Actinomycosis is a rare disorder caused by an anaerobic gram-positive bacillus (Actinomyces), predominantly by the Actinomyces israelii species. Only 20% of cases show an abdominal manifestation, the appendix and ileocecal valve being the most frequent locations. Definitive diagnosis is based on microbiological cultures, microscopy or macroscopy examination. Nevertheless, histological examination of the percutaneous biopsy and blood microbiological cultures are rarely positives. Preoperative diagnosis is hampered by the lack of specific clinical and imaging manifestations, which often mimic malignancy. The rate of preoperative diagnosis is less than 10%, however, the outcome is excellent, with a low mortality rate. The authors describe the case of a patient who was diagnosed with primary hepatic actinomycosis only by a histological examination of the surgical specimen of left hepatectomy extended to segments V and VIII, for suspected malignant lesion. This case demonstrates the difficulties in diagnosing hepatic actinomycosis.
e235 otics, Piperacillin/Tazobactam was most commonly used (23 cases, 33.8%) and Cefepime was next. (20 cases, 29.4%). Successful response to initial antibiotics was 5 cases (72.4%) in MDI, 30 cases (85.7%) in CDI, and 24 cases (92.3%) in UF. Mortality rate was 4.4% and all death was related to infection. Conclusion: There were no evident differences of clinical features between the 1st period and the 2nd period. But we found two specific clinical features. The rate of successful response to initial antibiotics was the highest in UF (92.3%). It means that we need to change or add the empirical antibiotics if we could guess the site of infection rather than use the recommended antibiotics in 2002 IDSA guidelines. And extremely high portion of gram-positive bacteria (85.7%) were isolated compared with other clinics in Korea. We think it might be an unique clinical feature in Jeju island. In the future, empirical antibiotics that cover the grampositive bacteria for NF may need to be routinely used in Jeju island.
BackgroundRegorafenib and trifluridine/tipiracil (TAS-102) are indicated in metastatic colorectal cancer (mCRC) refractary to standard therapies. Both have been approved after being compared to placebo, so comparative studies with other therapies are needed.PurposeTo compare effectiveness and safety of regorafenib and TAS-102 in patients with advanced mCRC in real clinical practice.Material and methodsA retrospective observational study including all patients with mCRC who started treatment with regorafenib or TAS-102 between February 2013 and May 2017 was carried out.The following variables were collected: sex, KRAS-mutation, age and Eastern Cooperative Oncology Group scale (ECOG) at the beginning of treatment and previous lines. Qualitative and quantitative variables between groups were compared using chi2 and t-student tests, respectively.Median progression-free survival (PFS) and overall survival (OS) were recorded to evaluate effectiveness. Differences in survival were evaluated with the logrank test.Adverse effects (AEs) classified according to the Common Toxicity Criteria v4.0 and dose reductions were recorded to measure safety.Statistical analysis was carried out using Stata® 14.ResultsThroughout the period of the study 31 patients (41% males, median age 60.7 years, 77% ECOG 1, median previous lines 3.3) started treatment with regorafenib or TAS-102 (10 and 21, respectively). Both groups were comparable in the variables above described.The median PFS and OS in the regorafenib group were 1.77 (0.13–4.36) and 7 (0.03–13.97) months, while in the TAS-102 group these were 2.07 (1.38–3.15) and 7 (5.09–8.91) months. Differences in PFS (p=0.483) and OS (p=0.850) were not statistically significant.The median number of AEs per patient was 4.70 and 2.71 with regorafenib and TAS-102, respectively. Most of them were grade (G) 1–2. The most frequent AEs related to regorafenib were asthaenia (70%, n=7), diarrhoea, hand-foot syndrome, mucositis and hyporexia (30%, n=3), whereas the most common AEs with TAS-102 were asthaenia (42%, n=9), neutropaenia (38%, n=8) and nausea (33%, n=7). Dose reductions were necessary in three patients treated with regorafenib due to infections and asthaenia G3 and in four patients with TAS-102 due to neutropenia G2 (n=2), G3 (n=1) and G4 (n=1).ConclusionIn our study, regorafenib and TAS-102 have similar, modest effectiveness. Differences in toxicity may be decisive in the choice of either treatment.No conflict of interest
