Benign Pigmented Schwannoma of the Great Omentum: Report of a Rare Case and Review of the Literature

Schwannoma in the abdomen is an uncommon neoplasm that occurs most frequently in the cranial and peripheral nerves; it is extremely rare in the great omentum and only 6 cases of schwannoma of the great omentum have been observed previously. We report the case of a schwannoma found in the great omentum of a 55-year-old man who was treated with laparoscopic surgery. Though it was difficult to diagnose preoperatively, the tumor showed malignant potential by rapidly increasing in size. Histologically it was configured by a well-encapsulated round mass measuring 30 × 18 × 15 mm in diameter. Immunohistochemically most of the neoplastic cells reacted moderately to NSE, NCAM and S-100 protein. We document the clinicopathological study of a schwannoma of the great omentum, followed by a review of the literature

Subcutaneous Achilles tendon rupture in an eighty-year-old female with an absence of risk factors

Achilles tendon ruptures rarely occur in patients over 80 years of age. However, it is unclear what treatment, surgical or conservative, is suitable for such an Achilles tendon rupture in the elderly. In addition, the clinical results of an Achilles tendon rupture in the elderly are disappointing. We report here the case of a subcutaneous Achilles tendon rupture in an eighty-year-old, healthy female, who returned to her previous level of activity following surgical treatment. Additional case reports of other instances of successful treatment are needed to help establish the optimal treatment protocol for an Achilles tendon rupture in the elderly

Congenital Dysfibrinogenemia Presented with Massive Hematomas Formed after Hysterectomy

ArticleCase Reports in Clinical Medicine. 10: 108-116 (2021)journal articl

EGFR Mutations in NSCLC treated with Afatinib

Epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors such as afatinib are used for non-small cell lung cancer (NSCLC) and show varying efficacy depending on EGFR gene mutation. Few studies have examined the relationship between EGFR gene mutations and the adverse events of afatinib in NSCLC. This retrospective study included 32 Japanese patients with NSCLC with EGFR gene mutation who were treated with afatinib between May 2014 and August 2018 at Kagawa University Hospital. Among the 32 Japanese patients with NSCLC treated with afatinib, 19 patients were positive for exon 19 deletion mutation (Del 19) and 13 patients were negative for Del 19. The incidence of grade ≥ 2 skin rash was slightly higher in patients positive for Del 19 (42.1% vs. 7.7%, P = 0.050). No significant differences were detected in other adverse events between the two patient groups. Patients positive for Del 19 also showed significantly longer median progression-free survival (288 vs. 84 days, P = 0.049). Our study indicates a higher incidence of skin rash associated with afatinib treatment in Japanese patients with NSCLC positive for Del 19 compared with patients without Del 19. The Del 19 positive patient group also showed better progression-free survival

TAZ / PIPC agranulocytosis in puerperal

Tazobactam / piperacillin (TAZ / PIPC) is an injectable combination drug consisting of a broad-spectrum penicillin and a β-lactamase inhibitor. This antimicrobial has a wide spectrum of efficacy against both Gram-positive bacteria and anaerobes. Adverse events usually present as diarrhea or liver dysfunction ; agranulocytosis has not been reported in Japanese patients with puerperal disorders. However, we report a 32-year-old Japanese woman who received TAZ / PIPC to treat an intraperitoneal infection that developed after complications related to transvaginal delivery. Within 14 days of beginning TAZ / PIPC therapy, the patient developed agranulocytosis, indicated by a white blood cell count of 1900 cells / μL and a neutrophil count of 475 cells / μL. We discontinued TAZ / PIPC at this point and changed the antimicrobial to meropenem. Seven days later, her white blood cell count increased to 3700 cells / μL (neutrophil count : 1684 cells / μL), and the intraperitoneal infection resolved. Patients receiving TAZ / PIPC should be monitored periodically for agranulocytosis as well as for diarrhea and liver dysfunction