Journal of the College of Physicians and Surgeons--Pakistan : JCPSP
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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.
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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.
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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 ReportsTumour-to-tumour Metastasis: Cutaneous Melanoma Metastasizing to Leiomyoma Uteri.
The incidence of melanoma is increasing worldwide. It is known that melanoma frequently progresses to metastatic disease. The aim of this report is to emphasise the metastatic potential of cutaneous melanoma to various body areas, as well as the ability to produce unexpected presentation of the disease. ⋯ The metastasis to uterine leiomyoma was the first site of distant spread. Melanoma is a type of tumour with aggressive and unpredictable behaviour, so metastases to unexpected localisations could occur. A careful examination of patient's body is mandatory, including the remote areas and even benign tumours.
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J Coll Physicians Surg Pak · Dec 2019
Case ReportsA Case of Polyautoimmunity: Celiac Hepatitis, Grave's Disease and Autoimmune Hemolytic Anemia.
Celiac disease (CD) is an autoimmune disorder with high incidence of multi organ involvement; especially, gastrointestinal manifestations and an increased risk of malignancies. Here we report a case of CD with celiac hepatitis, autoimmune hemolytic anemia (AIHA) and Grave's disease (GD) with their complications. Polyautoimmunity requires comprehensive analysis. ⋯ All three diseases were treated afresh with strict adherence to a gluten-free diet (GFD) and carbimazole along with addition of medications for cirrhosis complicated by ascites. This was a rare case where non-adherence to a GFD led to such severe adverse events. A case of celiac hepatitis presenting with such a wide array of signs and symptoms has rarely been reported in the literature and the management of this patient was unique and challenging.