Cardiac-to-Bronchial Fistula in Hepatocellular Carcinoma: A Case Report.

Hepatocellular carcinoma (HCC) stands as a significant contributor to cancer-related mortality globally. While the acute and often fatal manifestations of locally advanced HCC primarily present within the abdomen, it is crucial to recognize that the respiratory and circulatory systems can also fall victim due to the liver's unique anatomical position within the body. Here, we present the case of a 63-year-old male recently diagnosed with locally advanced HCC with vascular invasion. Shortly after receiving target therapy and focal radiotherapy, the patient developed repeated secondary infections and a persistent diaphragmatic defect. As the necrotic tissue invaded the pleural space, subsequent tumor-to-bronchial and tumor-to-cardiac fistulas emerged, resulting in an abnormal connection between the respiratory and cardiovascular systems, leading to massive air emboli in circulation. This report highlights the risk of supradiaphragmatic complications in HCC patients with post-treatment secondary infections, particularly in patients predisposed to developing diaphragmatic defects.

Small bowel intramural hematoma secondary to abdominal massage.

Oral anticoagulant therapy with warfarin is commonly used to prevent thromboembolic event in patients at risk with atrial fibrillation [1]. Spontaneous intramural hematoma of small intestine is rare complication of anticoagulant therapy and occurs in patient who receives excessive warfarin that may result in potentially serious complications. Small bowel intramural hematoma secondary to warfarin therapy is a recognized complication [2]. In the present report, we report an unusual case of small bowel intramural hemorrhage secondary to anticoagulant therapy after abdominal massage. The emergency physicians should be aware that the potential spontaneous small bowel intramural hemorrhage in the patients has a high index of suspicion because most patients are treated nonoperatively with a good outcome.

Correlation of hematologic factors to carotid intima-media thickness in men and women: a study of 2767 asymptomatic subjects of Taiwan.

PURPOSE: A correlation between carotid intima-media thickness (CIMT) and blood cells has not been well documented. Studies of a possible relationship between blood cell components and left (Lt) and right (Rt) side CIMT in asymptomatic men and women in Taiwan have not been conducted previously. The study aims to correlate factors of complete blood cells (CBC) to CIMT for men and women. METHODS: Data collection from 2767 asymptomatic healthy checkup individuals, age 35-75, 1517 men and 1250 women, were separated into four groups: CIMTML (men's Lt), CIMTMR (men's Rt), CIMTWL (women's Lt), and CIMTWR (women's Rt) for analysis of CBC factors vs. CIMT. A cut-off point for each factor was examined for the existence of significant differences in CIMT for individuals among the four test groups who had abnormal CBC data. RESULTS: The regression equations of eight CBC factors vs. CIMT of four groups calculated as R2adj range were from 70.5% to 79.4%. Further comparison of CIMT in different groups by cut points of CBC factors showed significant differences in red blood cells (RBC) and platelets (PLT), but not in white blood cells (WBC). CONCLUSION: Higher RBC, and lower mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH) were associated with lower CIMT in asymptomatic men in Taiwan. Further studies to confirm these differences are warranted.

A 25-Year-Old Chronic Ketamine User with Urinary Symptoms; a Case Report.

Ketamine is mainly used for short-acting general anesthesia, chronic pain, sedation, depression, and bipolar disorder. Long-term ketamine use may cause lower urinary tract symptoms and voiding dysfunction. Small capacity and fibrotic bladder can be associated with chronic ketamine use. Here, we present a 25-year-old male with a history of chronic ketamine use complicated with contracted heart-shape bladder.

Trends in Research about COVID-19 Vaccine Documented through Bibliometric and Visualization Analysis.

