1
|
Salif A, Bigirimana F, Willems S, Reichman G, Noels J, Wijngaert SVD, Lecomte S, Maillart E, Clevenbergh P. Bacillus Calmette-Guérin (BCG) prostato-epididymitis in a patient treated for a non-invasive urothelial cancer: A case report. IDCases 2024; 36:e01967. [PMID: 38699528 PMCID: PMC11064455 DOI: 10.1016/j.idcr.2024.e01967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/26/2024] [Accepted: 04/14/2024] [Indexed: 05/05/2024] Open
Abstract
Introduction The Bacillus Calmette-Guérin (BCG) used as anti-tuberculous vaccine is also a well-known therapy for superficial urothelial cancer. Local or general side effects can occur, although it is generally well tolerated. Case We present the case of a 65 year-old caucasian man consulting for gross hematuria and lower urinary tract symptoms. Magnetic resonance imaging (MRI) demonstrated a non-invasive urothelial carcinoma (NMIBC) and Prostate Imaging-Reporting and Data System (PIRADS) IV lesions. Transurethral resection of the bladder tumor revealed a non-invasive transitional cell carcinoma. Intravesical Bacillus Calmette Guerin (BCG) therapy was provided. After 6 intravesical instillations, the patient presented with prostato-epididymitis. Forthcoming BCG instillations were canceled, and cancer treatment was switched to epirubicine. Treatment with ethambutol, rifampicin and isoniazid was started with rapid resolution of the symptoms. Urinary and semen cultures grew Mycobacterium tuberculosis complex strain BCG. As prostate specific antigen (PSA) rose, prostate's biopsies were performed showing extensive necrosis boarded by granulomas without signs of malignancy. Discussion BCGitis is a rare complication in patients treated for non-invasive urothelial cancer. Several risk factors, local and systemic, should be considered prior to this immunotherapy. BCGitis (local or disseminated) or hypersensitivity reactions to BCG must be included in the differential diagnosis even if therapy was administered several years before the symptoms. Adequate treatment must be started as fast as possible to avoid serious complications.
Collapse
Affiliation(s)
- Ayemane Salif
- Department of Surgery, Brugmann University Hospital, Free University of Brussels, Brussels, Belgium
| | - Ferdinand Bigirimana
- Department of Infectious Diseases, Brugmann University Hospital, Free University of Brussels, Brussels, Belgium
| | - Sophie Willems
- Department of Infectious Diseases, Brugmann University Hospital, Free University of Brussels, Brussels, Belgium
| | - Gina Reichman
- Department of Infectious Diseases, Brugmann University Hospital, Free University of Brussels, Brussels, Belgium
| | - Johanna Noels
- Department of Infectious Diseases, Brugmann University Hospital, Free University of Brussels, Brussels, Belgium
| | - Sigi Van Den Wijngaert
- Department of Microbiology, University Laboratory of Brussels, LHUB-ULB, Free University of Brussels, Brussels, Belgium
| | - Sophie Lecomte
- Pathology department, Brugmann University Hospital, Free University of Brussels, Brussels, Belgium
| | - Evelyne Maillart
- Department of Infectious Diseases, Brugmann University Hospital, Free University of Brussels, Brussels, Belgium
| | - Philippe Clevenbergh
- Department of Infectious Diseases, Brugmann University Hospital, Free University of Brussels, Brussels, Belgium
| |
Collapse
|
2
|
He Q, Xiong Y, Yu Y, Chen Z. Transarterial embolization for enoxaparin-induced massive abdominal wall hematoma: A case report and literature review. Asian J Surg 2024; 47:1865-1866. [PMID: 38185548 DOI: 10.1016/j.asjsur.2023.12.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 12/25/2023] [Indexed: 01/09/2024] Open
Affiliation(s)
- Qifan He
- Department of Radiology, Haining People's Hospital, Jiaxing, Zhejiang, China
| | - Yue Xiong
- Department of Radiology, Haining People's Hospital, Jiaxing, Zhejiang, China
| | - Yihui Yu
- Department of Radiology, Haining People's Hospital, Jiaxing, Zhejiang, China
| | - Zhonghua Chen
- Department of Radiology, Haining People's Hospital, Jiaxing, Zhejiang, China.
| |
Collapse
|
3
|
Hasegawa J, Nishimura Y, Saji S. Ectopic uterine cervical ripening dilator. J Med Ultrason (2001) 2024; 51:145-146. [PMID: 37715881 DOI: 10.1007/s10396-023-01361-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/15/2023] [Indexed: 09/18/2023]
Affiliation(s)
- Junichi Hasegawa
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan.
