Sternocleidomastoid flap for reconstruction of tongue small cell carcinoma: A case report

BACKGROUND

The management of tongue carcinoma is excision and radical neck dissection followed with reconstruction. This is a case report of a patient with tongue squamous cell carcinoma (SCC) who underwent the procedure with sternocleidomastoid (SCM) flap reconstruction.

CASE SUMMARY

A 52-year-old woman without smoking history complained tongue ulcer since 3 years ago. Based on the histopathological examination, the patient was diagnosed with T2N2M0 right tongue SCC and underwent wide excision of tumor; right mandibular; neck dissection and were reconstructed with SCM flap.

CONCLUSION

SCC of the tongue requires wide excision and dissection of the neck and mandible if infiltration into the surrounding lymph nodes has been found. The SCM flap reconstruction could be used post-surgery.

Malignant adnexal tumor of the skin on breast: A case report of apocrine carcinoma

INTRODUCTION

Malignant adnexal tumors of the skin (MATS) are a group of rare and varied tumors that lack standardized guidelines for their management. Apocrine carcinoma (AC) is a highly uncommon form of breast malignancy, contributing to less than 1 % of all female invasive breast carcinomas. AC has a similar microscopic growth pattern to invasive ductal carcinoma, which can result in early misdiagnosis.

PRESENTATION OF CASE

This report presents a case of a 67-year-old female with a lump in the superior lateral quadrant of her left breast for six years. Surgical therapy was performed with wide excision due to clinical operability, no significant involvement of the axillary lymph nodes, and without metatasis. During the operation, Wide excision of 1-2 cm free margin according to standard and local reconstruction flaps were performed, with berry packing for the identified lymph nodes.

DISCUSSION

The tumor was ER and PR negative, so hormonal treatment would be ineffective, assuming that this is an apocrine carcinoma of the breast. A metastatic work up was already done, and no metastasis was found. A mastectomy would appear to be a viable option.

CONCLUSION

It is important to perform a clinical reevaluation to provide optimal treatment for breast malignancy. Misdiagnosis can occur early. In this case, a surgical procedure involving wide excision was performed, and as of now, the patient has not reported any recurrence.

Review Terapi Bisfosfonat pada Pasien Kanker Payudara, Berapa Lamakah Diberikan?

Tujuan: Untuk mengetahui efektivitas, efek samping serta durasi yang optimal dalam pemberian bisfosfonat pada pasien kanker payudara. Metode: Pencarian komprehensif dilakukan pada database PubMed, Science Direct, dan CENTRAL dari tahun 2012 hingga 2022 yang dilakukan selama 10 tahun. Hasil: Tinjauan saat ini, yang termasuk tiga studi randomized controlled trials, yang melibatkan 7.162 kasus kanker payudara, menilai efek bisfosfonat pada risiko kanker payudara serta durasi penggunaan bisfosfonat. Ditemukan adanya pengurangan risiko kanker payudara dengan paparan bisfosfonat. Penggunaan bisfosfonat jangka pendek (<1 tahun)  tidak menyebabkan perubahan yang signifikan, sementara penurunan risiko kanker payudara yang signifikan sebesar 26% tercatat dengan penggunaan jangka panjang (>1 tahun). Efek perlindungan bisfosfonat ditunjukkan pada kanker payudara kontralateral. Simpulan: Tinjauan ini menunjukkan bahwa penggunaan bisfosfonat dikaitkan dengan penurunan risiko payudara kanker, termasuk kanker payudara kontralateral. Dibandingkan dengan jenis bisfosfonat lainnya, hanya etidronat yang menunjukkan signifikansi hubungan terbalik. Selain itu, penggunaan bisfosfonat jangka panjang (>1 tahun) lebih signifikan dalam mengecilkan risiko kanker payudara.

Clinical and Subtypes of Breast Cancer in Indonesia

Background: Breast cancer is still a global public health problem, especially in women and is the second leading cause of death after lung cancer. Indonesia is a country with a high incidence of breast among women. Methods: This study used a retrospective study of breast cancer patients registered at Division of Surgical Oncology in Indonesia. Information about demographic, clinical and pathological characteristics of patients for a period of 5 years (2014 to 2020) were collected and described. Results: Information for 1260 cases of breast cancer who underwent IHC examination with an average age of 53.73 years of patients, with the most age above 50 years (63.6%) were collected. On IHC examination, 58.6% positive estrogen receptors were found, positive progesterone receptors were 55.4%, Her2 was positive 37.7% and high Ki67 protein was 56.9%. The most common breast cancer subtypes were luminal B (43.2%), followed by luminal A (21.7%), TNBC (18.1%), and Her2 (17%), with the highest stages being IIIB (31.7%).Conclusions: The breast cancer was presented at higher stage, with more cases with estrogen or progesterone receptors are positive with low frequency of Her2 positivity and high in Ki67 protein expression.  

