Receptor status in recurrent breast cancer-a retrospective study

MBBCh Department of Surgery University of the Witwatersrand 08 March 2017Background: Breast cancer recurrence is a major clinical event and represents a principal cause of breast cancer related death. A discordance rate between receptor status of primary and matched recurrence tumours has been reported in the literature but the extent of this in our population is unknown. Repeating Immuno-histochemistry (IHC) and fluorescent in-situ hybridization (FISH) studies have financial and workforce implications in a resource-constrained environment. However, the results of these receptor studies have prognostic implications. Therefore it is important to determine the extent of change in receptors in the recurrence. Aim: To compare the hormone receptor profile between breast cancer primary and matched loco-regional recurrence and to ascertain the extent of receptor discordance. Methods: All patients who presented to the respective breast care facilities for breast cancer recurrences between 2006 and 2014 were identified using the mammography department records. The specimens for each patient were scrutinized. Oestrogen receptor (ER) and progesterone receptor (PgR) status as well as the Human Epidermal growth factor type 2 receptor (HER2) receptor statuses were noted for each patient and a comparison was made between primary and matching recurrence, with loss and gain being noted. Results: In the analysis, significant discordance was found for matching hormone receptor status. Discordance in oestrogen receptor status occurred in 14.3% of cases: change occurred both from ER-positive to -negative and vice versa. For progesterone receptor status this occurred in 25.7% of cases. A discordance of 14.8% was noted for HER2 receptor status. These results are not dissimilar to what has been previously reported in the literature. Of note, adverse receptor discordance: positive to negative was noted in a total of 19 receptors (ER 4; PgR 11; HER2 4) Conclusion: These results confirm the phenomenon of receptor discordance between breast cancer primary and recurrence. The results support the necessity of confirming receptor status on all loco-regional recurrent disease. This reinforces the importance of obtaining a confirmatory biopsy in patients where recurrence is suspected and therefore allowing the appropriate targeted therapy to be selected.MT201

Gall bladder schistosomiasis diagnosed incidentally post laparoscopic cholecystectomy: A case report

Introduction and importance: Schistosomiasis is a neglected tropical disease caused by parasitic worms of the genus Schistosoma. It primarily affects the intestines, liver, and urinary tract however, rare cases have been reported where the parasite invades other organs. This case report presents an incidental finding of schistosomiasis, upon histopathology evaluation, in a patient who underwent laparoscopic cholecystectomy for symptomatic gallstone disease with recurrent attacks of cholecystitis. Case presentation: We present the case of a 42-year-old female patient who presented to the emergency department with symptoms and signs suggestive of acute cholecystitis. She underwent conservative management with interval laparoscopic cholecystectomy with histopathology findings of Schistosoma eggs within the walls of the gallbladder. Underwent eradication therapy with praziquantel. Clinical discussion: The finding of Schistosoma eggs in the gallbladder wall during routine histopathological examination highlights the importance of considering schistosomiasis, and other parasites, in cases of recurrent bouts of cholecystitis. The case challenges the conventional understanding of the transmission patterns of this parasitic infection and raises questions about potential atypical life cycle routes within the human body. It also emphasizes the importance of routine histopathology analysis of specimen removed from the body. Conclusion: This case report presents a rare occurrence of schistosomiasis cholecystitis in a 42-year-old female patient underscoring the importance of considering parasitic infections. Thorough histopathological examination in routine surgeries is crucial for early detection and targeted treatment. The patient\u27s positive response to praziquantel therapy highlights its effectiveness in managing schistosomiasis, which is a neglected tropical disease

Incidental actinomycosis in a 44-year-old female during total abdominal hysterectomy for abnormal uterine bleeding: A case report

