जर्नल ऑफ़ क्लिनिकल केस रिपोर्ट्स

Background: To describe a case of a 38-year old pregnant woman with an intraoperative diagnosis of placenta percreta complicated by central placenta previa. The ultrasound scan did not show signs of any type of abnormal placental invasion, just central placenta previa was visualized.

Methods: At 36 weeks of gestation, she underwent an elective cesarean section combined with peripartum hysterectomy with bladder wall resection under general anesthesia because of antenatally undiagnosed placenta percreta.

Results: The therapy was provided by a multidisciplinary team, and the patient was in relatively good condition. Intraoperative blood loss was 2500 mL. A total of 10 units of red blood cells and 3 units of fresh frozen plasma were used. Anesthesia time was 2 h and 15 min. The postoperative course was adequate. A live, premature male baby (2420 g) was born 8 min after the beginning of the operation with Apgar scores 8 and 7 at 1 minute and 5 minutes.

Conclusion: We want to emphasize that, in spite of the absent typical symptoms and absent typical ultrasound signs of placenta percreta, we have to be cautious in the presence of risk factors. If we have a suspicion for adherent placenta, an MRI scan should be performed.

Phyllodes tumor (PT) also known as cystosarcoma phyllodes are rare fibro epithelial lesions characterized by bilayer epithelium and leafy fronds, accounting for less than 1% of breast neoplasms. The World Health Organization (WHO) has sub classified it into benign, borderline and malignant. These tumors need to be differentiated with fibro adenomas due to potential for metastasis and recurrence and similar clinical presentation. These tumors have been challenging for surgeons and pathologists because it is difficult to predict their behavior on core needle biopsies, while advances in immunohistochemical techniques may increase diagnostic accuracy in these lesions. Benign phyllodes do not metastasize but can reoccur locally and more aggressively. While the minority of patients with metastatic disease can develop symptoms within few months to years after initial treatment. Metastatic disease typically occurs in lung, mediastinum and bones. Most common treatment for these tumors is wide local excision, with mastectomy indicated for patients with larger lesions.

Carcinoid tumors are rare and slow-growing neuroendocrine tumors. In the United States, the prevalence is reported at 2 cases per 100,000 persons. The classic carcinoid syndrome occurs in up to 5% of cases and its vasoactive effects can induce flushing, secretory diarrhea, bronchospasm and hypotension1. Carcinoid induced cardiac dysfunction is rare and involves development of plaques on the tricuspid and pulmonic valves, often manifesting as tricuspid insufficiency and pulmonic stenosis (TIPS). More specifically, these plaques cause hemodynamic dysfunction as a result of thickening and restricted motion of the valve leaflets. Of all cardiac carcinoid cases, the left-heart valves are affected in less than 10% of cases, due to atrial right-to-left shunt or primary bronchial carcinoid. Despite appropriate valve replacement therapy, rarely does the subsequent congestive heart failure resolve; necessitating an ongoing balance between cardiac treatment options and chemotherapy. Herein, we present a case of aggressive carcinoid heart disease manifesting as left-sided valvular plaque with subsequent development of severe tricuspid valve regurgitation after triple-valve replacement surgery. We will also review the treatment strategy in this patient with aggressive carcinoid syndrome.

Patients with acute aortic dissection report often the typical sharp, abrupt chest pain. In some cases, when the disease leads to the coronary malperfusion, the symptoms of acute coronary syndrome may be reported. Low cardiac output as the result of the accompanying coronary flow disturbances can require the mechanical cardiopulmonary support. In some selected cases extracorporeal membrane oxygenation can be successfully used as a bridge to recovery or bridge to decision. The additional advantage of this therapeutic option is the possibility of choice of the cannulation strategy: veno-venous, veno-arterial, veno-pulmonal, central/peripheral. Oxygen delivery can be easily regulated on oxygenator. We present two patients with acute type A aortic dissection and acute coronary syndrome, who recovered thanks to such therapy.

Diet and lifestyle of mother during pregnancy as well as lactation have long-term effect on child’s health and development. Detection of early risk markers of adult age chronic diseases which begin during prenatal life and appliance of complex nutritional interventions at the right time may reduce the risk of these diseases.

