Estradanikolajsen3095

Invasive urothelial carcinoma shows marked propensity for divergent differentiation. Several of these 'variant' morphologies have been described in literature and recognised in the 2004 WHO classification. In this report, we detail a case of bladder tumour, diagnosed to be a lipid-rich variant on histopathology after transurethral resection of bladder tumour. Our case encompasses the complete clinical spectrum of this rare and aggressive subtype of urothelial carcinoma starting from initial presentation to postoperative follow-up and recurrence. A keen eye for recognising these variants can ensure a timely diagnosis of these variant and administration of a therapy distinctive from that used in conventional invasive urothelial carcinoma.COVID-19 has now emerged from a respiratory illness to a systemic viral illness with multisystem involvement. There is still a lot to learn about this illness as new disease associations with COVID-19 emerge consistently. We present a unique case of a neurological manifestation of a patient with structural brain disease who was COVID-19 positive and developed mental status changes, new-onset seizures and findings suggestive of viral meningitis on lumbar puncture. We also review the literature and discuss our case in the context of the other cases reported. We highlight the value of considering seizures and encephalopathy as one of the presenting features of COVID-19 disease.Calciphylaxis is a rare life-threatening condition, with calcification of small and medium-sized vessels leading to skin necrosis. It has a high morbidity and mortality, and most of the patients die from wound superinfection and sepsis. A 48-year-old man with a history of end-stage renal disease on haemodialysis and Coumadin therapy for venous thromboembolism presented with pulmonary oedema after missing two haemodialysis treatment. At examination, he had bilateral lower extremity dark brown, possibly necrotic, painful ulcers. He was diagnosed with calciphylaxis and treated with sevelamer hydrochloride, low calcium dialysate and sodium thiosulfate with haemodialysis. He received daily wound care with topical collagenase. After daily wound care treatment for 4 months, the patient's ulcers completely healed. The patient had been followed for 8 months, which included 29 additional readmissions, 3 admissions related to bacteraemia and 26 admissions with the diagnosis of pulmonary oedema and hyperkalaemia requiring haemodialysis.Peritonitis remains a common and serious complication of peritoneal dialysis. Peritonitis caused by gram-positive organisms includes coagulase-negative staphylococci, Streptococcus spp and Enterococcus spp. We present a rare case of peritoneal dialysis-associated peritonitis, where persisting abdominal pain and worsening laboratory findings despite antibiotic therapy led to the identification of Enterococcus avium, requiring Tenckoff catheter removal and temporary transfer to haemodialysis. The available literature reports only few cases where peritonitis is caused by this agent, underlining the need to consider atypical microbial agents when heterogeneous clinical course is presented.Colonoscopy is the gold-standard tool to investigate the colon which also allows to biopsy or treat intraluminal pathologies. About 900 000 colonoscopies are performed annually in UK. It is considered a relatively safe procedure; however, some serious complications might take place. The common complications of colonoscopy are bleeding and perforation. Splenic injury is a rare complication of colonoscopy which can be fatal. Our case report describes a grade two subscapular splenic haematoma after routine colonoscopy that has been managed conservatively.Congenital hyperinsulinism (CHI) characterised by inappropriate secretion of insulin despite low blood glucose can result in irreversible brain damage if not promptly treated. The most common genetic cause of hyperinsulinism is the pathogenic variants in ABCC8 and KCNJ11, causing dysregulated insulin secretion. Rapid testing is crucial for all patients because finding a mutation significantly impacts this condition's clinical management. We report a rare case of focal CHI after a homozygous KCNJ11 mutation who underwent a selective lesionectomy and required octreotide for euglycaemia.We report a case of a 73-year-old female patient, who was admitted to the coronary care unit due to chest pain, malaise and near syncope. During physical examination, the patient was hypotensive and there were signs of left-sided heart failure and a loud systolic murmur. Echocardiogram showed apical ballooning with dynamic left ventricular outflow tract obstruction, based on systolic anterior motion of the mitral valve with important mitral valve regurgitation. In the acute setting, the cardiogenic shock was treated cautiously with fluid resuscitation and intravenous metoprolol, resulting in direct stabilisation of her haemodynamic condition. As a codiagnosis, there was a significant stenosis of left anterior descending artery, which was treated successfully by percutaneous coronary intervention with drug eluting stents. During follow-up, left ventricular function normalised, and the left ventricular outflow tract obstruction, systolic anterior motion of mitral valve and related mitral regurgitation all resolved.Hydroxychloroquine has been widely prescribed to treat patients with COVID-19 pneumonia. read more A 73-year-0ld woman with COVID-19 pneumonia was treated with dexamethasone and hydroxychloroquine. Her home medications, citalopram and donepezil, were continued. The ECG prior to starting hydroxychloroquine showed normal sinus rhythm with prolonged corrected QT (QTc) of 497 ms, due to citalopram and donepezil therapy. Repeat ECG on days 3 and 4 of hydroxychloroquine therapy showed significantly prolonged QTc of 557 ms and 538 ms, respectively, despite normal serum electrolytes. All QT-prolonging medications including hydroxychloroquine were discontinued on day 4; however, she suffered a transient torsades de pointes lasting for about 15 s, which resolved before any intervention. QTc improved