| | - Yoko Nishimura
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Shota Saji
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan
| |
Collapse
|
4
|
Khdhir M, Jabbour Y, Azzi C, El-Alam R, Muallem N, Moukaddam H. Complications associated with improper palpation-guided iliac bone marrow biopsy tracts identified on follow-up imaging. Skeletal Radiol 2022; 51:2155-2166. [PMID: 35612650 DOI: 10.1007/s00256-022-04078-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/13/2022] [Accepted: 05/19/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Bone marrow biopsy complications are rare. Our aim is to study the association of improper palpation-guided iliac biopsy tract with complications. MATERIALS AND METHODS This is a retrospective study of adult patients who underwent iliac bone marrow biopsy without image guidance at our hospital from January 2019 to January 2021, and have cross-sectional radiologic imaging of the pelvis within 30 days following the procedure. Electronic health records were reviewed for clinical data. Two radiologists reviewed images of the pelvis for assessment of biopsy tract and complications. RESULTS A total of 443 procedures were included in 309 patients, mean age 53.4 ± 18.1 years, 112 females (36.2%). In addition, 332 tracts were proper (75%), 97 improper (22%), and 14 unidentified (3%). All 11 complications occurred in procedures with improper tracts; nine bleeding, one fracture, and one facet joint injury. Improper tract was significantly associated with complications (p < .001). There was no statistically significant association between platelet count, international normalized ratio, antiplatelet use and anticoagulant use, and presence of complications (p > .05). Body mass index and subcutaneous fat thickness overlying posterior superior iliac spine were not associated with improper tract (p > .05). Procedures performed by providers with ≤ 12 months' experience were significantly associated with improper tract (p < .001) and hence associated with complications (p = .007). CONCLUSION Improper tracts were common in palpation-guided iliac bone marrow biopsy and significantly associated with complications. No complications were encountered in proper tract procedures. Procedures performed by providers with ≤ 12 months' experience were significantly associated with improper tract and complications.
Collapse
Affiliation(s)
- Mihran Khdhir
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Riad El-Solh 1107 2020, PO Box 11-0236, Beirut, Lebanon.
| | - Yara Jabbour
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Riad El-Solh 1107 2020, PO Box 11-0236, Beirut, Lebanon
| | - Caline Azzi
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Riad El-Solh 1107 2020, PO Box 11-0236, Beirut, Lebanon
| | - Raquelle El-Alam
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Riad El-Solh 1107 2020, PO Box 11-0236, Beirut, Lebanon
| | - Nadim Muallem
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Riad El-Solh 1107 2020, PO Box 11-0236, Beirut, Lebanon
| | - Hicham Moukaddam
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Riad El-Solh 1107 2020, PO Box 11-0236, Beirut, Lebanon
| |
Collapse
|
5
|
Urabe D, Ide M, Matsuoka M, Miyake R. Iatrogenic right coronary artery occlusion during minimally invasive cardiac surgery-tricuspid annuloplasty-a case report. JA Clin Rep 2022; 8:81. [PMID: 36201119 PMCID: PMC9537403 DOI: 10.1186/s40981-022-00571-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 11/30/2022] Open
Abstract
Although rare, right coronary artery (RCA) injury is a serious complication of tricuspid annuloplasty (TAP) and warrants close attention. We report a case of ST elevation myocardial infarction secondary to iatrogenic RCA occlusion during minimally invasive cardiac surgery (MICS). Electrocardiography (ECG) revealed ST segment elevation in lead II. Transesophageal echocardiography (TEE) revealed inferior wall hypokinesis after cardiopulmonary bypass, and coronary angiography revealed peripheral RCA occlusion. Intraoperatively, we detected an atrioventricular groove deformity during the second surgical procedure. Wall motion and ECG abnormalities showed normalization after TAP was reestablished. Vigilant monitoring using TEE and ECG is important to detect intraoperative myocardial ischemia during MICS-TAP.
Collapse
Affiliation(s)
- Daichi Urabe
- grid.410843.a0000 0004 0466 8016Department of Anesthesia and Critical Care, Kobe City Medical Center General Hospital, 2-2-1, Minatojima-minamimachi, Chuo-ku, Kobe, Hyogo 650-0047 Japan
| | | | - Motoyuki Matsuoka
- grid.413465.10000 0004 1794 9028Department of Anesthesia, Akashi Medical Center, Akashi, Japan
| | - Ryuichiro Miyake
- grid.413465.10000 0004 1794 9028Department of Anesthesia, Akashi Medical Center, Akashi, Japan
| |
Collapse
|
6
|
Shakir HJ, Rooney PJ, Rangel-Castilla L, Yashar P, Levy EI. Treatment of iatrogenic V2 segment vertebral artery pseudoaneurysm using Pipeline flow-diverting stent. Surg Neurol Int 2017; 7:104. [PMID: 28168090 PMCID: PMC5223396 DOI: 10.4103/2152-7806.196235] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 10/27/2016] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Iatrogenic injury to the vertebral artery is a rare but potential complication of cervical spine surgery. Previous authors have commented on the use of flow-diverting stents for treatment of aneurysms of the V3 segment of the vertebral artery. CASE DESCRIPTION Here, we report a case in which injury occurred at the V2 segment of the vertebral artery with the development of a pseudoaneurysm, which was found on angiography. After decompressing the spinal cord from an epidural hematoma, the pseudoaneurysm was treated by deploying two Pipeline flow-diverting stents (Medtronic, Minneapolis, MN). Obliteration of the pseudoaneurysm was noted on follow-up angiography 4 days after the treatment. CONCLUSION This case highlights a unique treatment at a region which, to our knowledge, has not been mentioned in the literature.