We present a case of patient who was affected with pulmonary embolism (PE) associated with free-floating thrombotic mass in the right heart chambers. She was planned to undergo heart valve surgery and presented with the symptoms now of introducing of the anesthesia. The emergency operation was performed successfully.

A 55-year-old Arabic and Moroccan male patient presented with a painful nodule in the left knee without a previous history or trauma. The patient underwent a wide excision of the nodule. The histological study evoked the diagnosis of a subcutaneous leiomyoma. The final diagnosis was established by the immunohistochemistry. One year after the operation no tumor recurrence has been detected. Leiomyomas are benign soft tissue tumours, which occur most commonly in the skin of the lower extremities in middle-aged females. The main differential diagnosis is the leiomyosarcoma, hence the necessity of an extensive sampling of the lesion.

Objective: Describe the evolution of infective thrombosis of the vena cava and removal of thrombus. Study selection: Case report.

Data synthesis: We present a case report of a critically ill patient complicated with infectious thrombosis of the superior vena cava. The patients developed sepsis, staphylococcal embolic pneumonia and multiorgan dysfunction. The patient underwent successful thrombectomy with aspiration catheter guided by transesophageal echocardiography. The patient remains completely asymptomatic month.

Conclusions: Aspiration thrombectomy could be a technique which, although novel, possible in these patients.

Introduction: Uterine sarcoma is rare, Leiomyosarcoma is the main type of sarcoma that may resemble to leiomyoma. Metastasis to small bowel is extremely rare, treatment is chemotherapy and the prognosis is unfavorable.

Case presentation: A 41-year-old Moroccan women, with no significant past medical history, was diagnosed with intracavitary myoma. The patient underwent subtotal hysterectomy with bilateral salpingectomy. Pathology findings indicated high grade leiomyosarcoma. The patient was re-operated, she underwent bilateral oophorectomy, omentectomy, segmental small bowel resection and excision of uterine cervix. Histopathology revealed a metastatic lesion of the primary uterine leiomyosarcoma of the small bowel. The patient was treated by chemotherapy: Doxorubicin 75 mg/m2 every 3 weeks for 6 cycles. The follow-up of this patient is 10 months and her ECOG is 0.

Conclusion: Leiomyosarcoma is the main type of sarcoma that may resemble to leiomyoma. Metastatis to small bowel is rare, treatment is chemotherapy and the prognosis is poor.

Epidermal growth factor receptor (EGFR) mutation status guides treatment in non-small cell lung cancer; del E746-A750 in exon 19 and p.L858R in exon 21 are the most common mutations. We present a patient whose initial lymph node and computed tomography-guided pathology led to a suspicion of poorly differentiated carcinoma; however, during the clinical course, no obvious tumor origin was noted, and the pathologic morphology favored the squamous type. Not until the EGFR mutation status of secondary sites was checked did we confirm the disease origin as the lung.

Life-threatening hematuria from radiation induced hemorrhagic cystitis remains a difficult clinical problem for the urologists. We report the use of multiple inflated Foley balloon catheters for compression on the bleeding bladder mucosa via the suprapubic and urethral routes in a patient with hemorrhagic shock due to intractable bleeding of radiation induced hemorrhagic cystitis. This method is simple and quick to stop bladder bleeding for life saving.

Skin-to-skin contact (SSC) is a well-documented benefits manner for neonates and mothers. Neonates are placed on their mothers’ chest after birth immediately which will contribute to the transition from fetal to extra-uterine life such as stabilizing babies’ respiration, body temperature and blood sugar. Besides, SSC also helps mothers’ recovery after delivery. However, some acute life-threatening events happened during SSC. Herein, we reported the sudden unexpected collapse of a well-appearing full-term baby occurred during SCC and to make health care providers and parents aware of this possible risk.

Since April 2014, a fatal human infection with a novel reassortant H5N6 avian influenza virus was identified in China. Eight of 10 patients died from this virus. Two H5N6 patients were hospitalized in Shenzhen Third People’s Hospital in China, with one patient recovered. Here, we describe their clinical characteristics and treatment strategies. We suggest these strategies in the early stage may be important for severe avian influenza patients, including early combined antiviral therapy, oxygen therapy and ventilator support treatment, short-term usage of low-dose corticosteroid and appropriate immune globulin and keeping negative fluid balance in the progression period.