. CASE SUMMARY: We report a successful case of a 59-year-old female with unresectable locally advanced T4 ESCC treated by two additional courses of chemotherapy with CF after induction chemotherapy with docetaxel, cisplatin and fluorouracil (DCF) followed by dCRT. Initial esophagogastroduodenoscopy (EGD) detected a type 2 advanced lesion located on the middle part of the esophagus, with stenosis. Computed tomography detected the primary tumor with suspected invasion of the left bronchus and 90° of direct contact with the aorta, and uppe r mediastinal lymph node metastasis. Pathological findings from biopsy revealed squamous cell carcinoma. We initially performed induction chemotherapy using three courses of DCF, but the lesion was still evaluated unresectable after DCF chemotherapy. Therefore, we subsequently performed dCRT treatment (CF and radiation). After dCRT, prominent reduction of the primary tumor was recognized but a residual tumor with ulceration was detected by EGD. Since the patient had some surgical risk, we performed two additional courses of CF and achieved a clinically complete response. After 14 mo from last administration of CF chemotherapy, recurrence has not been detected by computed tomography and EGD, and biopsy from the scar formation has revealed no cancer cells. CONCLUSION: We report successful case with tumor remnants even after DCF and subsequent dCRT, for whom a complete response was finally achieved with two additional courses of CF chemotherapy. Additional CF chemotherapy could b e one radical treatment option for residual ESCC after treatment with induction DCF followed by dCRT to avoid salvage surgery, especially for high-risk patients. PMID:33969062 | PMC:PMC8058665 | DOI:10.12998/wjcc.v9.i12.2801 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Updated Kimura-Takemoto classification of atrophic gastritis

paythelady.612 shared this article with you from Inoreader Updated Kimura-Takemoto classification of atrophic gastritis Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 May 6;9(13):3014-3023. doi: 10.12998/wjcc.v9.i13.3014. ABSTRACT BACKGROUND: The Updated Sydney system for visual evaluation of gastric mucosal atrophy via endoscopic observation is subject to sampling error and interobserver variability. The Kimura-Takemoto classification system was developed to overcome these limitations. AIM: To compare the morphological classification of atrophic gastritis between the Kimura-Takemoto system and the Updated Sydney system. METHODS: A total of 169 patients with atrophic gastritis were selected according to diagnosis by the visual endoscopic Kimura-Takemoto method. Following the Updated Kimura-Takemoto classification system, one antrum biopsy and five gastric corpus biopsies were taken according to the visual stages of the Kimura-Takemoto system. The Updated Kimura-Takemoto classification system was then applied to each and showed 165 to have histological muco sal atrophy; the remaining 4 patients had no histological evidence of atrophy in any biopsy. The Updated Kimura-Takemoto classification was verified as a reference morphological method and applied for the diagnosis of atrophic gastritis. Adding one more biopsy from the antrum to the six biopsies according to the Updated Kimura-Takemoto classification, constitutes the updated combined Kimura-Takemoto classification and Sydney system. RESULTS: The sensitivity for degree of mucosal atrophy assessed by the Updated Sydney system was 25% for mild, 36% for moderate, and 42% for severe, when compared with the Updated Kimura-Takemoto classification of atrophic gastritis for morphological diagnosis. Four types of multifocal atrophic gastritis were identified: sequential uniform (type 1; in 28%), sequential non-uniform (type 2; in 7%), diffuse uniform (type 3; in 23%), diffuse non-uniform (type 4; in 24%), and "alternating atrophic - non-atrophic" (type 5; in 18%). The pattern of the spr ead of atrophy, sequentially from the antrum to the cardiac segment of the stomach, which was described by the Updated Kimura-Takemoto system, was histologically confirmed in 82% of cases evaluated. CONCLUSION: The Updated Sydney system is significantly inferior to the Updated Kimura-Takemoto classification for morphological verification of atrophic gastritis. PMID:33969087 | PMC:PMC8080746 | DOI:10.12998/wjcc.v9.i13.3014 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Positive reverse transcription-polymerase chain reaction assay results in patients recovered from COVID-19: Report of two cases