Collapse
Affiliation(s)
- Hakeem J Shakir
- Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Patrick J Rooney
- Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Leonardo Rangel-Castilla
- Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Parham Yashar
- California Neurosurgical Institute, Valencia, California, USA
| | - Elad I Levy
- Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, New York, USA; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York, USA
| |
Collapse
|
7
|
Mehta RI, Mehta RI. Polymer-induced central nervous system complications following vascular procedures: spectrum of iatrogenic injuries and review of outcomes. Hum Pathol 2016; 53:178-90. [PMID: 27072640 DOI: 10.1016/j.humpath.2016.01.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 01/06/2016] [Accepted: 01/06/2016] [Indexed: 10/22/2022]
Abstract
Polymer substances are commonly applied as surface coatings on endovascular catheters and vascular devices. Adverse effects related to their use have been reported, although the overall clinical significance and appropriate methods of detection of these complications have been unclear. In this analysis, we systematically reviewed clinical and diagnostic features in 32 patients (age, 36-87years; mean, 59years) in whom intracranial polymer reactions were documented following vascular interventions. Associated neuroradiologic and neuropathologic findings were variable and included cerebral vasculitis or vasculopathy (63%), abscess or granuloma formation (38%), ischemic infarcts (28%), parenchymal hematomas (28%), white matter change (25%), and/or chemical meningitis (22%). Location(s) of polymer reactions varied and included sites adjacent to and/or downstream from instrument insertion or implantation. Presenting clinical signs included focal neurologic deficits (41%), headache (22%), constitutional symptoms (19%), meningitis (16%), seizure and/or involuntary movements (9%), coma (6%), and syncope (3%). Adverse outcomes included stroke (31%), death (28%), delayed communicating hydrocephalus (9%), steroid dependency (9%), steroid complications (6%), and cerebral volume loss (3%). In some cases, these complications necessitated increased cost and length of medical care. In this review, we highlight the diverse features of polymer-induced reactions involving the central nervous system and summarize distinct diagnostic patterns that may enable earlier premortem detection of these lesions in the postprocedural clinical setting. Further work in this area is necessary to identify additional etiologic, preventative and therapeutic strategies. These data have potentially broad implications pertaining to the safety, efficacy, standards of use, storage, manufacturing, and regulation of new and emerging vascular devices and polymer nanotechnologies.
Collapse
Affiliation(s)
- Rashi I Mehta
- Department of Radiology, State University of New York Upstate Medical University, Syracuse, NY 13210.
| | - Rupal I Mehta
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY 14642; Center for Neural Development and Disease (CNDD), University of Rochester Medical Center, Rochester, NY 14642
| |
Collapse
|
8
|
Abstract
Every form of medical and surgical treatment, even the most trivial one, carries with it some chance of complications. This risk is usually small, and the benefit of the treatment should clearly outweigh the risk. Treatment-related complications may occur, however, presenting either soon after the intervention or remote from it. In this review, the focus is on imaging findings of surgical materials used in abdominal surgery, and of a wide array of implanted abdominal devices. The pertinent complications of these devices and of retained surgical objects are highlighted and illustrated.
Collapse
Affiliation(s)
- Gabriela Gayer
- Department of Radiology, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, 2 Derech Sheba, Ramat-Gan 52621, Israel; Department of Radiology, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94304, USA.
