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BMJ Case Rep ; 14(11)2021 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-34753726


Renal cell carcinoma (RCC) frequently presents with osseous metastasis, predominantly lytic and prone to pathological fracture. The metastatic lesion in the extremity presents with local swelling, pain and immobility due to pathological fracture. The solitary or oligometastatic lesions should be treated with curative intent, which can help the patient to lead a more prolonged and disability-free life. The RCCs and their metastases are hypervascular with an exuberant arterial supply. Surgery can lead to uncontrolled life-threatening haemorrhage. Preoperative transarterial embolisation reduces tumour vascularity significantly and reduces intraoperative blood loss. We present a 46-year-old male patient with solitary hypervascular metastatic recurrence of RCC with a pathological femoral fracture with an infeasible initial surgery due to profuse haemorrhage. He was successfully treated by preoperative transarterial embolisation, followed by surgical resection and implantation of a megaprosthesis. Multidisciplinary management reduces patient morbidity and mortality with successful treatment in solitary hypervascular metastasis from RCC.

Carcinoma de Células Renais , Embolização Terapêutica , Fraturas do Fêmur , Fraturas Espontâneas , Neoplasias Renais , Carcinoma de Células Renais/complicações , Fraturas do Fêmur/diagnóstico por imagem , Fraturas do Fêmur/etiologia , Fraturas Espontâneas/etiologia , Fraturas Espontâneas/terapia , Humanos , Neoplasias Renais/complicações , Masculino , Pessoa de Meia-Idade
J Fungi (Basel) ; 7(8)2021 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-34436209


Mucormycosis due to Cunninghamella spp. is a rare disease, especially in immunocompetent individuals. Here, we describe the isolation and characterization of a new species of Cunninghamella, causing chronic rhino-orbital-cerebral disease, and review cases of mucormycosis due to Cunninghamella spp. in immunocompetent individuals. The Basic Local Alignment Search Tool (BLAST) analysis of the internal transcribed spacer region (ITS) sequence of isolate NCCPF 890012 showed 90% similarity with Cunninghamella bigelovii, while the large ribosomal subunit (28S) and translation elongation factor-1 alpha (EF-1 alpha) gene sequences showed 98% identity. Further, the phylogenetic analysis with concatenated sequences clustered isolate (NCCPF 890012) closely with C. bigelovii. The ITS sequence showed the maximum variation among three genes analyzed and helped in the new species' delineation. Comparison of the assembled whole genome of NCCPF 890012 with other Mucorales using 123 single-copy orthologous genes showed clustering within the genus Cunninghamella. Based on these findings, the isolate is considered to be a new species of Cunninghamella and designated as Cunninghamella arunalokei sp. nov. Despite repeated debridement and antifungal treatment, the patient had multiple recurrences with intracranial extension and succumbed to the illness.

BMJ Case Rep ; 14(2)2021 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-33541987


An 88-year-old man presented to the emergency department with exertional dyspnoea and orthopnoea. Clinical examination revealed mildly raised jugular venous pressure, increased respiratory rate, palpable non-tender hepatomegaly and reduced right basal breath sounds. Ultrasonography showed a large right simple hepatic cyst, multiple small left hepatic and renal cysts. A non-contrast CT scan revealed a large, right hepatic thin-walled cyst of volume 4.2 L, exhibiting few thin septae and tiny nodular mural calcifications. Pressure effects were elevated right haemidiaphragm, right atrial compression and adjacent atelectasis. He had a similar episode 2 years ago, treated by percutaneous needle aspiration. Giant simple hepatic cysts are rare and present when symptomatic due to pain, mass effect on adjacent organs, infection or rupture. These may unusually cause dyspnoea or orthopnoea by compressing cardiac chambers. Simple aspiration has a high recurrence rate. Percutaneous sclerosant injection, laparoscopic deroofing and cystectomy are better treatment modalities.

Cistos/complicações , Cistos/diagnóstico por imagem , Dispneia/etiologia , Fígado , Idoso de 80 Anos ou mais , Humanos , Masculino , Paracentese , Recidiva , Tomografia Computadorizada por Raios X , Ultrassonografia
Am J Phys Med Rehabil ; 98(7): 549-557, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30676339


OBJECTIVE: The aim of the study was to compare the effects of single intra-articular platelet-rich plasma (PRP) and corticosteroid (CS) injections in patients with adhesive capsulitis of the shoulder. DESIGN: Patients aged 18-70 yrs of either sex, diagnosed with adhesive capsulitis of shoulder, with less than 6-mo duration, were included. In intra-articular corticosteroid (IA-CS, control) group, 30 patients received a single injection (4 ml) of IA-CS and in IA-PRP (test) group, 30 patients received single IA-PRP injection (4 ml) into the glenohumeral joint under ultrasound guidance. All patients were prospectively followed for 12 wks. RESULTS: Twenty-eight patients in IA-PRP group and 27 in IA-CS group finished the entire 12-wk study period. At 12 wks, decrements in visual analog scale and total shoulder pain and disability index scores, in IA-PRP group, were 58.4 and 55.1, compared with 48.7 and 45.8 in IA-CS group. In range of movement, IA-PRP group showed significant improvement in passive abduction (-50.4 vs. -39.4), internal (-36.8 vs. -25.8), and external rotations (-35.4 vs. -25.9) compared with IA-CS group, respectively. No major complications were observed in any patients. CONCLUSIONS: At 12-wk follow-up, a single dose of IA-PRP injection was found to be more effective than an IA-CS injection, in terms of improving pain, disability, and shoulder range of movement in patients with adhesive capsulitis of the shoulder.

Corticosteroides/administração & dosagem , Bursite/tratamento farmacológico , Plasma Rico em Plaquetas , Dor de Ombro/tratamento farmacológico , Adulto , Idoso , Bursite/complicações , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Humanos , Injeções Intra-Articulares , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/prevenção & controle , Medição da Dor , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Dor de Ombro/etiologia , Adulto Jovem
Int J Appl Basic Med Res ; 7(4): 272-274, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29308370


Sickle cell trait is a highly prevalent condition. It is not a disease. However, it has been associated with few rare complications. Splenic infarction is one among them. The altitude-related hypoxia is the most common predisposing factor for this. The simultaneous occurrence of this complication in more than one member of a family is so rare that possibly, it is the only second such case report. We encountered this in two members of a family, the father and his son. They were on a religious visit to a 12,756 feet high mountain cave, when they developed pain left upper abdomen. A thorough workup including contrast-enhanced computed tomography abdomen established the diagnosis. Both recovered uneventfully on the conservative management. As it is a rare occurrence, the finding must be interpreted carefully. There is no need to screen the individuals for sickle cell trait before high-altitude travel.