paythelady.612 shared this article with you from Inoreader Positive reverse transcription-polymerase chain reaction assay results in patients recovered from COVID-19: Report of two cases Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 26;9(12):2816-2822. doi: 10.12998/wjcc.v9.i12.2816. ABSTRACT BACKGROUND: Coronavirus disease 2019 (COVID-19) has spread around the globe. On February 28, 2020, the World Health Organization adjusted the risk of spread and impact of COVID-19 to "very high" at the global level. Studies have mainly focused on the etiology, epidemiology, and treatment of COVID-19 to limit further spread and the negative impact of the disease, while less attention has been devoted to the follow-up and reexamination of patients who recovered from COVID-19 or were released from quarantine. CASE SUMMARY: This study reports two cases where patients who had negative reverse transcription-polymerase chain reaction (RT-PCR) test results and met the criteria for discharge subsequently had positive RT-PCR test results. The clinical manifestations and computed tomography (CT) findings of these patients were examined. The conversion of RT-PCR test results in these two patients may be related to false-negative and false-positive outcomes of the test. CT images helped track improvement of pulmonary lesions. CONCLUSION: The timing of discharge of COVID-19 patients should be determined by comprehensive analysis of CT images and RT-PCR test results. PMID:33969064 | PMC:PMC8058663 | DOI:10.12998/wjcc.v9.i12.2816 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Systematic review and meta-analysis of the impact of deviations from a clinical pathway on outcomes following pancreatoduodenectomy

paythelady.612 shared this article with you from Inoreader Systematic review and meta-analysis of the impact of deviations from a clinical pathway on outcomes following pancreatoduodenectomy Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 May 6;9(13):3024-3037. doi: 10.12998/wjcc.v9.i13.3024. ABSTRACT BACKGROUND: Enhanced recovery after surgery is steadily gaining importance in patients undergoing pancreatic surgery, including pancreatoduodenectomy (PD). While clinical pathways targeting enhanced-recovery can achieve their intended outcome in reducing length of stay, compliance to these pathways, and their relevance is poorly understood. The aim of this systematic review was to assess the impact of deviations from/non-compliance to a clinical pathway on post-PD outcomes. AIM: To assess the impact of deviations from/non-compliance to a clinical pathway on post-PD outcomes. METHODS: A systematic review of major reference databases was undertaken, according to preferred reporting items for systematic reviews and meta-analysis guidelines, between January 2000 and November 2020 relating to compliance with clinical pathways and its impact on outcomes in patients undergoing PD. A meta-analysis was performed using fixed-effects or random-effects models. RESULTS: Eleven studies including 1852 patients were identified. Median overall compliance to all components of the clinical pathway was 65.7% [interquartile range (IQR): 62.7%-72.3%] with median compliance to post-operative parameters of the clinical pathway being 44% (IQR: 34.5%-52.25%). Meta-analysis using a fixed-effects model showed that ≥ 50% compliance to a clinical pathway predicted significantly fewer post-operative complications [pooled odds ratio (OR): 9.46, 95% confidence interval (CI): 5.00-17.90; P < 0.00001] and a significantly shorter length of hospital stay [pooled mean difference (MD): 4.32, 95%CI: -3.88 to -4.75; P < 0.0001]. At 100% compliance which was associated with significantly fewer post-operative complications (pooled OR: 11.25, 95%CI: 4.71-26.84; P < 0.00001) and shorter hospital stay (pooled MD of 4.66, 95%CI: 2.81-6.51; P < 0.00001). CONCLUSION: Compliance to post-PD clinical pathways remains low. Deviations are associated with an increased risk of complications and length of hospital stay. Under-standing the relevance of deviations to clinical pathways post-PD presents pancreatic surgeons with opportunities to actively pursue an enhanced-recovery of their patients. PMID:33969088 | PMC:PMC8080740 | DOI:10.12998/wjcc.v9.i13.3024 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Prostate stromal tumor with prostatic cysts after transurethral resection of the prostate: A case report