Due to COVID-19, people's lives have changed greatly. In accordance with former experience, an efficacious vaccine is the most effective way to curb the pandemic; thus, many researchers have published related publications in the short term. Hence, this study aims at using bibliometric analysis and visualization to document research trends regarding COVID-19 vaccines, and offer some directions and suggestions for future research. Initially, all eligible publications were downloaded from Web of Science on 1 January 2022. Subsequently, some publications published before December 2019 were removed since COVID-19 did not occur before that date. Finally, Microsoft Excel is used for bibliometric analysis to analyze publication date, author, affiliation, country, publication title, publisher, research area, document type, and language, and visualized software (VOSviewer) is used to visualize author, affiliation, country, and keywords. After analyzing a total of 17,392 publications, the results show that the overall research trend was upward. Moreover, the prominent authors, institutions, and countries inclined towards regional cooperation instead of international cooperation. Furthermore, the most popular research areas were immunology and medicine (general and internal). Ultimately, COVID-19, vaccine, and SARS-CoV-2 were the top 3 keywords. In conclusion, this study shows the approximate research trend for COVID-19 vaccine during the completely first two years of the pandemic. The research focuses moved from safety, effectiveness, and immunology at the early stage to the optimal allocation strategies for COVID-19 vaccine, and eventually to public attitudes and acceptance towards COVID-19 vaccination.

Preoperative computerized tomography-guided blue dye localization for metastatic lymphadenopathy and peritoneal tumor implants during laparoscopic surgery: Two case reports.

RATIONALE: Computerized tomography (CT)-guided blue dye localization has been widely discussed for preoperative localization of pulmonary nodules. However, few studies have investigated this technique for intra-abdominal lesions. Although preoperative localization is not commonly required in laparotomy, it may assume importance with advancements in the field of laparoscopic surgery. PATIENT CONCERNS: Herein, we report the cases of 2 patients diagnosed with colon cancer who underwent hemicolectomy with extended lymphadenectomy and subsequent chemotherapy. DIAGNOSES: Follow-up CT scans showed newly developed metastatic lymphadenopathy and peritoneal tumor implants. INTERVENTIONS: Considering the difficulty in identification of and access to the target lesions during laparoscopic surgery, preoperative CT-guided blue dye localization was performed in both cases. OUTCOMES: All the target lesions were identified by the dye marker and removed successfully. The pathologic results revealed adenocarcinoma. LESSONS: We established the following strategy for preoperative CT-guided dye localization of intra-abdominal lesions:Intra-abdominal lesions that are hard to identify due to their size or morphology, and difficult to approach due to their location or surrounding structures, maybe the candidates for this procedure, especially in cases of laparoscopic surgery.Operators should adjust their localization planning based on the surgery method, cutting path, and location of port sites. The target dye marker should be clearly visible in the presumed intra-operative field of view.A second dye marker should be made to ensure surgical success when the target dye marker is obscured by the surrounding structures in the presumed intra-operative field of view.

Spontaneous superior mesenteric artery dissection following upper gastrointestinal panendoscopy: A case report and literature review.

BACKGROUND: Complications associated with upper gastrointestinal (UGI) endoscopy are uncommon, and rarely involve those of cardiovascular nature. We report herein a unique case of spontaneous superior mesenteric artery dissection (SMAD) after UGI pandenoscopy. CASE SUMMARY: A 45-year-old man who had previously undergone UGI panendoscopy and colonoscopy during a voluntary health check-up at our facility was admitted to the emergency room (ER) at the same facility due to persistent epigastric pain with radiation to the back. At the ER, the patient did not present notable abnormalities upon physical, conscious, or laboratory examinations apart from mild tenderness in the epigastric abdomen. Acute abdominal aortic dissection was suspected, and abdominal contrast-enhanced computed tomography confirmed SMAD. He was then transferred to the cardiovascular ward and treated conservatively with fasting, prostaglandin E1, and aspirin. The patient recovered and returned home soon after, and was symptom-free 6 months after discharge from the facility. CONCLUSION: SMAD after UGI panendoscopic procedure is a previously unreported complication. Awareness of this complication and associated sequela is warranted.