Actinomycosis, a rare chronic bacterial infection caused by Actinomyces species, presents diagnostic challenges due to diverse clinical presentations. This report presents a case of peritoneal actinomycosis incidentally discovered during a total abdominal hysterectomy in a 44-year-old female with refractory abnormal uterine bleeding and a history of long-term intrauterine contraceptive device use. The patient presented with persistent abnormal uterine bleeding despite conservative management. Intraoperative findings during total abdominal hysterectomy revealed peritoneal involvement, prompting histopathological evaluation confirming actinomycosis. This case highlights diagnostic complexities associated with actinomycosis, emphasizing the significance of histopathological confirmation. Postoperative management with antibiotics demonstrated favorable outcomes, supporting their efficacy in treating actinomycosis. The case underscores the importance of considering uncommon infections in pelvic pathology, particularly in patients with prolonged intrauterine contraceptive device usage. It prompts further exploration of actinomycosis in relation to intrauterine contraceptive device use and highlights the need for timely intervention and histopathological confirmation for optimal patient care

Shortness of breath in a young lady, rare case report of thoracic endometriosis

Introduction and importance: Endometrial glandular tissue can implant in the thorax of women suffering from endometriosis. The clinical presentation is depends on site of implantation. Complications include pneumothorax, pneumohemothorax or hemothorax. Case presentation: A 31 year old woman with history of infertility presented with shortness of breath and was found to have a significant right sided pneumohemothorax. Drainage was done followed by chemical pleurodesis using bleomycin with resolution of symptoms on her follow up. Clinical discussion: Thoracic endometriosis tend to present with chronic or sub-acute symptoms which are nonspecific symptoms leading to late diagnosis. Video Assisted Thoracoscopic surgery offer both diagnostic and therapeutic in thoracic endometriosis. However in limited settings chemical pleurodesis can be carried out done to prevent recurrence of shortness of breath due to thoracic endometriosis. Conclusion: Therefore, clinical suspicion of thoracic endometriosis in evaluation of shortness of breath in a young lady with history of infertility or pelvic surgery is indispensable

Postoperative myocardial injury in a patient with left ureteric stone and asymptomatic COVID-19 disease

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It was first identified on 8thDecember 2019 in Wuhan, Hubei, China, and has since spread globally to become an emergency of international concern. Patients infected with SARS-CoV-2 may be asymptomatic or present with symptoms ranging from mild clinical manifestations: such as fever, cough, and sore throat to moderate and severe form of the disease such as pneumonia and acute respiratory distress syndrome (ARDS). In some patients, SARS-CoV-2 can affect the heart and cause myocardial injury which is evidenced either by electrocardiographic (ECG) changes or by a rise in serum troponin level. Patients with myocardial involvement are generally at risk of developing severe illness and tend to have a poor outcome. We hereby present a case of a hypertensive male patient with undiagnosed, asymptomatic COVID-19, who underwent an emergency urologic procedure for ureteric calculi. He eventually sustained a postoperative myocardial injury resulting in his demise. This case highlights the importance of detailed preoperative assessment and anticipation of complications during this global pandemic

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Pregnancy following robot-assisted laparoscopic bilateral endometriotic cystectomy rare case report of endometriosis stage IV

Introduction and importance: Endometriosis is a common cause of infertility in women. In this case report we explain successful conception in deep-infiltrating ovarian endometriosis following robot-assisted surgery and androgenic agonist treatment. Case presentation: A 38-year-old current Para 2, Living 2 presented 8 years ago with chronic lower abdominal pain, dysmenorrhea, and delayed conception. Advance endometriosis was highly suspected from the history and examination. Robot-assisted laparoscopic partial cystectomy was performed for the deep-infiltrating ovarian endometriosis. She was then discharged with postoperative androgenic agonists and with timed intercourse, she got pregnant within 9 months. Clinical discussion: Advanced endometriosis (Stage III or IV disease) is associated with distorted pelvic anatomy and adhesions. These changes can impair oocyte release or pick-up, alter sperm motility, cause disordered myometrial contractions, and impair fertilization and embryo transport. Successful rate of conception in advanced endometriosis is \u3c20 %, with minimal chances of successful conception, however, our patient conceived. Conclusion: Endometriosis should be considered in evaluation of reproductive woman with chronic lower abdominal pain, history of infertility and dysmenorrhea. Prompt management is crucial, and in a setting of advanced technology, robotic laparoscopic surgery is the best to diagnosis and treat advanced endometriosis

