ABSTRACT
Most germ cell tumors are located in the gonads however there are instances where these tumors are located elsewhere in which are termed extragonadal germ cell tumors. When primary lesion of the testicular tumor has regressed, the term "burned-out testicular tumor" has been proposed. We herein report the first case of burned-out seminoma of the testis presenting as a cervical spinal mass causing cord compression with bone metastasis.
Subject(s)
Bone Neoplasms/secondary , Neoplasms, Germ Cell and Embryonal/secondary , Retroperitoneal Neoplasms/secondary , Ribs , Spinal Cord Compression/etiology , Testicular Neoplasms/pathology , Adult , Biopsy , Bone Neoplasms/complications , Bone Neoplasms/diagnosis , Cervical Vertebrae , Humans , Magnetic Resonance Imaging , Male , Neoplasms, Germ Cell and Embryonal/complications , Neoplasms, Germ Cell and Embryonal/diagnosis , Retroperitoneal Neoplasms/complications , Retroperitoneal Neoplasms/diagnosis , Spinal Cord Compression/diagnosis , Testicular Neoplasms/complications , Testicular Neoplasms/diagnosis , Testicular Neoplasms/secondary , Tomography, X-Ray ComputedABSTRACT
Acquired Factor V deficiency is a rare and challenging condition to treat. It has been associated with major surgeries, antibiotics, blood transfusions, infections, autoimmune disorders, malignancy and exposure to bovine thrombin. The clinical presentation can be heterogeneous and can manifest as asymptomatic laboratory abnormalities to fatal hemorrhage with mortality rates around 15-20% . We report a case of acquired factor V deficiency in which the patient developed a life-threatening bleeding coagulopathy with elevated prothrombin time, activated partial thromboplastin time and factor V inhibitor titers following multiple surgical procedures that were performed after a motor vehicle accident. The patient was successfully treated with immunosuppressive therapy including steroids and cyclophosphamide resulting in the complete elimination of inhibitor levels.
ABSTRACT
The initiation of extracorporeal membrane oxygenation (ECMO) in the emergency department (ED) is a rare event. Herein, we report a case of acute fulminant myocarditis in a nine-year-old girl who was successfully resuscitated by early initiation of ECMO support in the paediatric ED of KK Women's and Children's Hospital, Singapore. The patient had rapidly progressed into a witnessed pulseless ventricular tachycardia on presentation, and ECMO was started in the ED following the failure of standard resuscitation measures to establish spontaneous circulation. ECMO was continued for nine days. The patient recovered well with normal neurocognitive function. The initiation of ECMO in the ED is potentially life-saving in the resuscitation of children with witnessed in-hospital cardiac arrest due to a reversible cause.