to 477 ms, after discontinuation of QT-prolonging medications. The patient had QTc prolongation and torsades de pointes due to therapy with multiple QT-prolonging medications. Medicine reconciliation and careful monitoring of QTc may help prevent cardiac complications in patients with COVID-19 treated with hydroxychloroquine.A 50-year-old woman presented with a right-sided isolated third cranial nerve palsy. MRI brain showed a mass lesion arising from the right clivus with extension into the cavernous sinus. Blood investigations and bone marrow biopsy were suggestive of multiple myeloma with hypercalcaemia and renal dysfunction. It was unclear at first if the intracranial lesion was due to myelomatous involvement or a separate disease entirely. The patient declined consent for a biopsy and cerebrospinal fluid analysis was inconclusive. She was treated with bortezomib based chemotherapy and the palsy resolved by day 6, which helped clinch the rare diagnosis of central nervous system (CNS) involvement by multiple myeloma. Most patients with CNS myeloma have a dismal survival of under 6 months but she is on therapy for relapse 26 months after diagnosis. While placed under the umbrella of CNS myeloma, patients with osteodural myeloma have better outcomes, perhaps due to their distinct aetiopathogenesis.Acute cholangitis is a condition of bacterial infection following hepatobiliary tract obstruction, which signifies poor prognosis unless adequately drained. The most common cause of bile duct obstruction is choledocholithiasis, in contrast to parasitic infestation, a rare entity causing acute cholangitis nowadays. Therefore, we reported the case of a 68-year-old Thai man who presented with acute fever, intense right upper quadrant abdominal pain and jaundice for 2 days. His medical history was normal except for the history of intermittent biliary colic for a year. Endoscopic retrograde cholangiography was performed and demonstrated multiple, creamy-coloured roundworms coming out from the ampulla of Vater as well as a tubular filling defect in dilated common bile duct from cholangiography. He was diagnosed with acute cholangitis by biliary ascariasis and underwent endoscopic parasitic removal, which subsequently improved symptoms.Ellis-van Creveld (EVC) syndrome is a relatively rare chondroectodermal dysplasia considered mainly as a generalised disorder of the maturation of endochondral ossification. Congenital heart disease occurs in approximately half of the patients with EVC syndrome, 60% of which is a common atrium. Common atrium is a rare variety of interatrial communication characterised by absence or virtual absence of the atrial septum. Patients with this syndrome rarely survive to an old age. We report a case of EVC who presented for the first time at 60 years of age, as survival to an advanced age is exceptional in case of EVC.Medium chain acyl-CoA dehydrogenase deficiency (MCADD) is an autosomal recessive fatty acid β-oxidation defect. The enzyme, medium chain acyl-CoA dehydrogenase is important in the breakdown of medium chain fats into acetyl-CoA to produce ketones. Ketones are used as an alternative energy source when glucose or hepatic glycogen stores become depleted during prolonged fasting. In MCADD during periods of fasting or acute illness, there are insufficient ketones to compensate for the glucose energy deficit, resulting in an hypoketotic hypoglycaemia alongside a build-up of fatty acids. This build-up of fatty acids can be neurotoxic and lead to altered brain function and even unexpected death. Management includes avoiding prolonged periods of starvation, consuming high carbohydrate drinks during periods of illness and in symptomatic patients, reversal of catabolism and sustained anabolism by provision of simple carbohydrates by mouth or intravenously. Coexistence of MCADD and type 1 diabetes (T1D) is rare, there is no causal association though there are some documented cases. A key goal of management in T1D is achievement of good glycaemic control to reduce risk of long-term complications. This can in some cases increase the risk of hypoglycaemia which can be catastrophic in the presence of MCAD.Human herpes virus-6 (HHV-6) infection is a common infection in the paediatric population and is increasingly reported in immunosuppressed adult patients. It has been reported as the causative agent of disease in few case reports in immunocompetent adults. We report herein an unusual case of HHV-6-associated viraemia, pneumonitis and meningitis in a patient who presented with dyspnoea, hypoxia, dry cough and headache. She was treated for atypical pneumonia with no improvement. Meningitis was suspected as headache kept worsening. HHV-6B was detected by PCR in the cerebrospinal fluid, and subsequently, in the bronchoalveolar lavage and serum samples. Studies were negative for the most common primary and secondary immunodeficiency syndromes, and serology could not be performed to differentiate virus reactivation from a primary infection. The patient was successfully treated with ganciclovir and had no residual sequelae.Monoclonal gammopathy of undetermined significance (MGUS)-associated involvement of the peripheral nervous system is widely reported in the literature. At the same time, involvement of central nervous system (CNS) occurs far less frequently. Analysing the reported cases, almost all the authors pose the question whether there is a relationship between CNS involvement and MGUS, and at what stage it is necessary to begin therapy of haematological disorders. The limited number of reported cases precludes us from getting a definite answer to these questions, thus making further accumulation of clinical data highly relevant. In this article, we present two cases of CNS involvement in patients with MGUS, which, in our opinion, may suggest the existence of a causal relationship between MGUS and CNS involvement. Currently, the above hypothesis cannot be taken as proved due to the lack of a sufficient number of clinical observations and scientific studies. Therefore, the issue of MGUS-associated CNS involvement requires further research.