A Review and Current Update on Sentinel Lymph Node Biopsy of Breast Cancer

Sentinel lymph node biopsy (SLNB) has become the standard staging technique in the surgical treatment of breast cancer, replacing the older method of dissecting lymph nodes of the axilla. Several advantages like lowering of the morbidities that accompany the technique and being less invasive have given rise to a promising effect on life aspects of patients suffering from this morbidity. The procedure has evolved over the last few decades, but further studies are still needed to make improvements. Several aspects of the evolution of SLNB, such as the incorporation of the management in early cancer, the technique of lymphatic mapping, the accuracy of the technique, and its utility and evaluation in clinical response after neoadjuvant chemotherapy are discussed in this review.  

Management of Maxillofacial Fracture: Experience of Emergency and Trauma Acute Care Surgery Department of Sanglah General Hospital Denpasar Bali

BACKGROUND:

Maxillofacial fracture is one of the major trauma; the cases were increasing because of the high number of motorcycles in Bali. The goal of the treatment is proper positioning of the occlusion, and it depends on rapid diagnosis and proper treatment.

AIM:

This study aims to know the characteristics of the maxillofacial fracture patients in Sanglah General Hospital Denpasar Bali.

METHODS:

A retrospective study, based on medical record were concluded, samples taken in Sanglah General Hospital from January to June 2015. Total recorded patient were 35 patients. The data obtained include age, gender, type of the fractures, and operation management.

RESULTS:

The injury was more common in male compared to female (80% vs 20%). Age 20 to 40 years old were more common (48.57%), followed by the child to adolescent (aged 0 to 20 years old) were 31.43%, and adult to elderly (aged 40 to 60 years old) was 20%. The mandibular fracture was most common (51.43%), other fractures such as a zygomatic fracture (31.43%) and maxillary fracture (17.14%). Internal fixation was the gold standard of the treatment (65.71%), and the other was an arch bar (34.29%).

CONCLUSION:

Diagnosing the right injury to the facial bone is a key step in determining a treatment plan. Rapid diagnosis and proper treatment lead to good occlusion, both internal fixation and arch bar were an effective treatment. The importance of dealing with almost all maxillofacial fracture problems in the first surgery.

Combination of modified Sugiura technique and proximal splenorenal shunt for the management of portal vein thrombosis in noncirrhotic portal hypertension

Background: Noncirrhotic portal hypertension (NCPH) is a condition when a high hepatic venous pressure gradient with preserved liver functions and the absence of parenchymal dysfunction. NCPH with portal vein thrombosis (PVT) is a rare condition. Surgery aims to reduce portal vein flow and alter portal vein circulation. Case: A male, 59 years old, complained of blackish stool in the last 2 weeks and enlarged abdomen. Physical examination revealed anemia and melena with splenomegaly and ascites. Laboratory findings were anemia, normal hepatobiliary function, and no liver infection. Abdominal Doppler ultrasonography and contrast-enhanced abdominal computed tomography scan revealed ascites, splenomegaly, noncirrhotic liver, dilatation of portal vein, low portal vein peak velocity, and PVT. Esophagogastroduodenoscopy revealed esophageal varices grade 3 with a positive red color sign and cardia stomach varices. We performed a modified Sugiura technique through the left subcostal incision and proximal splenorenal shunt. The procedures of the modified Sugiura technique are splenectomy, devascularization, transection, and end-to-end anastomosis of the lower esophagus above the gastroesophageal junction, devascularization of the upper 2/3 of the lesser and greater curvatures of the stomach, and pyloroplasty. Portal circulation alteration used the proximal splenorenal shunt with end-to-side anastomosis of the splenic vein to left renal vein. At the one-year follow-up after surgery, his physical condition was better and there was no sign of complications. Conclusion: Devascularization procedure using a modified Sugiura technique is useful to treat and avoid rupture of esophageal varices. Portal circulation alteration using the proximal splenorenal shunt is a good choice. The treatment in NCPH utilizing the combination of modified Sugiura technique and the proximal splenorenal shunt is proper without complication.

Retrieval of Intravascular Fractured Fragment of Tunnelled Double Lumen Catheter in Hemodialysis Patient

BACKGROUND:

Intravascular fractured fragment of double lumen catheter with embolisation is a serious and rare complication. Another serious complication includes infection, thrombosis, arrhythmias, and pulmonary embolism. We report a successful surgical venous cut-down technique in the retrieval of an intravascular fractured fragment of tunnelled double lumen catheter in a hemodialysis patient.