Liquid Biopsy Detects Relapse Five Months Earlier than Regular Clinical Follow-Up and Guides Targeted Treatment in Breast Cancer.

Genetic alterations in circulating tumor DNA (ctDNA) are an emerging biomarker for the early detection of relapse and have the potential to guide targeted treatment. ctDNA analysis is often performed by droplet digital PCR; however, next-generation sequencing (NGS) allows multigene testing without having to access a tumor sample to identify target alterations. Here, we report the case of a stage III hormone receptor-positive breast cancer patient who remained symptomless after receiving surgery and adjuvant chemotherapy. Liquid biopsy analysis by NGS revealed the presence of a ctDNA PIK3CA N345K mutation five months before the detection of relapse with multiple liver metastases by regular clinical follow-up. To date, clinical implications of the PIK3CA N345K variant remain insufficiently investigated; however, everolimus treatment resulted in the shrinkage of tumor lesions and decreased the levels of tumor markers. Four months after treatment initiation, a second ctDNA analysis suggested a relapse, and the patient clinically progressed after five months of everolimus therapy. This case report demonstrates the value of ctDNA analysis by NGS for the early detection of relapse in breast cancer patients. The study further indicates its usefulness for the choice of targeted treatments, suggesting that the variant PIK3CA N345K might be associated with everolimus sensitivity.

Terminal ileum perforation from a misplaced percutaneous suprapubic cystostomy.

Iatrogenic bowel injury is a recognized complication of percutaneous suprapubic cystostomy. In the present report, we report an unusual case of small bowel perforation caused by a misplacement of suprapubic catheter into terminal ileum. For safe placement of a suprapubic catheter, the patients must have an adequately distended bladder and be placed in Trendelenburg position that allows safe extraperitoneal puncture of the bladder.

Hypertension due to co-existing paraganglioma and unilateral adrenal cortical hyperplasia.

A rare case of combined unilateral adrenal hyperplasia and paraganglioma is reported. A 27-year-old woman presented with hypertension, palpitation, dizziness, and headache for about 3 months. Elevated plasma aldosterone with low renin and a high level of urine vanillylmandelic acid (VMA) were found. Computed tomography showed a microadenoma of the left adrenal gland and a well demarcated left retroperitoneal para-aortic mass. Adrenal vein sampling for aldosterone and renin levels suggested left adrenal lesion. Surgical removal of the left adrenal gland and para-aortic mass was performed. Pathologic examination of the resected left adrenal gland showed adrenal cortical hyperplasia and the left retroperitoneal para-aortic mass showed a paraganglioma. Postoperatively, blood pressure, plasma renin, aldosterone and urine VMA all returned to within normal ranges. The possible relationship of these two diseases is discussed.

Fatal Vibrio vulnificus Bacteremia in Two Cirrhotic Patients with Abdominal Pain and Misty Mesentery.

Two cirrhotic patients with unexplained abdominal pain deteriorated rapidly and fatally after presenting to our emergency department. Abdominal computed tomography in both patients showed "misty mesentery", which could not be explained by other etiologies. Both blood cultures revealed Vibrio vulnificus, which suggested the possible correlation of CT-finding and bacteremia.

A 5-Month-Old Infant with Right Scrotum Swelling; a Case Report.

Migration of the distal catheters of ventriculoperitoneal (VP) shunt is a rare event. Here, we report an unusual case of a 5-month-old infant with post-hemorrhagic hydrocephalus, who developed right scrotum swelling soon after VP shunting. Plain abdominal x-ray showed the shunt tubing, which was twisted and kinked in its distal portion and coiled in the right scrotum. The infant was operated on and managed with successful outcome.

Periampullary Diverticulum Perforation Following Endoscopic Retrograde Cholangiopancreatography (ERCP); a Case Report.