Dorsal pancreas agenesis, an incidental finding during acute appendicitis diagnosis; A case report

Introduction and importance: Dorsal pancreas agenesis is a rare congenital anomaly characterized by the absence or severe underdevelopment of the dorsal pancreatic bud. We report a case of a man who presented with features of appendicitis only to the incidentally discovery of dorsal pancreas agenesis during the diagnosis of acute appendicitis. We describe our experience on radiological diagnostic formulation and work up. Case presentation: We present the case of a 45-year-old male patient who presented to the emergency department with symptoms and signs suggestive of acute appendicitis. A computed tomography scan and laboratory investigations confirmed the diagnosis of appendicitis. Incidentally, the scan also revealed the absence of dorsal pancreatic tissue, leading to the incidental diagnosis of dorsal pancreas agenesis. Clinical discussion: Dorsal pancreas agenesis is often asymptomatic and can be incidentally discovered during imaging studies or surgical interventions for unrelated conditions. In our case, the initial presentation of acute appendicitis provided an opportunity for the fortuitous diagnosis of dorsal pancreas agenesis. This emphasizes the importance of comprehensive imaging reporting in patients who undergo imaging for other conditions. Conclusion: This case report highlights the fortuitous discovery of dorsal pancreas agenesis during the diagnostic workup for acute appendicitis. It emphasizes the need for thorough imaging evaluation and reporting along with the importance of considering anatomical variations in patients presenting with abdominal symptoms. Increased awareness among healthcare professionals about such congenital anomalies can lead to their early recognition and appropriate management

Case report: postoperative myocardial injury in a patient with left ureteric stone and asymptomatic COVID-19 disease

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It was first identified on 8th December 2019 in Wuhan, Hubei, China, and has since spread globally to become an emergency of international concern. Patients infected with SARS-CoV-2 may be asymptomatic or present with symptoms ranging from mild clinical manifestations: such as fever, cough, and sore throat to moderate and severe form of the disease such as pneumonia and acute respiratory distress syndrome (ARDS). In some patients, SARS-CoV-2 can affect the heart and cause myocardial injury which is evidenced either by electrocardiographic (ECG) changes or by a rise in serum troponin level. Patients with myocardial involvement are generally at risk of developing severe illness and tend to have a poor outcome. We hereby present a case of a hypertensive male patient with undiagnosed, asymptomatic COVID-19, who underwent an emergency urologic procedure for ureteric calculi. He eventually sustained a postoperative myocardial injury resulting in his demise. This case highlights the importance of detailed preoperative assessment and anticipation of complications during this global pandemic

Outcomes of Surgical Tracheostomy on Mechanically Ventilated COVID-19 Patients Admitted to a Private Tertiary Hospital in Tanzania

Objectives: The coronavirus disease 2019 (COVID-19) pandemic has resulted in an increase in the number of patients necessitating prolonged mechanical ventilation. Data on patients with COVID-19 undergoing tracheostomy indicating timing and outcomes are very limited. Our study illustrates outcomes for surgical tracheotomies performed on COVID-19 patients in Tanzania. Methods: This was a retrospective observational study conducted at the Aga Khan Hospital in Dar es Salaam, Tanzania. Results: Nineteen patients with COVID-19 underwent surgical tracheotomy between 16 th March and 31st December 2021. All surgical tracheostomies were performed in the operating theatre. The average duration of intubation prior to tracheotomy and tracheostomy to ventilator liberation was 16 days and 27 days respectively. Only five patients were successfully liberated from the ventilator, decannulated, and discharged successfully. Conclusions: This is the first and largest study describing tracheotomy outcomes in COVID-19 patients in Tanzania. Our results revealed a high mortality rate. Multicenter studies in the private and public sectors are needed in Tanzania to determine optimal timing, identification of patients, and risk factors predictive of improved outcome