Journal of the College of Physicians and Surgeons--Pakistan : JCPSP
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J Coll Physicians Surg Pak · Dec 2019
Case ReportsSelf-expanding Metallic Stent Placement in Malignant Terminal Ileal Stricture.
Malignancies of gastro-intestinal tract cause stricture formation that leads to intestinal obstruction. In such cases, either surgery or placement of self-expanding metallic stents (SEMS) are options of palliation. For left sided colorectal obstruction, SEMS have been widely used and reported. ⋯ SEMS placement, particularly in the ileocecal region, is technically difficult. Few studies on SEMS deployment in right sided colon have been reported till now. We report a case of metastatic signet ring cell carcinoma of rectosigmoid junction with malignant terminal ileal stricture palliation done with placement of SEMS.
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J Coll Physicians Surg Pak · Dec 2019
Case ReportsAcute Viral Hepatitis: Simultaneous Infection from Hepatitis A, B and E Viruses.
Acute viral hepatitis is a significant health problem in the developing world. Usually, the disease runs a benign course with complete resolution of signs and symptoms within days to weeks. ⋯ Here, we report a unique case of acute hepatitis caused by simultaneous infection from Hepatitis A Virus (HAV), Hepatitis B Virus (HBV) and Hepatitis E Virus (HEV). This case is rare as all work-ups for probable causes of acute hepatitis were negative; and the review of the literature showed that such a case had not been previously reported.
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J Coll Physicians Surg Pak · Dec 2019
Case ReportsA Patient of Advanced NSCLC with a New EGFR Exon 19 Insertion Mutation and its Response to EGFR-TKIs.
Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) are the standard therapy for patients with advanced non-small-cell lung cancer (NSCLC) harbouring common EGFR mutations. However, about 10% of EGFR mutations are uncommon mutations and their response to EGFR-TKIs remains unclear. ⋯ In conclusion, patients harbouring new subtype of EGFR exon 19 insertion mutations, IPVAIL insertion may have a poor prognosis. Further experiences are required to characterise these uncommon mutations.
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J Coll Physicians Surg Pak · Dec 2019
A Simple Bed-side Method of Enteral Feeding through Distal Mucous Fistula in Patients with Short Bowel Syndrome to overcome Parenteral Dependency: The Jategaonkar Technique.
Today, massive proximal small bowel resection with diverting stoma formation is a relatively common occurrence, especially in an emergency setting. However, the resultant short bowel syndrome remains difficult to manage on various nutritional fronts and commencing total parenteral nutrition, along with plethora of its associated complications, becomes almost obligatory for these unfortunate patients. ⋯ Backed with successful experience of 18 cases, it is especially useful in low-income countries and can be mastered readily even by junior doctors, paramedic staff, and stoma therapists or by patient's kin, alike. Such a procedure is yet to be reported in the available literature.
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J Coll Physicians Surg Pak · Dec 2019
Case ReportsHigh Grade Encapsulated Papillary Carcinoma of Breast in a Young Female.
Encapsulated papillary carcinoma (EPC) is a special type of papillary breast lesion known to be of low and intermediate grade. But recent data suggests existence of such tumors with high nuclear grade and mitotic index rendering them aggressive with chances of recurrence and lymph node metastasis which may alter the management of this tumor. ⋯ The subsequent radiologic findings showed a solid mass with cystic component and the patient underwent wide local excision along with excision of lymph nodes. Microscopy revealed a high-grade encapsulated tumor with papillary features; and a diagnosis of high grade encapsulated papillary carcinoma was given.