CASE REPORT:

A 51-year-old female underwent hemodialysis through a tunnelled double lumen catheter and had her arterio-venous graft matured. During retrieval of tunnelled double lumen catheter procedure, the distal part of the catheter was fractured and slipped into the internal jugular vein. Chest radiograph revealed intravascular double lumen catheter extending from the distal part of the right internal jugular vein to right atrium. The procedure of foreign body retrieval was done the next day under general anaesthesia and C-Arm guidance using right internal jugular venous cut-down approach. A right-angle clamp was used to retrieve the fragment without any post-procedure complications.

CONCLUSION:

Intravascular fractured fragment of double lumen catheter is a dangerous situation as are all the intravascular foreign bodies. The choices of the technique for retrieval of the fractured fragment are varied. It depends on the type and site of a fractured fragment as well as the surgeon experiences.

An Intracerebral Penetration of Air Shotgun Pellet in Toddler: A Case without Neurological Sequelae

BACKGROUND

A non-powder firearm including air shotgun remains a significant source of injury to children. It causes severe damage and can involve the brain, eyes, heart, abdomen, and other body parts.

CASE REPORT

A toddler boy was accidentally shot by an air shotgun at the forehead, and there was no sign of neurological deficit, both before and after surgical removal of the pellet. Herein, we report a case of air shotgun pellet which penetrated a toddler's head from the forehead, all the way up to the occiput. Removal of the pellet was successfully performed without eliciting any neurological sequelae.

CONCLUSION

Air shotgun pellet may potentially cause severe injury to the central nervous system when the head is affected, which can be safely prevented by a prompt but deliberate surgical removal. The study would also like to emphasise the importance of education to reduce gunshot incidence in the pediatric population.

Prevalence of dysfunction in sensory integration in kindergarten children

Background Children with dysfunction in sensory integration(DSI) have difficulty effectively and efficiently interacting withtheir environment. It has been estimated that 5 to 10% ofchildrenwithout disabilities have DSI. Late assessment and interventionin children with this problem may significantly impact furtherdevelopment. To date, there is no available data on DSI prevalencein Indonesian children, which is crucial for better understandingof the DSI burden in the community.Objective To estimate the prevalence of DSI in North Jakartachildren using standardized screening tools.Methods Parents of kindergarten children from two privateschools in N orth Jakarta were given questionnaire packetsincluding the Family Information Questionnaire and Winnie Dunn'sShort Sensory Profile (SSP) to assess demographic data and parents'perceptions of their children with regards to DSI.Results Of 264 questionnaire packets distributed, 117 packetswere returned (44.3%). Most children were of Chinese ethnicityand aged 3 to 5 years. Of the 117 children, 49 children ( 41.9%)met the criteria for DSI (definite difference), 33 children (28.2%)were in the probable difference category for DSI, and 35 children(29.9%) were in the category of typical performance. The scores forthe parameters of under-responsive and visual/auditory sensitivitywere the most commonly observed in subjects in the definitedifference category. From all questionnaire packets, a total of18.56% of children in selected kindergartens in North Jakartamet the screening criteria for DSI, while an additional 12.5%were likely to have the disorder.Conclusion Based on parental reports, we find that 18.56% ofchildren from two private kindergartens in North Jakarta hadDSI, while an additional 12.5% are likely to have the disorder.

Quality of life people living with HIV/AIDS: outpatient in Kramat 128 Hospital Jakarta

AIM

to provide an overview of the quality of life (OQL) for people living with HIV/AIDS (PLWHA) in Jakarta, particularly in the Kramat 128 Hospital, based on CD4 and viral load (VL) levels and the length of antiretroviral (ARV) treatment.

METHODS

a cross-sectional study performed at Kramat 128 Hospital Jakarta Outpatient Clinic from November 2010 to January 2011. Quality of life was assessed with the WHOQOL-BREF instrument. The data were analyzed using Chi-Square test, independent T-test, and One-Way Analysis of Variance (ANOVA) test.

RESULTS

the mean score in four domains of QOL in descending order were psychological (72.27), physical health (70.10), environment (65.59), and social relationships (64.44). There were a significant differences in overall QOL (p=0.000) and general health (p=0.001) between lower and higher CD4 levels. Patients who were interviewed look healthy physically and psychologically, have a good QOL based on statistical analysis. Patients with undetectable VL levels had better in general health (p=0.012), and those with longer ARV therapy (>1 year) had better overall QOL (p=0.024) and general health (p=0.003). Analysis with four domains of QOL showed a significant relationship of CD4 levels with the physical health (p=0.001) and psychological domain (p=0.043). VL levels showed significant relationships with the four domains of QOL (p<0.05). Duration of ARV therapy showed a significant association only with physical health domain (p=0.015).

CONCLUSION

higher CD4 levels, undetectable VL, and longer ARV therapy will increase patient's QOL. Higher QOL will make the patient have ability to cope with illness. So, a better QOL can be taken as indicator of successful ARV treatment.