RESUMOIntrodução: A metastização para a glândula tiroideia de um carcinoma renal de células claras é rara e só diagnosticável após análise imunohistoquímica de uma amostra histológica. O objetivo deste artigo é reportar um caso de metastização tiroideia como primeira manifestação de um carcinoma renal de células claras. Caso Clínico: Doente do sexo masculino com um nódulo sólido no lobo esquerdo da tiróide, com 5,3 cm, suspeito de malignidade, submetido a tiroidectomia total com linfadenectomia do compartimento central. A análise histológica concluiu serem duas metástases de carcinoma renal de células claras. Após estudo dirigido ao rim, o doente foi submetido a nefrectomia radical quatro meses depois. Discussão: O interesse deste caso reside no facto de a metastização para a tiroide como primeira manifestação de carcinoma renal de células claras ser rara mas, se tratada precocemente, permite uma 'dupla resseção cirúrgica' que pode levar a sobrevidas aos cinco anos de 80%. Palavras-chave: Carcinoma de Células Renais; Metástase Neoplásica; Neoplasias da Tiróide/secundária. ABSTRACT Introduction:Clear cell renal carcinoma metastases to the thyroid gland are rare and only diagnosable after an immunohistochemistry analysis of the histological sample. The purpose of this article is to report a case of thyroid metastasis as the initial presentation of a clear cell renal carcinoma. Case Report: Male patient with a solid nodule in the left lobe of the thyroid, 5.3 cm in diameter, suspicious of malignancy, for which a total thyroidectomy with central compartment lymphadenectomy was performed. Histology revealed two clear cell renal carcinoma metastases. After evaluation of the kidney, the patient underwent radical nephrectomy four months later. Discussion: What makes this case interesting is that thyroid metastases as the initial presentation of renal cell carcinoma are rare, but if treated early, a 'double surgical resection' is possible, leading to a 5 year survival rate of 80%. Keywords: Carcinoma, Renal Cell; Neoplasm Metastasis; Thyroid Neoplasms/secondary. INTRODUÇÃOA metastização para a glândula tiroideia é rara e está mais frequentemente associada aos tumores primários do pulmão, mama e rim.1 Em 10 anos de análise retrospetiva, Giampaolo Papi et al referem apenas 36 casos de metás-tases tiroideias 1 e a literatura refere que elas representam apenas 2% -3% de todas as neoplasias malignas da tirói-de.2 Em autópsias foi descrita uma incidência de aproximadamente 1,9% -24,2%. 3A baixa incidência de metastização para a tiróide deve--se provavelmente ao seu abundante fluxo sanguíneo e à elevada concentração de oxigénio e de iodo no seu parên-quima. 4 As glândulas afetadas por tiroidite, bócio ou neoplasias primárias da tiroide são mais suscetíveis à metastização do que as tiroides saudáveis. 2Quando existe uma história prévia de neoplasia renal e quando a análise imunohistoquímica é negativa para tiroglobulina, TTF-1 e calcitonina mas positiva para vimentina e CD10, devemos pensar na hipótese diagnóstica de nódu-lo met...
A doença de Darier é uma dermatose autossómica dominante causada por uma mutação do gene ATP2A2. Existem várias variantes clínicas menos frequentes nomeadamente as formas de doença de Darier hipertrófica, vesiculobolhosa, hipopigmentada e a variante comedónica. Apresentamos o caso de um homem saudável de 28 anos de idade, com mais de cem pápulas hiperqueratosicas pruriginosas, simulando comedões abertos, localizadas ao dorso e flancos. O exame histológico mostrou o infundibulo folicular dilatado, contendo rolhões queratina, acantólise suprabasal e células disceratósicas sendo compatível com a doença Darier do tipo comedónica. Existem menos de 10 casos publicados desta variante clínica e histológica.
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