Journal of the College of Physicians and Surgeons--Pakistan : JCPSP
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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
Case ReportsBenign Broncho-esophageal Fistula Presenting as Unresolved Pneumonia.
Benign acquired broncho-esophageal fistula (BEF) in adults is a very rare entity and has not been reported properly in the literature, compared to malignant BEF. Nonetheless, infection has predisposed most of the reported benign acquired BEF cases. ⋯ Upper gastrointestinal (GI) endoscopy showed BEF due to tuberculous mediastinal lymphadenopathy, and the patient was managed by surgery successfully. He was prepared for surgery for one month by nutritional support and anti-tuberculous treatment.
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J Coll Physicians Surg Pak · Dec 2019
Case ReportsPrimary Intra-Osseous Basaloid Squamous Cell Carcinoma of Mandible: Report of Rare Case with Proposed Diagnostic Criteria.
Basaloid squamous cell carcinoma (BSCC) is a distinctive variant of squamous cell carcinoma (SCC) characterised by nests of basaloid cells. BSCC is an aggressive and rare tumor of head and neck region; and is relatively rare in oral cavity in comparison to SCC. Although, infrequent, but primary intra-osseous SCC (PIOSCC) has been reported in the jaws. ⋯ As per the best of our knowledge, this is the first case of PIOBSCC of the jaw. There is no diagnostic criterion of PIOBSCC in the literature owing to the extreme rarity of this tumor. A diagnostic criterion is proposed here to make the diagnosis of this tumor easier.
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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 ReportsImprovement of Esophageal Anastomotic Leak by Vacuum-assisted Closure in Three Cases with Gastric Cancer.
This case report presents three consecutive patients who developed esophageal anastomotic leak after gastric cancer surgery and were treated by the two-way vacuum-assisted closure with open abdomen technique in addition to endoscopic stent application (ESA). Esophageal anastomotic leak follow-up was performed by fluoroscopic fistulography. Total parenteral nutrition was given until cessation of leak. ⋯ In case of the improvement of the esophageal anastomotic leak detected by fluoroscopy, the two-way vacuum-assisted closure application was terminated. The subcutaneous layer was bilaterally dissected from the fascial layer of the anterior wall of the abdomen, and the abdominal skin was closed without tension. The combination of ESA and the two-way vacuum-assisted closure technique should be suggested in case of severe abdominal sepsis in patients with an esophageal anastomotic leak.