ABSTRACT
BACKGROUND: Clear cell sarcoma is a very rare malignant tumor originating from neural crest cells, the tumor most commonly affects the lower limbs but there have been few cases reported to affect the trunk and para spinal area. Patients with Para spinal sarcoma have a variety of clinical presentations and a variable prognosis depending on several prognostic factors including tumor size. CASE PRESENTATION: A 14-year-old male patient presented with paraplegia for one month duration and he was diagnosed later on to have a paraspinal clear cell sarcoma at D12-L1 level. A wide local excision was made and patient was referred for oncology treatment. However, the patient came back to the same hospital after two months due to the recurrence of the tumor at the same site. CONCLUSION: Clear cell sarcoma, although rare, can affect the spine and present with weakness, paraplegia and backache. It also affects people from all age groups and can have a high metastatic rate and a high recurrence rate.
ABSTRACT
BACKGROUND: Conservative methods for weight loss are usually disappointing. Therefore, surgeries such as Laparoscopic Sleeve Gastrectomy (LSG) should be considered. We aimed to evaluate the outcomes (body mass index; BMI) of LSG among obesity patients in the Northern West Bank. METHODS: Hospital records were reviewed for all patients who had undergone LSG since 2010 in Arab specialized hospital in Nablus and Palestinian Red Crescent society hospital in Tulkarem. Then, patients have been invited again to participate in the study and asked to self-report further pre-/post-operative measures. The primary study outcome was the change in BMI while secondary outcomes included obesity associated co-morbidities' measures; hypertension (HTN) and diabetes mellitus (DM). RESULTS: The mean age (standard deviation; SD) of the study participants (n = 30; 20 women and 10 men) was 34.06 (10.71) years. The mean (SD) follow-up time was 7.16 (5.05) months. The mean ± SD of the pre-operative BMI was 47.23 ± 7.89 kg/m2 while 36.74 ± 7.74 kg/m2 post-operatively (95% CI for mean differences and P-value; 8.83-12.14 and 0.001). For the clinically diagnosed hypertensive patients, there was a mean (SD) reduction of 27.50 (9.87) mm Hg in systolic pressure (P < 0.026) and 18.33 (13.66) of the diastolic blood pressure (P < 0.042). For diabetics, there were clinically and biologically clear mean (SD) reductions in fasting blood sugar and glycated hemoglobin A1c of about 82.00 (22.70) mg/dl and 1.90 (0.78) %; respectively. Only practicing sports or exercise (no/yes) remained significant with post-operative BMI (regression coefficient B = -7.33; P-value and 95% CI for B; 0.009 and -12.68- -1.98). CONCLUSIONS: LSG can significantly improve BMI and could improve or resolve obesity associated co-morbidities like HTN and DM. LSG could be recommended for co-morbid obesity patients who fail to reach beneficial results from a structured weight loss programs.
