Current Issue : January - March Volume : 2020 Issue Number : 1 Articles : 5 Articles
Objective: To report a case of difficulties in the management of a typical ductal\nhyperplasia (ADH). Presentation of the case: Mrs. G, 50 years old, is\nconsulting following the discovery at autopalpation of a lesion on her left\nbreast. In its history: radical mastectomy Right Patey in 2004 for ductal carcinoma\nInfiltrant associated with carcinoma in situ ; 2 N+ /14; Positive hormone\nreceptors. Adjuvant treatment performed: chemotherapy, radiotherapy\nand hormone therapy. Summary of the clinical case: Left breast examination:\nSuperior External Quadrant nodule 5 cm * 4, mobile, hard, without inflammatory\nsigns, there is no palpable lymph node. The surgical scar of the\nright breast is without particularity. Mammography and left breast ultrasound\nshow an ACR4 lesion according to BIRADS. Microbiopsy: intradural\npapillomatous lesion requiring verification of the myoepithelial layer (P63\nand CK5/6). Immunohistochemistry: atypical ductal hyperplasia (ADH) with\nno sign of transformation. Normal CA15-3 dosage. Treatment: broad surgical\nremoval of the lesion. Analysis of the part shows a lesion with all the criteria\nof an HCA measuring 2 mm in its largest axis. The postoperative consequences\nare simple. Conclusion: The management of atypical hyperplasia is\nnot consensual and is often undervalued. The type of lesion characterizing\nHCA is decisive for therapeutic orientation....
Objective: To explore the effect of catgut implantation at Baliao and Xingfu\nOne Acupuncture point for patients with urinary incontinence secondary to\nspinal cord injury (SCI). Methods: Three SCI patients received catgut embedding\nat Baliao and Xingfu One Acupuncture point. The data of intermittent\ncatheterization (IC) volume, intermittent catheterization frequency and\nthe amount of using urine pad (urethral condom) were corrected. Results:\nCompared to the baseline data, IC volume increased and the leakage volume\ndecreased. Conclusions: Catgut Implantation at Baliao and Xingfu One\nAcupuncture point is effective for patients with urinary incontinence secondary\nto incomplete SCI....
Background: Serum uric acid (SUA) has been correlated with cardiac morbidity\nand mortality. However, its prognostic value in acute ST-segment\nelevation myocardial infarction (STEMI) is still uncertain. The aim of this\nstudy was to evaluate the prognostic value of SUA on admission in patients\nwith STEMI undergoing primary percutaneous coronary intervention (PPCI).\nMethods: We prospectively enrolled 150 STEMI patients underwent PPCI.\nThe mean age of the studied population was 56.1 years, 78% were males while\n22% were females. Patients were divided into tertiles based on the basal serum\nuric acid level. Patients with high SUA (n = 72) was defined as a value in\nthe third tertile (>6.4 mg/dl), and a low SUA group (n = 78) was set as a value\nin the lower two tertiles (<6.4 mg/dl). Clinical characteristics, angiographic\nfindings, echocardiographic data, in-hospital and three-month outcomes of\nPPCI were analyzed. Results: SUA level on admission carried prognostic value\nin patients with STEMI undergoing PPCI where the low uric acid group\nhad better KILLIP class (P = 0.001), better TIMI flow (P = 0.001), higher ejection\nfraction����...
Septic pulmonary emboli rarely cause respiratory failure that requires mechanical\nventilation. The most common causes of septic pulmonary emboli\nare related to intravenous drug abuse, indwelling intravenous catheters, endocarditis\nand septic pelvic thrombophlebitis. In addition, soft tissue injury-\nrelated thrombophlebitis rarely causes septic pulmonary emboli. We describe\na unique case of a 43-year-old man who developed septic thrombophlebitis\nof the femoral vein following soft tissue injury from trauma to the shin\nwith ensuing septic pulmonary emboli which necessitated endotracheal intubation\nand mechanical ventilation. The patient required mechanical ventilation\nfor eleven days, developed empyema and grew out methicillin-resistant\nStaphylococcus aureus on blood cultures. A transesophageal echocardiogram\nwas normal, and there was no indication of bacterial endocarditis. In addition\nto eleven days of mechanical ventilation, the patient was treated with intravenous\nheparin, cefepime and clindamycin. These medications were then\ndiscontinued and the patient was treated with weight-adjusted vancomycin.\nFollowing the return of cultures, the patient was treated for six weeks with\nceftaroline 600 mg IV twice a day. In addition, the patient received bilateral\nthoracentesis followed by chest tube drainage until resolution of the pleural\neffusions. The patient made a complete recovery. We describe this case and\nthe implications for differential diagnosis and treatment of these two uncommon\nconditions....
Background: Malaria causes a reduction in haemoglobin that is compounded by primaquine, particularly in\npatients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. The aim of this study was to determine the\nrelative contributions to red cell loss of malaria and primaquine in patients with uncomplicated Plasmodium vivax.\nMethods: A systematic review identified P. vivax efficacy studies of chloroquine with or without primaquine\npublished between January 2000 and March 2017. Individual patient data were pooled using standardised\nmethodology, and the haematological response versus time was quantified using a multivariable linear mixed\neffects model with non-linear terms for time. Mean differences in haemoglobin between treatment groups at day\nof nadir and day 42 were estimated from this model.\nResults: In total, 3421 patients from 29 studies were included: 1692 (49.5%) with normal G6PD status, 1701 (49.7%)\nwith unknown status and 28 (0.8%) deficient or borderline individuals. Of 1975 patients treated with chloroquine\nalone, the mean haemoglobin fell from 12.22 g/dL [95% CI 11.93, 12.50] on day 0 to a nadir of 11.64 g/dL [11.36,\n11.93] on day 2, before rising to 12.88 g/dL [12.60, 13.17] on day 42. In comparison to chloroquine alone, the mean\nhaemoglobin in 1446 patients treated with chloroquine plus primaquine was - 0.13 g/dL [- 0.27, 0.01] lower at day\nof nadir (p = 0.072), but 0.49 g/dL [0.28, 0.69] higher by day 42 (p < 0.001). On day 42, patients with recurrent\nparasitaemia had a mean haemoglobin concentration - 0.72 g/dL [- 0.90, - 0.54] lower than patients without\nrecurrence (p < 0.001). Seven days after starting primaquine, G6PD normal patients had a 0.3% (1/389) risk\nof clinically significant haemolysis (fall in haemoglobin > 25% to < 7 g/dL) and a 1% (4/389) risk of a fall in\nhaemoglobin > 5 g/dL.\nConclusions: Primaquine has the potential to reduce malaria-related anaemia at day 42 and beyond by\npreventing recurrent parasitaemia. Its widespread implementation will require accurate diagnosis of G6PD\ndeficiency to reduce the risk of drug-induced haemolysis in vulnerable individuals....
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