Journal of Case Reports in Practice
Volume:2 Issue: 3, Jul 2014

Prostate cancer remains the most common malignancy among men and second leading cause of cancer related mortality. American cancer society recommends screening of all men more than 50 years of age and men with their first degree relative who had prostate cancer to undergo screening starting from 40 years of age. Screening involves estimation of prostatic specific antigen and digital rectal examination. Almost all patients with metastatic prostate cancer present with raised prostate specific antigen. Gleason score is also another factor which accounts for mortality. high scores are associated with more advanced disease. We report a case where patient presented with metastatic prostatic carcinoma with PSA level in grey zone and low Gleason score.

Breakage of epidural catheter is a rare and worrisome complication. However, if this happens, the presence of retained epidural catheter fragment should be properly documented and should also be informed to the surgical team as well as to the patient. Visualization of retained catheter is difficult even with modern radiological imaging techniques and active surgical intervention should be reserved only for symptomatic cases. The usual guidelines and precautions for insertion and removal of catheter should strictly be followed on a routine basis to avoid such complication. Here we report a case with such complication in which catheter broke during insertion, the reason of which could be attributed to a multiple cause.

We describe a 25-year-old carpenter who was accidently injured by a nail gun. The nail penetrated the left side of the chest and settled behind the sternum. After stabilizing the patient, transthoracic echocardiography and Computed Tomography (CT) scan of the chest accurately diagnosed the cardiac injury and determined the site of the nail. Through median sternotomy, the nail was extracted and hemopericardium was evacuated. Fortunately, the lesion found in the right ventricle was non-penetrating. The patient had uneventful postoperative course and discharged in stable condition.

Epithelioid hemangioendothelioma (EH) is a rare neoplasm of vascular orgin with uncertain malignant potential, known to involve many organs. In terms of behavior it is considered to be intermediate between angiomas at the benign end and angiosarcoma at the malignant end. The rarity of the condition, non specific symptoms and lack of clinical experience can cause misdiagnosis. EH can present as a single organ disease or involve several organs, either as concurrent disease or as metastatic disease. The involvement of multiple organs can result in EH being mistaken for other conditions like metastatic carcinoma, granulomatous diseases etc, at the clinical and radiological level. We are presenting a case of EH with multiorgan involvement. With a clinical and radiological diagnosis of metastatic carcinoma a trucut biopsy was taken from liver. Diagnosis of EH was made based on histopathological and immunohistochemical findings. We are presenting this case to highlight the importance of knowing this entity so that diagnostic errors and subsequent treatment for unrelated conditions can be avoided.

Endocarditis with atypical organisms poses a diagnostic and therapeutic challenge to physicians despite medical and surgical advances. Pseudomonas aeruginosa endocarditis is rare, especially in the absence of intravenous drug use (IVDU). Here, we present a case of non-IVDU, prosthetic aortic valve P. aeruginosa endocarditis associated with sigmoid carcinoma. A seventy five year old gentleman with a bioprosthetic aortic valve presented with pyrexia on and off for six months and a 6 month history of weight loss. Three sets of blood cultures grew pseudomonas Aureginosa. A CT scan was done to find the source of the infection and showed a partially obstructive lesion of the sigmoid colon which was later biopsied and found to be moderately differentiated adenocarcinoma. A Trans-oesophageal echocardiogram (TOE) showed a large 2.7cm mobile mass attached to all three leaflets of the aortic valve. He was started on Augmentin initially and then changed to tazocin and ciprofloxacin. Gentamicin was added in later and the tazocin changed to meropenem. He continued to spike. One month post admission he had a redo aortic valve replacement to a tertiary care center. Despite his redo surgery he continued to spike and continued to grow pseudomonas aureginosa from his blood cultures. He passed away three months post-admission after deteriorating further.

Tanycytic cells are common progenitor cells of both ependymal cells and astrocytes. It is commonly seen in pediatric population but all ages are affected. The common location of intracranial ependymoma is the fourth ventricle. We report an adult female who presented with intrathecal mass posterior to Lumbar 1 and Lumbar 2 intervertebral disk spaces. She underwent thoracic-lumbar (T12, L2-L3) laminectomy with excision of the intramedullary tumor. The tumor was dissected down to the tip of the conus medullaris and it was gross total resection of tumor. Final pathology confirmed portions of a moderately hypercellular neoplasm composed of bland, uniform cells with small round nuclei, stippled chromatin and abundant eosinophilic cytoplasm that in some areas forms long fibrillary processes. She was not offered any adjuvant radiation treatment. In conclusion it is very important to distinguish from diffuse astrocytoma, which usually cannot be totally excised. Tanycytic ependymomas usually carry better prognosis as compared to other variant of ependymomas and astrocytomas. The objective of our case report is to document the radiological and typical ependymal features of the neoplasm and to increase awareness in oncology community.

Primary renal synovial sarcoma is a rare tumor, with a poor prognosis which must be differentiated from other renal tumors. We report a new case of renal synovial sarcoma in a 60 year-old man. Histologic examination showed a proliferation of monomorphic spindle cells arranged in fascicles with hemangiopericytomatous pattern. Tumor cells were immunoreactive for bcl2, CD99, cytokeratin and epithelial membrane antigen. The diagnosis of spindle cell type monophasic synovial sarcoma was proposed and confirmed by fluorescence in situ hybridization. Patient was treated with chemotherapy. He developed bone and liver metastasis and died 7 months after nephrectomy. The diagnosis of renal synovial sarcoma is based on histological and immunohistochemical studies and must be confirmed by molecular techniques which showed the translocation t (X; 18).

Complementary and alternative medicine (CAM) is a treatment modality that is not part of conventional and standard medical treatment and are used along with the conventional therapies. Nowadays, complementary alternative medicine is used by many patients around the world. This study discussed the prevalence of different types of complementary and alternative medicine used among patients attending the rheumatology clinics in Yazd. 350 patients who referred to rheumatology clinics in Yazd, Iran, were included in a cross sectional study over 17 weeks. The patients were at least 20 years old with known rheumatology disorder lasting at least for three months. Of the total 350 patients, 71 (20.3%) were male and 279 (79.7%) were female. 235 (67.1%) patients used CAM. The mean age of patients who used CAM was 46.8 years. Use of CAM was higher in females compared to males. (82.2% vs. 17.8%). Patients with rheumatoid arthritis, low back pain, osteoarthritis had more predilections for using CAM. Herbal medicine, restricted diet and hydrotherapy were the most used modalities. The most reasons for using different types of CAM were positive history for their effectiveness and usefulness as complementary to other methods of treatment. Using CAM among r heumat ol ogic pat ient s in Ir an (Yazd pr ovince) is r eal ly pr eval ent among educated, high income, married and upper age people. The most used CAM methods were herbals, restricted diet and hydrotherapy.