Journal of the College of Physicians and Surgeons--Pakistan : JCPSP
-
J Coll Physicians Surg Pak · Dec 2019
Case ReportsRobot-assisted Laparoscopic Nephroureterectomy for a Nephrogenic Adenoma of Ureter.
Nephrogenic adenoma is a rare and benign tumour of the urinary tract thought to be caused by metaplastic change of native urothelial tissue. The majority of cases arise in the bladder, with very few cases affecting the ureter reported in the literature. Herein, we describe the presentation, diagnostic challenges, and the eventual management of a nephrogenic adenoma of the ureter by robot-assisted laparoscopic nephroureterectomy. Urologists and pathologists should be aware of the potential diagnostic and management pitfalls associated with this rare tumour, as well as the sparsity of evidence with respect to follow-up.
-
J Coll Physicians Surg Pak · Dec 2019
Case ReportsAccessory Cardiac Conduction Pathway with an Unusual Presentation.
Pre-excitation syndrome (PES) is a congenital abnormality in which there is conduction through accessory pathway in addition to atrioventricular (AV) node between the atria and the ventricles. Conduction through accessory pathway is without any delay and; hence, results in early excitation of ventricles. This dual connection provides substrate for atrioventricular reciprocating tachycardia (AVRT), a type of supra-ventricular tachycardia. ⋯ However, ECG monitoring revealed CHB with intermittent conduction through accessory pathway. It highlights the critical evaluation of PES patients with syncope because therapeutic strategy is entirely different. This case was managed with dual chamber pacemaker implantation instead of accessory pathway ablation.
-
J Coll Physicians Surg Pak · Dec 2019
Case ReportsA Single Coronary Artery with an Absent Right Coronary and a Superdominant Left Circumflex Giving off a Branch Supplying the Right Coronary Artery Territory.
An absent right coronary artery (RCA) with single left coronary artery (LCA) originating from left aortic sinus with a superdominant left circumflex (LCX) and giving off an RCA branch is one of the rarest coronary artery anomalies. It occurs with an incidence of less than 0.1%. Usually, patients are asymptomatic and abnormality is found incidentally on cardiac catheterisation or CT angiography. ⋯ Patient was subjected to coronary angiography, which revealed absent RCA originating from distal LCX artery, supplying the base of heart and RCA territory. He underwent primary percutaneous intervention (PCI) with stenting to the left anterior descending (LAD) artery. This type of anomaly, in which single LCA from which dominant LCX continues as RCA, is important to diagnose and manage if diseased, as stenosis of the dominant LCX artery in such cases can jeopardise a large portion of myocardium, which can lead to increased morbidity and mortality, if left untreated.
-
J Coll Physicians Surg Pak · Dec 2019
Case ReportsRecurrent, Large, Extraskeletal Osteosarcoma at the Back.
Extraskeletal osteosarcoma is a rarely identified variety of sarcomas throughout the world, which is still a dilemma for the surgeons' community with respect to its diagnosis and treatment. It is slow-growing in nature, and attains a huge size usually at presentation, which puts the clinician in jeopardy with regard to its management. Our case is the first of its variety documented in Pakistan. ⋯ We did the excisional biopsy of the mass, followed by complete removal with intact margins. Histopathology revealed extraskeletal osteosarcoma as the final diagnosis. We suggest that this tumor should be included in the differential diagnosis of all large, recurrent soft tissue masses in the body.
-
J Coll Physicians Surg Pak · Dec 2019
Case ReportsStrangulated Intrapericardial Diaphragmatic Hernia after Hybrid Maze Procedure.
Convergent hybrid maze procedure is very safe and effective surgical modality for the treatment of refractory atrial fibrillation. It carries very little risk of complications and an intrapericardial diaphragmatic hernia is amongst the rarest of complications. ⋯ This case report describes a middle aged gentleman admitted in emergency department with life-threatening condition of small bowel obstruction secondary to strangulated intrapericardial diaphragmatic hernia. He was resuscitated in Surgical Assessment Unit and underwent emergency laparotomy involving bowel resection and repair of diaphragmatic hernia.