Persistent left superior vena cava is a rare congenital anomaly, occurring in 0.3% to 0.5% of general population and up to 10% in patients with congenital heart disease. This anomaly is usually discovered incidentally during central venous catheterization from left side. Since 2015, we have identified eight cases of persistent left superior vena cava out of a total of 2637 patients who had left sided venous port insertion in our department. The persistent left superior vena cavae were identified with the aid of intracavitary electrocardiogram. The characteristic finding was an initial negative P-wave (in lead II), followed by a biphasic P-wave pattern during catheter insertion. All the ports worked properly, with a total catheter dwelling time of 2586 days (range: 96–756 days, mean: 323.25 days), and no catheter-related complication was observed. However, because of the paucity of clinical evidence, we should still be prudent in the long-term use of venous ports in persistent left superior vena cava.
Colorectal cancer is the third most common cancer in the world and its incidence is on the rise. Dietary intervention has emerged as an attractive strategy to curtail its occurrence and progression. Diet is known to influence the gut microbiome, as dietary factors and gut bacteria can act in concert to cause or protect from colorectal cancer. Several studies have presented evidence for such interactions and have pointed out the different ways by which the diet and gut microbiome can be altered to produce beneficial effects. This review article aims to summarize the interrelationship between diet, gut flora and colorectal cancer so that a better preventive approach can be applied.
Histopathology A skin biopsy is usually done for any atypical, severe, persistent, recurrent or poorly tolerated rash following ICI treatment [1]. Histopathological examinations of skin biopsies from many patients have shown the presence of perivascular lymphocytic infiltrates going deep into the dermis, patchy necrotic keratinocytes, and few to a large number of eosinophils [1] with CD4 + and CD8 + T cells in close proximity to melanocytes [4,5]. Other characteristic histopathologic aspects can be similar to those seen in patients with psoriasis, Grover's disease, bullous pemphigoid, and granulomatous sarcoidlike dermatitis. Less commonly, a lichenoid reaction can be seen, and this is particularly common with anti-PD-1/PD-L1 agents [1]. Some patients may have vitiligo like lesions, but these lesions have a different pathophysiological mechanism, as reported by Larsabal M et al. They recently reported that the vitiligo-like lesions that develop as adverse effects of ICI differ histologically, particularly with regard to the presence ofskin infiltration by CD8 + T-cells expressing C-X-C motif receptor 3, which is not seen in true vitiligo [6].
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