ABSTRACT
Introduction: In this study, we aimed to retrospectively evaluate the characteristics of mucormycosis cases seen in our clinic during the COVID-19 pandemic, the management of their treatment and the SARS-CoV-2 variants that were dominant at that time. Method(s): The medical records of patients diagnosed with rhino-orbital mucormycosis between March 2020 and July 2022 were retrospectively evaluated. Result(s): Nine patients were diagnosed with rhino-orbital mucormycosis. Of these patients, six were male and three were female, and the patients were between the ages of 65-75 (mean 69.2). After the diagnosis of mucormycosis, antifungal treatment was initiated with liposomal amphotericin-B. Eight patients underwent surgery within 48 hours, only one patient refused to undergo surgery. Conclussions: Mucormycosis is a rapidly progressing opportunistic fungal infection. Therefore, the most basic criteria determining mortality is the early detection of about mucormycosis infection and to diagnose it as soon as possible, especially in patients with an underlying immunosuppressive condition. Once a diagnosis of mucormucosis has been established, risk factors, especially blood sugar regulation, should be corrected. Furthermore, systemic and local antifungal therapy shuold be initiated, and urgent debridement should be performed. Copyright © 2022, Geriatrics Society. All rights reserved.
ABSTRACT
Background: Pancreatic pseudocyst (PPC) is the rare complication of pancreatitis. Unlike to adults, it is ensued due to malunion of pancreatic ducts, autoimmune or frequently post-traumatic. During follow up although it might resolve by conservative treatment, may necessitate interventional approaches. Even endoscopic or percutaneous treatments have been the first line treatment, surgery is inevitably necessary in case of complicated or>6 cm diameter. In this study laparoscopic Roux-en-Y cysto-jejunostomy (LRYCJ), to complicated PPC that did not respond to percutaneous drainage, has been presented. Method(s): A 15-year-old boy had been admitted to state hospital with the complains of vomiting, epigastric pain two weeks after SARSCoV- 2 (SARSC2) virus infection. He has been following due to Autism. Initially he had been treated conservatively due to pancreatitis. One month after, PPC (20 mm) distal to pancreas had been specified. He was referred to our department as the cyst got bigger (75 mm) with recurrent complains. No ductal connection was identified however thrombosis of splenic vein, dilated collateral and distal esophageal variceal veins was detected. Ultrasound guided percutaneous drainage has been performed however two weeks after, 95175 mm PPC at the same location was detected. LRYCJ was performed with four ports via suspending stomach and transvers colon. While Roux-en-Y has been performed through expanded umbilical incision cysto-jejunostomy was intracorporeally performed. Penrose drain was left close to cysto-jejunostomy. Oral feeding has begun on postoperative day 2, drain was removed on day 3. Fullfed and discharged on postoperative day 4. Patient did well after a follow up of 3 months. Conclusion(s): Consequently, our case is the first reported PPC following pancreatitis owing to SARSC2 virus infection. Even endoscopic or percutaneous drainage is the most preferred approach for PPC, in case of large cyst or complicated ones, cysto-jejunostomy could be applied by minimally invasive approach in children also.
ABSTRACT
Background: Estrogen receptors (ER) are predictive of endocrine responsiveness. However, 30% of ER+ BC patients will relapse despite adjuvant ET and 10 to 20% of metastatic lesions loose the expression of ER. The early identification of endocrine resistant patients may help to improve treatment strategies, especially in the light of innovative drugs recently approved. In the ET-FES trial we evaluated 18F-FES CT/PET as a prediction tool for endocrine responsiveness in ER+ MBC. The ET-FES study was funded by the ERANET-Transcan project. Methods: MBC patients with ER+/HER2- disease, were eligible for the ET/FES study. All patients underwent a baseline [18]F-FES PET/CT in addition to conventional procedures. Patients were classified as endocrine sensitive if overall Standardized Uptake Value (SUV) ≥ 2 and received ET;patients with SUV <2 were randomized to receive ET or chemotherapy (CT). The prognostic role of [18]F-FES PET/CT was assessed for PFS and OS by univariate and multivariate analyses. The primary endpoint was disease progression rate (DPR) at 6 months. Results: From April 2015 to October 2020 146 patients, from 7 EU centers were enrolled: of them, 115 with a mean SUV >2 received ET and 30 with SUV <2 were included in the randomized study. Median follow up was 18.4 months (range 8.0 to 38.3 months) in endocrine sensitive patients (SUV > 2) versus 10.1 months (range 8.0 to 36.8) in patients with SUV <2. Overall, at the time of this analysis 67 patients (45.9%) had disease progression and 37 (25.3%) died. DPR at 6 months was 57% in patients with SUV >2 vs 50% in SUV <2 randomized to ET and 57% in case of CT. DPR at 12 months was 35% vs 17% and 14%, respectively. Median PFS was 7.3 months (IQR 3.8 – 17.3) vs 5.2 (IQR 3.1 – 9.4) vs 7.7 months (IQR 3.0 – 14.0), respectively. OS rate at 12 months was 31% versus 17% versus 14%. Conclusions: The ET-FES clinical trial was prematurely interrupted, due to COVID-19 pandemic. The discriminating ability of this assay was high, leading to a personalized endocrine approach;a considerable proportion of patients with a mean SUV >2 is still on ET. Clinical trial identification: EudraCT 2013-000287-29. Legal entity responsible for the study: Alessandra Gennari - Università del Piemonte Orientale. Funding: AIRC. Disclosure: All authors have declared no conflicts of interest.