Endoscopic Retrograde Cholangiopancreatography (ERCP) is widely used for the diagnosis and treatment of biliary and pancreatic tract disease. Perforation is a rare complication of it, but it is associated with high rate of mortality, an overall mortality rate of 1.0-1.5%. Here, a case of massive subcutaneous emphysema following ERCP was reported without an obvious retroperitoneal or peritoneal perforation.

T-Cell Lymphomas Presenting as Colon Ulcers and Eosinophilia.

Primary gastrointestinal T-cell lymphoma is an uncommon entity and primary colon T-cell lymphoma is even rarer. The majority of enteropathy-associated T-cell lymphomas present predominantly as ulcers or strictures in the endoscopic examinations, while primary B-cell lymphomas commonly present as exophytic lesions. Ulcerative colon T-cell lymphoma may mimic Crohn's disease (CD), which is a chronic inflammatory disease of the intestines with ulcer and fistula formations difficult for clinicians to diagnose based on endoscopic observations alone. Like CD, T-cell lymphoma may be characterized by the presence of multiple skipped ulcers distributed from the terminal ileum to the descending colon. Furthermore, it is difficult to diagnose this unusual lymphoma by a single endoscopic biopsy. Typically, the histological composition of T-cell lymphoma is made of medium to large atypical cells located in the base of the ulcer with extension to the muscle layer and the adjacent mucosa. However, it is common that biopsy specimens show only mixed inflammatory changes where the lymphoma cells are hard to be identified. The differential diagnosis of malignant lymphoma must be considered when clinically diagnosed CD is refractory to the medical treatment or when its clinical behavior becomes aggressive. The current study presents a rare case of primary colon T-cell lymphoma in a 56-year-old male with marked recent weight loss, watery diarrhea and bilateral neck lymphadenopathy, who received a laboratory checkup and endoscopic workup for colon biopsy. The initial pathological report was consistent with mucosal inflammation and benign colon ulcers. Interestingly, the blood test showed a prominent eosinophilia. A biopsy of the enlarged neck lymph nodes done approximately 1 month after the colon biopsy unexpectedly showed T-cell lymphoma, which led to a review of the initial colonic biopsy specimens. Additional immunohistochemical stains were used accordingly, which showed positive results for CD3, CD45RO and LCA antibodies confirming the diagnosis of lymphoma. The endoscopic diagnosis of ulcerative colon T-cell lymphoma is frequently confused with inflammatory conditions of the large bowel such as CD, and tuberculosis colitis. Our study aims to emphasize the difficulty in differentiating this ulcerative form of colon T-cell lymphoma from the inflammatory bowel diseases and the importance of its differential diagnosis due to the much more aggressive clinical behavior of the T-cell lymphoma.

Phlebosclerotic colitis: A case report and review of the literature.

Phlebosclerotic colitis (PC) is a rare but potentially life-threatening disease. The initial presentation may include non-specific symptoms, such as vomiting, constipation and abdominal pain; however, intestinal stenosis, gangrene and perforation may occur without appropriate management. The present report describes the case of a 56-year-old male with abdominal pain and constipation. Imaging studies revealed thread-like calcifications involving almost the entire colon, which had markedly progressed over a three-year period, and changes consistent with colonic ischemia. Angiography revealed decreased blood flow in the mesenteric veins. The patient underwent emergent subtotal colectomy, and pathological examination revealed gangrene of the colon and calcifications of the mesenteric veins. The patient's postoperative course was uneventful. In conclusion, PC is a potentially life-threatening condition that may be diagnosed by the presence of serpentine calcifications on imaging studies. Management depends on the severity of the disease, ranging from close follow-up to prompt surgical intervention.

Successful treatment of liver abscess secondary to foreign body penetration of the alimentary tract: a case report and literature review.

