Aggressive recurrent urachal adenocarcinoma: A case report and review of the literature

Recurrent urachal adenocarcinomas are rare. It is commonly associated with poor prognosis. A 51-year-old woman underwent a partial cystectomy for urachal cancer in 2014. She was well throughout follow-up with annual cystoscopies. She presented with a 1-month history of rapidly progressive suprapubic mass and hematuria. A contrasted computed tomography scan of the thorax, abdomen and pelvis showed a large mixed solid cystic tumour at the right lumbar region, suprapubic area and also at the pouch of Douglas. She refused surgical extirpation and now on chemotherapy. Urachal adenocarcinoma is rare, and resection is commonly advocated; usually, no standard adjuvant therapy is advocated. Recurrent cancers represent a management dilemma, and no standard follow-up protocols exist

Sternal Leiomyosarcoma: Primary or Secondary

Primary leiomyosarcoma of bone is an extremely rare, aggressive and a diagnostically challenging tumor which occurs mainly in the long bones. Clinically and radiographically, it can mimic other malignancy and its diagnosis is based on histopathology, immunochemistry and electron microscopy findings. It can be perplexing to ascertain whether a biopsy confirmed leiomyosarcoma of bone is primary or secondary in origin. Most of the cases are predominantly secondary from a distant metastasis. The case presented here is an illustration and analysis of this diagnostic problem

The global burden of adolescent and young adult cancer in 2019 : a systematic analysis for the Global Burden of Disease Study 2019

Background In estimating the global burden of cancer, adolescents and young adults with cancer are often overlooked, despite being a distinct subgroup with unique epidemiology, clinical care needs, and societal impact. Comprehensive estimates of the global cancer burden in adolescents and young adults (aged 15-39 years) are lacking. To address this gap, we analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, with a focus on the outcome of disability-adjusted life-years (DALYs), to inform global cancer control measures in adolescents and young adults. Methods Using the GBD 2019 methodology, international mortality data were collected from vital registration systems, verbal autopsies, and population-based cancer registry inputs modelled with mortality-to-incidence ratios (MIRs). Incidence was computed with mortality estimates and corresponding MIRs. Prevalence estimates were calculated using modelled survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated as age-specific cancer deaths multiplied by the standard life expectancy at the age of death. The main outcome was DALYs (the sum of YLLs and YLDs). Estimates were presented globally and by Socio-demographic Index (SDI) quintiles (countries ranked and divided into five equal SDI groups), and all estimates were presented with corresponding 95% uncertainty intervals (UIs). For this analysis, we used the age range of 15-39 years to define adolescents and young adults. Findings There were 1.19 million (95% UI 1.11-1.28) incident cancer cases and 396 000 (370 000-425 000) deaths due to cancer among people aged 15-39 years worldwide in 2019. The highest age-standardised incidence rates occurred in high SDI (59.6 [54.5-65.7] per 100 000 person-years) and high-middle SDI countries (53.2 [48.8-57.9] per 100 000 person-years), while the highest age-standardised mortality rates were in low-middle SDI (14.2 [12.9-15.6] per 100 000 person-years) and middle SDI (13.6 [12.6-14.8] per 100 000 person-years) countries. In 2019, adolescent and young adult cancers contributed 23.5 million (21.9-25.2) DALYs to the global burden of disease, of which 2.7% (1.9-3.6) came from YLDs and 97.3% (96.4-98.1) from YLLs. Cancer was the fourth leading cause of death and tenth leading cause of DALYs in adolescents and young adults globally. Interpretation Adolescent and young adult cancers contributed substantially to the overall adolescent and young adult disease burden globally in 2019. These results provide new insights into the distribution and magnitude of the adolescent and young adult cancer burden around the world. With notable differences observed across SDI settings, these estimates can inform global and country-level cancer control efforts. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Ortner’s Syndrome: Aortic Aneurysm as a Cause of Unilateral Vocal Cord Paralysis

Hoarseness is a symptom of Ortner’s syndrome, a rare disorder caused by mechanical left recurrent laryngeal nerve compression by enlarged cardiovascular structures. This is a case of Ortner’s syndrome in an elderly 74-year-old male with an aortic arch aneurysm presenting with hoarseness. We believe the aneurysm causes the left recurrent laryngeal nerve compression, resulting in unilateral vocal cord paralysis. We emphasise the significance of Ortner’s syndrome as hoarseness of voice, a significant differential diagnosis in an elderly patient despite the absence of cardiac symptoms

Isolated Intrasellar Pituitary Mucocele

Mucous cyst or mucocele are epithelial lined cavities containing mucous that occurs mainly in the frontal and ethmoid sinuses. Intracranial mucocele is a rare occurrence. We are presenting an interesting case of a young lady, presented with fainting spells, syncopal attack, recurrent frontal headache and blurring of vision for at least 2 months prior to presentation to us. CT scan showed shows a hyperdense mass arising from the tuberculum sellae with no foci of calcification within and no erosion of the adjacent bony structures. The intrasellar mucocele was diagnosed following surgery via trans-sphenoidal approach and biopsy with confirmatory histopathology

Malignant Melanoma of Oesophagus: A Rare Entity

We are discussing a case of malignant melanoma of esophagus, initially presented to us with very atypical presentation. On further history, patient claim having dysphagia for few months, initially to solid then followed by liquid, progressively worsening over few months. On further examination, OGDS reveal pedunculated growth at 30cm and 32 cm with skip free intact mucosa in between. Subsequently, we optimize his nutritional status and performed open tranhiatal total esophagectomy with cervical anastomosis and feeding jejunostomy. Post-operative recovery was uneventful, and patient was well upon discharge. Histopathology of the specimen revealed malignant melanoma of the esophagus. On subsequent follow up. PET scan was also done and shows stable disease with no evidence of tumor recurrence

A peculiar case of intususception in a pregnant woman: A diagnostic challenge

Adult intussusception presents a diagnostic challenge given its non-specific symptoms. It is not as common as in infants and young children. Traditionally, diagnostic steps are invariably fit for normal adults, but not in pregnancy which faces certain limitations. A 40-year-old pregnant mother, gravida 9 para 8 at 34-week gestation, complained of intermittent epigastric pain for 2 days, requiring hospitalization. She soon developed minimal per rectal bleeding that was ruled out as hemorrhoid. Imaging was limited due to her pregnancy status. She later developed spontaneous delivery to a premature baby. Computed tomography (CT) revealed an ileocolic intussusception, which was confirmed via exploratory laparotomy. Histology was consistent with inflammatory fibroid polyp. Acute abdomen in pregnancy can be due to various causes, thus a high index of suspicion and early CT abdomen might help in early diagnosis and treatment. The benefit of doing CT on the mother and the risk of CT on the fetus is to be weighed as the timely diagnosis can prevent bowel ischemia and reduce maternal morbidity and mortality. Surgery remains the definite management in adult intussusception and an exact diagnosis can be made during the operation

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially