Želučana metastaza infiltrativnog karcinoma dojke 22 godine nakon prve operacije - prikaz slučaja

Gastric metastasis from breast carcinoma is uncommon and rarely encountered in our daily practice. We report a case of late gastric metastasis from previous infiltrating lobular carcinoma of the breast. The patient had extended disease-free interval of 22 years prior to metastasis. Gastroscopy and fluoroscopy showed changes appearing like linitis plastica of the body of the stomach. Computed tomography of the thorax and abdomen demonstrated pulmonary metastasis and mediastinal lymphadenopathy. Biopsy of the mediastinal lymph node and stomach lesion confirmed metastatic adenocarcinoma from breast carcinoma based on immunohistochemistry staining. Immunohistochemistry staining of both specimens revealed strong positivity for cytokeratin 7 and negative for cytokeratin 20.Metastaze karcinoma dojke u želudac nisu česte i rijetko se vide u svakodnevnoj praksi. Opisujemo slučaj kasne želučane metastaze iz prethodnog infiltrativnog lobularnog karcinoma dojke. Prije nastanka metastaze bolesnica je imala dugotrajno razdoblje bez bolesti od 22 godine. Gastroskopija i fluoroskopija pokazale su promjene poput linitis plastica na tijelu želuca. Kompjutorizirana tomografija prsnog koša i trbuha pokazala je plućnu metastazu i limfadenopatiju. Biopsija limfnog čvora medijastinuma i želučane promjene potvrdila je metastatski adenokarcinom iz karcinoma dojke na osnovi imunohistokemijskog bojanja pri čemu su oba uzorka bila snažno pozitivna na citokeratin 7 i negativna na citokeratin 20

No coma, but expressive dysphasia with cerebellar signs: an unique presentation of cerebral malaria

Malarial infection is not uncommonly complicated by cerebral involvement and poses significant mortality and morbidity especially in children. Similar complications may be seen in the adult population. Cerebral malaria is defined as encephalopathy that presents with impaired consciousness, delirium, and/or seizures. Neurological deficits are commonly seen as sequelae of cerebral malaria rather than as presenting symptoms or signs. We present here a unique case of cerebral malaria with focal neurological deficits but without alteration in conscious level. Keeping rare presentations of common illnesses in mind, clinicians should consider the possibility of cerebral malaria in a patient with neurological deficits and a history of fever and travel in endemic areas

Parkinsonism complicating acute organophosphate insecticide poisoning

Organophosphate insecticides have a triphasic effect on the central nervous system, namely acute cholinergic crisis, intermediate syndrome and delayed polyneuropathy. Although acute organophosphate poisoning is relatively common, case reports describing parkinsonism as a neurological complication following an acute intoxication are limited. 1 We report a case of parkinsonism noted on day 24 of admission following an acute severe organophosphate poisoning which was successfully treated with benzhexol and levodopa. Previously, response to levodopa was reported to be poor in 3 patients studied by Bhatt et al 1whereas amantidine, dopamine agonist and bipiriden have been shown to be helpful. 2To the best of our knowledge, this is the fi rst case of parkinsonism complicating organophosphate poisoning which responded to levodopa and benzhexol therapy

Relationship between Serum Cytokeratin-18, Control Attenuation Parameter, NAFLD Fibrosis Score, and Liver Steatosis in Nonalcoholic Fatty Liver Disease

Backgrounds. The aim of this study was to appraise the relationship between serum fragmented cytokeratin-18(CK-18), controlled attenuation parameter (CAP), and liver steatosis assessed by ultrasound (US) in nonalcoholic fatty liver disease (NAFLD) patients. Methods. Patients who underwent abdominal US were recruited, followed with measurement of CAP using Fibroscan® and serum fragmented CK-18 using enzyme-linked immunosorbent assay. The degree of liver steatosis assessed by US was categorized into mild (S1), moderate (S2), and severe (S3). Results. A total of 109 patients were included in our study. CAP and fragmented CK-18 level were significantly correlated with liver steatosis grade with rs = 0.56 and 0.68, p=0.001, respectively. NAFLD Fibrosis Score was poorly correlated with liver steatosis grade (rs=-0.096, p=0.318). Using fragmented CK-18 level, area under receiver operating characteristic (AUROC) curves for S≥2 and S≥3 were excellent (0.82 and 0.84, respectively). Using CAP, AUROC curves for detection of S≥2 and S≥3 were good (0.76, 0.77, respectively). We also proposed cut-off value of CAP to detect S≥2 and S≥3 to be 263 and 319db/m, respectively, and fragmented CK-18 level to detect S≥2 and S≥3 (194 and 294 U/L, respectively). Conclusions. Both the fragmented CK-18 level and the CAP, but not NAFLD Fibrosis Score, were well correlated with hepatic steatosis grade as assessed by US

Normal values and regional differences in oesophageal impedance-pH metrics: a consensus analysis of impedance-pH studies from around the world.

OBJECTIVE: Limitations of existing impedance-pH thresholds include small sample size of normative studies, inclusion of artefactual pH drops and incorrect identification of impedance reflux events. We aimed to obtain new impedance-pH thresholds from expert consensus analysis of tracings from a large number of healthy subjects. DESIGN: Of 541 studies performed worldwide using two different systems (Diversatek, USA, and Laborie, Netherlands), 150 tracings with oesophageal diagnoses, behavioural disorders and study-related artefacts were excluded. The remainder studies were subject to two reviewer consensus analysis, in-person or through video conference, consisting of editing meals and pH drops, identification of impedance reflux and postreflux swallow-induced peristaltic wave (PSPW) using strict pre-established criteria and measurement of distal mean nocturnal baseline impedance (MNBI). RESULTS: Consensus analysis was performed in 391 tracings (age 32.7 years, range 18-71, 54.2% female). Normative thresholds were significantly different between Diversatek and Laborie (total acid exposure time: 2.8% and 5%; reflux episodes: 55 and 78; MNBI at 3 cm: 1400 and 1500 ohms, at 5 cm: 1400 and 1800 ohms). Males had higher acid exposure, more reflux episodes and lower MNBI. Significant regional differences were identified, including higher PSPW scores in Western countries, and higher MNBI in Asia using Diversatek, and higher acid exposure in the Netherlands, higher MNBI in Asia and South Africa, and lower MNBI in Turkey using Laborie. CONCLUSION: Normal impedance-pH monitoring thresholds have regional and system-related differences. Clinical interpretation needs to use normal thresholds valid for the system used and world region, following careful editing of the tracings.status: Published onlin

Normal values and regional differences in oesophageal impedance-pH metrics:a consensus analysis of impedance-pH studies from around the world

Objective: Limitations of existing impedance-pH thresholds include small sample size of normative studies, inclusion of artefactual pH drops and incorrect identification of impedance reflux events. We aimed to obtain new impedance-pH thresholds from expert consensus analysis of tracings from a large number of healthy subjects. Design: Of 541 studies performed worldwide using two different systems (Diversatek, USA, and Laborie, Netherlands), 150 tracings with oesophageal diagnoses, behavioural disorders and study-related artefacts were excluded. The remainder studies were subject to two reviewer consensus analysis, in-person or through video conference, consisting of editing meals and pH drops, identification of impedance reflux and postreflux swallow-induced peristaltic wave (PSPW) using strict pre-established criteria and measurement of distal mean nocturnal baseline impedance (MNBI). Results: Consensus analysis was performed in 391 tracings (age 32.7 years, range 18-71, 54.2% female). Normative thresholds were significantly different between Diversatek and Laborie (total acid exposure time: 2.8% and 5%; reflux episodes: 55 and 78; MNBI at 3 cm: 1400 and 1500 ohms, at 5 cm: 1400 and 1800 ohms). Males had higher acid exposure, more reflux episodes and lower MNBI. Significant regional differences were identified, including higher PSPW scores in Western countries, and higher MNBI in Asia using Diversatek, and higher acid exposure in the Netherlands, higher MNBI in Asia and South Africa, and lower MNBI in Turkey using Laborie. Conclusion: Normal impedance-pH monitoring thresholds have regional and system-related differences. Clinical interpretation needs to use normal thresholds valid for the system used and world region, following careful editing of the tracings