paythelady.612 shared this article with you from Inoreader Prostate stromal tumor with prostatic cysts after transurethral resection of the prostate: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 26;9(12):2830-2837. doi: 10.12998/wjcc.v9.i12.2830. ABSTRACT BACKGROUND: A prostatic stromal tumor is deemed to be a rare oncology condition. Based on the retrospective analysis of clinical data and scientific literature review, a case of prostatic stromal tumor was reported in this article to explore the diagnosis, treatment and prognosis of this rare disease. CASE SUMMARY: The present case involved an older male patient who was admitted to our department for a medical consultation of dysuria. Serum prostate-specific antigen was 8.30 ng/mL, Ultrasound and magnetic resonance imaging suggested evident enlargement of the prostate and multiple cystic developments internally. Considering that the patient was an elderly male with a poor health status, transurethral resection of the prostate was performed to improve the symptoms of urinary tract obstruction. Furthermore, based on histopathologic examination and immunohistochemical staining, the patient was pathologically diagnosed with prostatic stromal tumor. The patient did not receive any further adjuvant therapy following surgery leading to a clinical recommendation that the patient should be followed up on a long-term basis. However, during the recent follow-up assessment, the patient demonstrated recurrence of lower urinary tract symptoms and gross hematuria. CONCLUSION: Referring to scientific literature review, we believe that the management of these lesions requires a thorough assessment of the patient. Furthermore, the treatment of prostate stromal tumors should be based on the imaging examination and pathological classification. Active surgical treatment is of great significance to the prognosis of patients, and subsequent surveillance after the treatment is warranted. PMID:33969066 | PMC:PMC8058689 | DOI:10.12998/wjcc.v9.i12.2830 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Early vs late cholecystectomy in mild gall stone pancreatitis: An updated meta-analysis and review of literature

paythelady.612 shared this article with you from Inoreader Early <em>vs</em> late cholecystectomy in mild gall stone pancreatitis: An updated meta-analysis and review of literature Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 May 6;9(13):3038-3047. doi: 10.12998/wjcc.v9.i13.3038. ABSTRACT BACKGROUND: Gallstone pancreatitis is one of the most common causes of acute pancreatitis. Cholecystectomy remains the definitive treatment of choice to prevent recurrence. The rate of early cholecystectomies during index admission remains low due to perceived increased risk of complications. AIM: To compare outcomes including length of stay, duration of surgery, biliary complications, conversion to open cholecystectomy, intra-operative, and post-operative complications between patients who undergo cholecystectomy during index admission as compared to those who undergo cholecystectomy thereafter. METHODS: Statistical Method: Pooled proportions were calculated using both Mantel-Haenszel method (fixed effects model) and DerSimonian Laird method (random effects model). RESULTS: Initial search identified 163 reference articles, of whi ch 45 were selected and reviewed. Eighteen studies (n = 2651) that met the inclusion criteria were included in this analysis. Median age of patients in the late group was 43.8 years while that in the early group was 43.6. Pooled analysis showed late laparoscopic cholecystectomy group was associated with an increased length of stay by 88.96 h (95%CI: 86.31 to 91.62) as compared to early cholecystectomy group. Pooled risk difference for biliary complications was higher by 10.76% (95%CI: 8.51 to 13.01) in the late cholecystectomy group as compared to the early cholecystectomy group. Pooled analysis showed no risk difference in intraoperative complications [risk difference: 0.41%, (95%CI: -1.58 to 0.75)], postoperative complications [risk difference: 0.60%, (95%CI: -2.21 to 1.00)], or conversion to open cholecystectomy [risk difference: 1.42%, (95%CI: -0.35 to 3.21)] between early and late cholecystectomy groups. Pooled analysis showed the duration of surgery to be prolonged by 3 9.11 min (95%CI: 37.44 to 40.77) in the late cholecystectomy group as compared to the early group. CONCLUSION: In patients with mild gallstone pancreatitis early cholecystectomy leads to shorter hospital stay, shorter duration of surgery, while decreasing the risk of biliary complications. Rate of intraoperative, post-operative complications and chances of conversion to open cholecystectomy do not significantly differ whether cholecystectomy was performed early or late. PMID:33969089 | PMC:PMC8080749 | DOI:10.12998/wjcc.v9.i13.3038 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Partial response to Chinese patent medicine Kangliu pill for adult glioblastoma: A case report and review of the literature