Hepatic abscess caused by foreign body penetration of the alimentary tract is rare. We report a case of gastric antrum penetration due to a toothpick complicated by liver abscess formation. A 41-year-old man was admitted to our hospital with the chief complaint of upper abdominal pain for 2 mo. Esophagogastroduodenoscopy performed at a local clinic revealed a toothpick penetrating the gastric antrum. Computed tomography (CT) of the abdomen at our hospital revealed a gastric foreign body embedded in the posterior wall of gastric antrum with regional phlegmon over the lesser sac and adhesion to the pancreatic body without notable vascular injury, and a hepatic abscess seven cm in diameter over the left liver lobe. Endoscopic removal of the foreign body was successfully performed without complication. The liver abscess was treated with parenteral antibiotics without drainage. The patient's recovery was uneventful. Abdominal ultrasonography demonstrated complete resolution of the hepatic abscess six months after discharge. Relevant literature from the PubMed database was reviewed and the clinical presentations, diagnostic modalities, treatment strategies and outcomes of 88 reported cases were analyzed. The results showed that only 6 patients received conservative treatment with parenteral antibiotics, while the majority underwent either image-guided abscess drainage or laparotomy. Patients receiving abscess drainage via laparotomy had a significantly shorter length of hospitalization compared with those undergoing image-guided drainage. There was no significant difference in age between those who survived and those who died, however, the latter presented to hospitals in a more critical condition than the former. The overall mortality rate was 7.95%.

Complete remission of pancreatic pseudoaneurysm rupture with arterial embolization in a patient with poor risk for surgery: a case report.

Pancreatic pseudoaneurysm is a rare vascular complication of chronic pancreatitis resulting from erosion of the pancreatic or peripancreatic artery into a pseudocyst that is identified as a pulsating vascular malformation which may lead to lethal complications if left untreated. Many publications in the literature consider angiography as the first step in the management of pancreatic pseudoaneurysm to stabilize the patient's critical condition; it should be followed by surgical intervention as the definite treatment. We report a rare case of pancreatic pseudoaneurysm rupture with hemodynamic embarrassment in a critical patient with multiple comorbid conditions and poor risk for surgery who responded dramatically to angiographic management as a single therapeutic modality without further surgical intervention. The results observed in our patient suggest that pancreatic pseudoaneurysm may be successfully managed with angiography only and that not all cases require surgical intervention. This is particularly relevant in critically ill patients in whom surgical intervention would be unfeasible.

Epiploic appendagitis: an uncommon and easily misdiagnosed disease.

OBJECTIVE: Epiploic appendagitis (EA) is a rare cause of focal abdominal pain in otherwise healthy patients. It may mimic diverticulitis, appendicitis or mesenteric infarction on clinical manifestation. The diagnosis of EA is very infrequent due in part to low awareness by clinical physicians. The aim of this study was to review and describe the clinical presentation and computed tomography (CT) findings of EA. METHODS: Twenty-one patients (6 women and 15 men, average age 40 years [range 27-65 years]) were diagnosed with EA by CT between January 2006 and October 2009. The patients' medical records were retrospectively reviewed with regard to their socioeconomic data, characteristics of abdominal pain, associated symptoms, laboratory results, radiological findings and treatment. RESULTS: Abdominal pain was the leading symptom. The pain was localized in the left lower quadrant (17 patients, 81.0%), left middle abdomen (2 patients, 9.5%) and right lower quadrant (2 patients, 9.5%), respectively. Leukocytosis (white blood cell > 10 × 10(9) /L) without left shift was found in 6 patients but all patients were afebrile. Characteristic CT findings of paracolonic oval hypodense fat tissue with thickened peritoneal ring and periappendageal fat stranding were all presented in 21 patients, but the central dot sign was presented in only 7 patients. They were all treated was conservative therapy. CONCLUSIONS: Epiploic appendagitis is the inflammatory response of an appendage to infarction or spontaneous venous thrombosis. A CT scan provides a definite diagnosis of epiploic appendagitis, thus avoiding unnecessary surgical intervention and antibiotics.