Primary renal angiosarcoma is an exceedingly rare and aggressive neoplasm. Although it may occur in youth, this tumour is frequently reported in the sixth and seventh decades of life. The clinical presentation is frequently varied. Pathogenesis remains largely unknown and it has overlapping features with other tumours of the kidney. Current treatment options include variable combinations of surgery, chemotherapy and radiotherapy. Reports regarding the disease prognosis and natural history are limited. In this article, we chronicle the case of a patient with primary renal angiosarcoma presenting at an advanced stage as a widely metastasised tumour. Additionally, we undertake here a brief literature review highlighting the rarity and aggressiveness of this condition, its poor prognosis, and the lack of specific management guidelines.

Foreign body ingestion is commonly encountered in clinical practice. According to standard guidelines, urgent therapeutic endoscopy should be performed in cases involving sharp objects to prevent complications. Although several extraction methods are available, few cases may still pose a therapeutic challenge. This report describes a novel endoscopic technique utilizing modification of the standard overtube to facilitate the removal of a large razor blade. This technique offers a minimally invasive approach for rapid retrieval of large sharp-edged foreign bodies, obviating the need for a surgical exploration. Additionally, this article compares various imaging modalities for prompt detection of gastrointestinal foreign bodies to avoid unnecessary delays in endoscopic intervention.

Primary gastrointestinal lymphoma is a rare neoplasm that accounts for less than 5% of all gastrointestinal malignancies. We present a case of a 37-year-old woman positive for human immunodeficiency virus who presented with abdominal pain and vomiting for three months. She underwent endoscopic biopsy and was found to have high-grade diffuse large B-cell lymphoma in the jejunum. This report discusses her treatments and includes a brief literature review highlighting the rarity of this entity, the etiological agents implicated in its pathogenesis, and the lack of specific guidelines for treatment.

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BackgroundCMS requires participating long-term care facilities (LTCF) to have an antibiotic stewardship program (ASP). Common barriers encountered by LTCF include lack of antibiotic use (AU) data and inability to benchmark use. We initiated a project that utilized a long-term care pharmacy (LTCPh) database to obtain and compare AU data across enrolled LTCF.MethodsWe partnered with a regional LTCPh that dispenses and reviews medications for 40 LTCF, of which 32 agreed to participate. Prescriptions filled by the pharmacy were used to calculate antibiotic (AB) starts and days of therapy (DOT). Start and end dates were used to calculate DOT, if available. For those without an end date (<10%), duration was obtained by manual review of administration records. Bed-size and proportion of short-stay (Medicare-A) beds were estimated for each LTCF based on a cross-sectional evaluation of billing records at the LTCPh. Baseline resident-days (RD) during 2017 were obtained from each LTCF. The influence of short-stay residents on AB start rates and DOT was evaluated by grouping LTCF in three cohorts based on estimated proportion of short-stay residents.ResultsData from 29 (90.6%) LTCF were included in the final analysis; 3 were excluded due to lack of RD data. Median bed-size was 57 (range 17–253). Overall, 13.9% of LTCF residents were in the short-stay category. Fifteen LTCF were estimated to have 5% to 20% of RD attributable to short-stay residents, six had <5% while eight had >20%. Antibiotic starts/1000 RD varied from 3.84 to 19.38 and DOT/1000 RD from 34.86 to 252.09, and showed strong correlation (Figure 1). The proportion of short-stay beds correlates better with AB starts/1,000 RD than DOT/1,000 RD (Figure 2). LTCF cohort with >20% short-stay residents had higher mean AB starts/1000 RD compared with LTCF with 5%-20% and <5% short-stay residents (13.08, 9.78, 7.45, respectively; P < 0.05 by one-way ANOVA). However, a similar trend was not noted for DOT/1000 RD (179.30, 128.29, 128.12, respectively; P = 0.12). ConclusionLTCPh can play an important role in supporting ASP in LTCF by providing AU data for benchmarking. Antibiotic use in LTCF is highly variable and may be influenced by the proportion of beds dedicated to short-stay residents amongst other factors.Disclosures S. Bergman, Merck: Grant Investigator, Grant recipient. T. Vanschooneveld, Merck: Grant Investigator, Grant recipient. M. S. Ashraf, Merck & Co. Inc.: Grant Investigator, Research grant.

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