paythelady.612 shared this article with you from Inoreader Partial response to Chinese patent medicine Kangliu pill for adult glioblastoma: A case report and review of the literature Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 26;9(12):2845-2853. doi: 10.12998/wjcc.v9.i12.2845. ABSTRACT BACKGROUND: Glioblastoma is the most common type of brain tumor and is invariably fatal, with a mean survival time of 8-15 mo for recently diagnosed tumors, and a 5-year survival rate of only 7.2%. The standard treatment for newly diagnosed glioblastoma includes surgery followed by concurrent chemoradiotherapy and further adjuvant temozolomide. However, the prognosis remains poor and long-term survival is rare. This report aimed to demonstrate a new therapeutic strategy for the treatment of glioblastoma. CASE SUMMARY: A patient was referred to the Department of Neurosurgery with an intracranial space-occupying lesion with a maximum diameter of approximately 5 cm. The tumor was compressing functional areas, and the patient accordingly underwent partial resection and concurrent chemoradiotherapy. The imaging and pathological findings were cons istent with a diagnosis of glioblastoma with oligodendroglioma differentiation (World Health Organization IV). The patient was finally diagnosed with glioblastoma. However, the patient discontinued treatment due to intolerable side effects, and was prescribed Kangliu pill (KLP) 7.5 g three times/d, which he has continued to date. Significant shrinkage of the tumor (maximum diameter reduced from about 3.5 to about 2 cm) was found after 3 mo of KLP therapy, and the tumor was further reduced to about 1 cm after 3 years. The patient's symptoms of headache, limb weakness, and left hemiplegia were relieved, with no side effects. CONCLUSION: KLP has been a successful intervention for glioblastoma, and the current case indicates that traditional Chinese medicine may offer effective alternative therapies for glioblastoma. PMID:33969068 | PMC:PMC8058673 | DOI:10.12998/wjcc.v9.i12.2845 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Effects of intravascular laser phototherapy on delayed neurological sequelae after carbon monoxide intoxication as evaluated by brain perfusion imaging: A case report and review of the literature

paythelady.612 shared this article with you from Inoreader Effects of intravascular laser phototherapy on delayed neurological sequelae after carbon monoxide intoxication as evaluated by brain perfusion imaging: A case report and review of the literature Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 May 6;9(13):3048-3055. doi: 10.12998/wjcc.v9.i13.3048. ABSTRACT BACKGROUND: Delayed neurological sequelae (DNS) caused by carbon monoxide (CO) intoxication poses considerable treatment challenges for clinical practitioners. In this report, we used nuclear medicine imaging and the Mini-Mental State Examination (MMSE) to evaluate the effectiveness of intravascular laser irradiation of blood (ILIB) therapy for the management of DNS. CASE SUMMARY: A 51-year-old woman presented to our medical center experiencing progressive bradykinesia, rigidity of limbs, gait disturbance, and cognitive impairment. Based on her neurological deficits, laboratory tests and imaging findings, the patient was diagnosed with delayed neurological sequelae of CO intoxication. She received intensive rehabilitation and ILIB therapy during 30 sessions over 2 mo after diagnosis. Brain single-photon emission computed tomography was perfor med both prior to and after ILIB therapy. The original hypoperfusion area in bilateral striata, bilateral frontal lobe, right parietal lobe, and bilateral cerebellum showed considerable improvement after completion of therapy. The patient's MMSE score also increased markedly from 6/30 to 25/30. Symptoms of DNS became barely detectable, and the woman was able to carry out her daily living activities independently. CONCLUSION: ILIB therapy could facilitate recovery from delayed neurological sequelae in patients with CO intoxication, as demonstrated by improved cerebral blood flow and functional outcomes in our patient. PMID:33969090 | PMC:PMC8080739 | DOI:10.12998/wjcc.v9.i13.3048 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Successful endoscopic surgery for emphysematous pyelonephritis in a non-diabetic patient with autosomal dominant polycystic kidney disease: A case report

