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Hoppe Cheng posted an update 6 months, 2 weeks ago
Primary chest wall abscess is considered a rare disease.
A 60-year-old man presented with swelling of the pectoral muscle in the left side of his chest. Needle aspiration revealed pus. Computed tomography discovered fluid build-up anterior to the left pectoralis major muscle extending up to the left shoulder. selleck chemical There were multiple air pockets within the pectoralis major muscle and the surrounding fat stranding. Following antibiotic administration, we performed surgical debridement and irrigated the affected region. During surgery, the pectoralis major muscle was partially damaged; necrotic tissue was found only within the muscle. We diagnosed this condition as a pectoralis muscle abscess that most likely developed spontaneously from hematogenous spread. His postoperative course was uneventful, and there was no recurrence during a 3-month follow-up.
Pyomyositis is an acute infection of the skeletal muscle. Although it is more commonly found in tropical climates, it is also diagnosed in temperate climates in patients who are immunocompromised. Pyomyositis can be divided into three stages. Stage 1, which is considered the invasive stage, presents with low-grade fever, pain, local myalgia, and local edema but no pus collection. Stage 2, which is the purulent stage, presents with fever, severe muscle pain and tenderness, moderate edema, and abscesses. Stage 3 is diagnosed when sepsis develops secondary to S. aureus bacteremia.
In immunocompromised patients, the detection of pyomyositis at the early stage is challenging; however, most patients present at stage 2 or 3, which can increase the risk of complications.
In immunocompromised patients, the detection of pyomyositis at the early stage is challenging; however, most patients present at stage 2 or 3, which can increase the risk of complications.
Totally endoscopic mitral valve repair (TEMVR) is the highest level of minimally invasive cardiac surgery (MICS). It brings many benefits to patients but the downside is that a robotic system is always required. The deployment of robotic surgery is very complicated and expensive. Therefore, we improvised, making it possible to perform TEMVR without the aid of a robotic system.
A 66-year-old male patient presented with severe mitral valve regurgitation due to posterior leaflet prolapse. He was treated with TEMVR without robotic assistance. No chest incision was over 1.2 cm. The repair techniques included posterior leaflet resection and annuloplasty with ring implantation.
A midline sternotomy is still the standard approach for mitral valve repair. In recent years, MICS has gradually replaced conventional surgery with the most advanced strategy being totally robotic mitral valve repair. However, complex surgical techniques and high cost make it less accessible for the majority of patients. Instead of using robot, we improved mitral valve exposure techniques, surgical port placement and therefore were able to perform TEMVR with MICS instruments.
TEMVR without robotic assistance is a safe, effective and cost-efficient procedure, which can be adopted in most cardiac centers.
TEMVR without robotic assistance is a safe, effective and cost-efficient procedure, which can be adopted in most cardiac centers.
Marfan syndrome (MFS) is a disorder of the connective tissue that is inherited in an autosomal dominant fashion and is caused by mutations in the gene coding for fibrillin-1 (FBN1). This condition commonly affects the skeletal system, pulmonary system, ocular system and the cardiovascular system. Surgical intervention is often needed to correct the various deformities affecting the patients to restore the function, improving the patient’s aesthetic appearance and quality of life.
It’s a rare case report of a young male patient suffering through unilateral temporomandibular joint ankylosis, obstructive sleep apnea and unaesthetic appearance while being a case of Marfan syndrome.
This paper highlights the various surgical procedures undertaken to correct the deformities affecting the individual and improving the overall health of the patient.
Our patient’s management shows the necessity of a multidisciplinary, multi factorial and multi-faceted approach with early visual identification and diagnosis.
Our patient’s management shows the necessity of a multidisciplinary, multi factorial and multi-faceted approach with early visual identification and diagnosis.
Primary malignant melanoma of the esophagus (PMME) is a rare disease with a poor prognosis. Here, we report a case of retroperitoneal recurrence of PMME successfully treated with the anti-programmed cell death 1 antibody, nivolumab.
A 70-year-old male with dysphagia was referred to our hospital. Esophagogastroscopy showed an elevated tumor in the lower thoracic esophagus. A histopathological examination of the biopsy revealed poorly differentiated squamous cell carcinoma. The patient was diagnosed with clinical T3N1M0 stage III esophageal squamous cell carcinoma and was treated with neoadjuvant chemotherapy followed by radical esophagectomy. A postoperative histopathological examination revealed that atypical cells with a brown pigment were scattered in the tumor. Immunohistochemical staining demonstrated positive expression of human melanoma black 45, melan A, and S100. A pathological diagnosis of PMME was confirmed. Sixteen months after surgery, abdominal computed tomography revealed solitary retroperitoneal recurrence in the lateral portion of the ascending colon. Fluorine-18 fluorodeoxyglucose positron emission tomography (PET) showed hypermetabolic accumulation with a maximum standardized uptake value of 5.8. The patient was treated with nivolumab (240 mg) every two weeks. After eight courses of nivolumab, abnormal accumulation of the retroperitoneal mass disappeared on PET, and this therapeutic effect continued for 20 months.
Nivolumab was effective for recurrence of PMME in our case. There are few reports of treatment with nivolumab for PMME. Further studies are necessary to establish the usefulness of nivolumab for PMME in the future.
Nivolumab was effective for recurrence of PMME in our case. There are few reports of treatment with nivolumab for PMME. Further studies are necessary to establish the usefulness of nivolumab for PMME in the future.
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