| | - Meghan G Lubner
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, 600 Highland Avenue, Madison, WI 53792-3252, USA
| | - Sanjeev Bhalla
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway, St Louis, MO 63110, USA
| | - Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine & Public Health, 600 Highland Avenue, Madison, WI 53792-3252, USA
| |
Collapse
|
9
|
Mehta RI, Mehta RI, Choi JM, Mukherjee A, Castellani RJ. Hydrophilic polymer embolism and associated vasculopathy of the lung: prevalence in a retrospective autopsy study. Hum Pathol 2014; 46:191-201. [PMID: 25543660 DOI: 10.1016/j.humpath.2014.09.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 09/17/2014] [Accepted: 09/24/2014] [Indexed: 01/12/2023]
Abstract
Hydrophilic polymers are commonly applied as surface coatings on vascular devices and have been shown to dissociate during endovascular use, causing hydrophilic polymer embolism (HPE). Adverse effects related to this phenomenon have been recognized and reported. The prevalence of this complication is unknown. We conducted a retrospective study to determine the prevalence of HPE among hospital autopsies over a 29-month period. Postmortem tissue was histologically evaluated for the presence, location(s) and extent of HPE. HPE findings were correlated with documented clinical and laboratory data and patient outcome. Of 136 hospital autopsies examined, 18 (13%) showed evidence of HPE involving the lungs (n = 18), heart (n = 1) or central nervous system (n = 1). Localized pulmonary HPE was seen in 12 patients (9%). Multifocal pulmonary HPE was found in 6 patients (4%) and was associated with clinical vasculitis (33%; P < .0001), suspected pulmonary ischemia (50%; P = .008), coagulopathy (67%; P = .002), and constitutional disease (83%; P = .01). Within affected lung, associated histopathologic changes included occlusive intravascular or perivascular inflammation (89%), intravascular fibrous response (56%), microthrombus formation (44%), vasculitis (28%), and/or pulmonary microinfarction (28%). Statistically significant differences in hospital days (P = .008) and number of vascular interventions (P = .01) were noted between affected and unaffected patients. We conclude that HPE is an underdiagnosed phenomenon with primary involvement of the lungs, where secondary vascular changes are common. Additional studies may be needed to clarify risks and to identify preventative strategies for this iatrogenic complication of catheterizations and "minimally invasive" endovascular techniques.
Collapse
Affiliation(s)
- Rupal I Mehta
- University of Maryland Medical Center, Department of Pathology, Baltimore, MD, 21201.
| | - Rashi I Mehta
- State University of New York Upstate Medical University, Department of Radiology, Syracuse, NY, 13210
| | - Julia M Choi
- University of Maryland Medical Center, Department of Pathology, Baltimore, MD, 21201
| | | | - Rudy J Castellani
- University of Maryland Medical Center, Department of Pathology, Baltimore, MD, 21201
| |
Collapse
|
10
|
Manser CN, Bauerfeind P, Gubler C. Iatrogenic Complications in Five Patients with Upper Gastrointestinal Bleeding due to Ambient Air: Case Series and Literature Review. Case Rep Gastroenterol 2012; 6:197-204. [PMID: 22649332 PMCID: PMC3362206 DOI: 10.1159/000338647] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Despite the increasing use of carbon dioxide for endoscopies during the last years, ambient air is still used. The amount of air depends on several factors such as examination time, presumable diameter of the endoscope channel and of course active use of air by the operator. Although endoscopic complications due to ambient air in the gastrointestinal (GI) tract are a rare observation and mostly described in the colon, we report five cases in the upper GI tract due to insufflating large amounts of air through the endoscopes. All 5 patients needed an emergency upper endoscopy for acute presumed upper GI bleeding. In two cases both esophageal variceal bleeding and ulcer bleeding were detected; the fifth case presented with a bleeding due to gastric cancer. Due to insufflation of inadequate amounts of air through the endoscope channel, all patients deteriorated in circulation and ventilation. Two rumenocenteses and consecutively three laparotomies had to be performed in three patients. In the other two, gastroscopies had to be stopped for an emergency computed tomography. All critical incidents were believed to be a consequence of a long-lasting examination with use of too much air. Therefore in emergency situations, endoscopies should be performed with either submersion, low air flow pumps or even better by the use of carbon dioxide.
Collapse
Affiliation(s)
- Christine N Manser
- Clinic of Gastroenterology and Hepatology, Department of Internal Medicine, University Hospital, Zurich, Switzerland
| | | | | |
Collapse
|
11
|
Jo DJ, Lee BJ, Sung JK, Yi JW. Development of postdural puncture headache following therapeutic acupuncture using a long acupuncture needle. J Korean Neurosurg Soc 2010; 47:140-2. [PMID: 20224715 DOI: 10.3340/jkns.2010.47.2.140] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2009] [Revised: 11/10/2009] [Accepted: 12/27/2009] [Indexed: 11/27/2022] Open
Abstract
Acupuncture appears to be a clinically effective treatment for acute and chronic pain. A considerable amount of research has been conducted to evaluate the role that acupuncture plays in pain suppression; however, few studies have been conducted to evaluate the side effects of the acupuncture procedure. This case report describes a suspected postdural puncture headache following acupuncture for lower back pain. Considering the high opening pressure, cerebrospinal fluid leakage, and the patient's history of acupuncture in the lower back area, our diagnosis was iatrogenic postdural puncture headache. Full relief of the headache was achieved after administration of an epidural blood patch.
Collapse
Affiliation(s)
- Dae-Jean Jo
- Department of Neurosurgery, East-West Neo Medical Center, Kyung Hee University School of Medicine, Seoul, Korea
| | | | | | | |
Collapse
|