ABSTRACT
INTRODUCTION AND IMPORTANCE: Inflammatory myofibroblastic tumor (IMT) of the bladder is a rare sight, which can be distinguished by the proliferation of spindle cells and the presence of a persistent chronic inflammatory infiltrate. IMT is usually benign, but in a few cases it has a tendency for malignant transformation and metastases. CASE PRESENTATIONS: A 30-year-old male with a history of recurrent hematuria. His initial symptoms was unfrequent painless hematuria. Abdomen multislice computerized tomography (MSCT) with contrast shows an enhancing solid mass with necrotized center measuring +/- 12.9 × 16.5 × 18.9 cm and extending from cavum pelvis to cavum abdomen. Cystectomy and bilateral ureterocutaneostomy were performed. The histology report found an IMT with mitotic cells, a necrotic region, and a positive ki67, which suggest the tumor's malignant transformation. Unfortunately, the patient's overall condition continued to deteriorate, and he passed away seven days after hospital discharge. CLINICAL DISCUSSIONS: IMT is comprised of spindel cells and inflammatory cells. IMT might become aggressive locally, recurring, or progress to malignancy. Fifty percent of IMTs are caused by rearrangements of the anaplastic lymphoma kinase (ALK) gene on chromosome 2p23, resulting in ALK-1 overexpression. A change from uniform spindled cells to atypical polygonal cells or plump cells with oval vesicular nuclei, prominent nucleoli, and mitoses is indicative of malignant transformation. CONCLUSION: This case emphasizes the importance of continuous monitoring and raising awareness about the possibility of malignant transformation of IMT. Understanding the characteristics of the findings could result in better decision-making and outcomes.
ABSTRACT
INTRODUCTION AND IMPORTANCE: Bile duct stones are a widespread condition that can pose a significant risk to life due to the occurrence of complications. In recent years, there has been a growing inclination toward the use of one-stage minimally invasive procedures for the treatment of this condition. However, it is important to note that in developing countries, such as Indonesia, where the National Healthcare Insurance System is established, the implementation of these procedures is still relatively uncommon due to limitations in healthcare facilities. CASE PRESENTATION: This study presents a case series involving 13 patients who underwent a consecutive initial attempt of one-stage Laparoscopic Cholecystectomy with subsequent Intraoperative Endoscopic Retrograde Cholangiopancreatography (LC-ERCP) for the extraction of bile duct stones. These patients were among the 124 individuals treated for bile duct stones at our hospital for one year (June 2022 to May 2023). All the participants in this study were covered by the National Health Insurance. CLINICAL DISCUSSION: Among the 124 patients diagnosed with bile duct stones, thirteen (10.5 %) were subjected to an initial attempt of one-stage LC-ERCP procedure, which had a success rate of 76.4 %. However, three of them experienced difficulties during the cannulation of bile duct, leading to the failure of this approach. The patients included in the study had a mean age of 46.5 years, with average serum levels of total bilirubin and direct bilirubin measuring 2.1 and 1.4 mg/dL, respectively. The average duration of successful and unsuccessful procedures was 121.5 min and 183.3 min, respectively. The average length of postoperative hospital stay was 3.5 days, and no instances of mortality or complications were recorded during the study. CONCLUSION: One-stage LC-ERCP procedure offered a promising treatment option for bile duct stones in Indonesia, particularly for patients registered under the National Healthcare Insurance System. This approach could serve as a viable alternative for facilities that lack proficiency in LC-CBDE skills. Furthermore, the ability to perform ERCP in a supine position is crucial in achieving a high success rate. The results of this study showed the need for advancements in Indonesian public healthcare facilities to meet the growing demand for improved treatment modalities.
ABSTRACT
Complicated intra-abdominal infections (cIAIs) lead to high morbidity and mortality, especially if poorly managed. However, Indonesia's microbial pattern and susceptibility data are limited, especially for new antibiotics. Ceftolozane/tazobactam (C/T) is reported to be a new potent antibiotic against various pathogens. Thus, we aim to investigate C/T in vitro activity against clinical isolates from cIAI patients. This prospective cross-sectional study was conducted in three major referral hospitals in Indonesia, including Dr. Cipto Mangunkusumo Hospital (Jakarta), Dr. Kariadi Hospital (Semarang), and Dr. Soetomo Hospital (Surabaya), enrolling those diagnosed with cIAIs. Blood specimens were collected before or after at least 72 h of the last antibiotic administration. Meanwhile, tissue biopsy/aspirate specimens were collected intraoperatively. These specimens were cultured, followed by a susceptibility test for specific pathogens. The minimum inhibitory concentration (MIC) of isolates was determined according to CLSI M100. Two-hundred-and-eighty-four patients were enrolled from 2019-2021. Blood culture was dominated by Gram-positive bacteria (GPB, n = 25, 52.1%), whereas abdominal tissue culture was dominated by Gram-negative bacteria (GNB, n = 268, 79.5%). The three most common organisms were GNB, including E. coli, K. pneumoniae, and P. aeruginosa. C/T was susceptible in 96.7%, 70.2%, and 94.1% of the E. coli, K. pneumoniae, and P. aeruginosa isolates, respectively. In addition, C/T also remained active against ESBL Enterobacterales and carbapenem-non-susceptible P. aeruginosa. Overall, C/T demonstrates a high potency against GNB isolates and can be considered an agent for carbapenem-sparing strategy for cIAI patients as the susceptibility is proven.