paythelady.612 shared this article with you from Inoreader Successful endoscopic surgery for emphysematous pyelonephritis in a non-diabetic patient with autosomal dominant polycystic kidney disease: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 26;9(12):2862-2867. doi: 10.12998/wjcc.v9.i12.2862. ABSTRACT BACKGROUND: Emphysema pyelonephritis (EPN) is a very dangerous type of urinary tract infection. It is a lethal disease that develops rapidly and causes the patient to deteriorate rapidly, and it can easily lead to systemic infections and even sepsis. The incidence is extremely low, and it is prevalent in patients with diabetes. We here report a case of EPN in a non-diabetic patient with autosomal dominant polycystic kidney disease (ADPKD). We share the diagnosis and treatment procedure for this extremely rare condition to make this disease easier to identify and address early. CASE SUMMARY: A 47-year-old woman presented to the emergency department of our hospital with a high fever and left back pain lasting 4 d. She had a history of autosomal dominant polycystic kidney and polycystic liver. She was diagnosed with left type I EPN and her vita l signs deteriorated so quickly that she underwent an emergency operation in which a D-J tube was inserted into her left ureter on the second day after admission. Two months later, she underwent a second-stage flexible ureteroscopy and lithotripsy. Despite postoperative sepsis, she finally recovered after active symptomatic support treatment and effective anti-infective treatment. CONCLUSION: Although EPN is more likely to occur in diabetic patients, for non-diabetic patients with ADPKD and upper urinary tract obstruction, the disease also causes rapid deterioration. Early and accurate diagnosis and timely removal of the obstruction by invasive means may be able to save the damaged kidney and the patient's life. PMID:33969070 | PMC:PMC8058662 | DOI:10.12998/wjcc.v9.i12.2862 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Crumbs homolog 2 mutation in two siblings with steroid-resistant nephrotic syndrome: Two case reports

paythelady.612 shared this article with you from Inoreader <em>Crumbs homolog 2</em> mutation in two siblings with steroid-resistant nephrotic syndrome: Two case reports Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 May 6;9(13):3056-3062. doi: 10.12998/wjcc.v9.i13.3056. ABSTRACT BACKGROUND: Crumbs homolog 2 (CRB2) is a recently discovered gene that is closely related to the maintenance of normal polarity in podocytes; mutations can directly lead to steroid-resistant nephrotic syndrome (SRNS). However, the characteristics of nephrotic syndrome (NS) caused by CRB2 mutations have not been described. CASE SUMMARY: We report a novel compound heterozygous mutation of the CRB2 gene in two siblings with SRNS. The two siblings had edema, proteinuria, hypoproteinemia and hyperlipidemia. Both their father and mother had normal phenotypes (no history of NS). Whole exon sequencing (WES) of the family showed a novel compound heterozygous mutation, c.2290 (exon 8) C > T and c.3613 (exon 12) G > A. Glucocorticoid therapy (methylprednisolone pulse therapy or oral prednisone) and immunosuppressive age nts (tacrolimus) had no effect. During a 3-year follow-up after genetic diagnosis by WES, proteinuria persisted, but the patient was healthy. CONCLUSION: CRB2 mutations related to SRNS often occur in exons 7, 10, and 12. Clinical manifestations of SRNS caused by CRB2 mutations are often less severe than in other forms of SRNS. PMID:33969091 | PMC:PMC8080757 | DOI:10.12998/wjcc.v9.i13.3056 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.