Surgical outcomes after performing a lymph node dissection in locally advanced RCC: A retrospective analysis There is still controversy whether to perform a lymph node dissection (LND) in patients with locally advanced renal cell carcinoma (RCC) due to limited available literature which failed to demonstrate an overall survival benefit. In case of uncertain benefit, safety should be assessed to be able to make a recommendation. A retrospective analysis was performed in patients with locally advanced RCC who received a radical nephrectomy (RN) with or without LND between 2010 and 2020 at Ghent University Hospital. 17 patients (15%) experienced a high-grade postoperative complication (need for re-intervention, intensive care or death). Performing a LND was associated with a significantly higher risk of high-grade postoperative complications (26% vs 9% without lymph node dissection, p=0.028).
Carpal tunnel syndrome: an atypical presentation In this report, we present a case of distinct dermatological lesions in a patient with a new diagnosis of polymyalgia rheumatica (PMR) who developed a bilateral carpal tunnel syndrome (CTS). There are rare reports of dermatological signs of CTS in literature with inconclusive pathogenic theories. The unique aspect of this patient is hyperhidrosis and vasomotor reactions of the skin localized to one particular area: the innervation area of the palmar cutaneous branch of the median nerve (PCBm). The PCBm travels partially through the carpal tunnel, and then crosses the retinaculum to the surface. Additionally, up to 56% of patients with CTS have abnormal sensory conduction of the PCBm. Electromyography was performed, showing a bilateral CTS, and also a significant delay in the sensory nerve conduction of the PCBm. To our knowledge, this is the first report of involvement of the PCBm causing dermatological signs associated with CTS.
Increasing virilization in a postmenopausal woman with negative imaging: case report Hirsutism during menopause is a common complaint caused by physiological hormonal changes. In cases of virilization characterized by severe hirsutism, male-pattern alopecia, a deepened voice, or clitoromegaly, further diagnostic evaluation is essential to exclude an underlying cause of severe hyperandrogenism. Such symptoms may be associated with various pathologies, including endocrinological disorders, adrenal tumors, or ovarian tumors. This case discusses a 62-year-old patient with progressive symptoms of virilization. The diagnostic approach included a comprehensive medical history, physical examination, biochemical testing, and medical imaging. Despite this thorough evaluation, the exact cause initially remained unclear. Ultimately, with the assistance of interventional radiology, a testosterone-producing ovarian tumor was identified. Surgical intervention followed, and the final diagnosis was confirmed through histopathological examination. This case highlights how a common complaint, such as hirsutism during menopause, may occasionally require further investigation. Based on existing literature, a distinction is made between physiological causes of hirsutism and serious pathologies requiring additional diagnostics. This article provides a guide for the systematic approach to similar cases in clinical practice.
Paraneoplastic dermatoses as initial presentation of multiple myeloma A 70-year-old woman presents with painful annular, papular to edematous erythematous lesions on the chin, neck, chest, and upper back. A skin biopsy shows a dense neutrophilic infiltrate in the dermis, consistent with Sweet's syndrome. In the following weeks, the clinical picture evolves into erythema gyratum repens, a rare paraneoplastic entity. Biochemical analysis reveals inflammatory markers with elevated sedimentation rate and the presence of a monoclonal spike. Further hematological examination leads to the diagnosis of multiple myeloma with osteolytic bone lesions, preserved renal function and absence of hypercalcemia. Treatment with daratumumab, lenalidomide and dexamethasone is initiated. Two months after starting treatment, the patient presents with rapidly growing nodules on the scalp. A biopsy confirms the presence of plasmocytomas, an extramedullar manifestation of multiple myeloma, for which radiotherapy is initiated. This case illustrates how paraneoplastic phenomena, specifically Sweet’s syndrome and erythema gyratum repens, can lead to the diagnosis of an internal malignancy. Paraneoplastic dermatoses are rare, yet timely recognition is essential for detecting an underlying malignancy. This article summarizes the available literature on cutaneous paraneoplastic phenomena in multiple myeloma.
Orbital cellulitis of dental origin: a case report Introduction: Dental infection is a rare cause of orbital cellulitis, but it can occur with potentially hazardous complications, such as blindness and sinus cavernosus thrombosis. Urgent diagnostics and treatment are crucial in preventing irreversible damage. Case presentation: A 59-year-old man presented to the emergency department with an orbital compartment syndrome and loss of vision due to orbital cellulitis, originating from a decayed upper molar. After fast and multiple surgical interventions, vision was restored. Discussion: Patients with orbital cellulitis should be checked for dental problems or recent dental procedures, as toothache is not consistently present. Odontogenic infections can spread in various ways to the orbit. Sole use of antibiotics is often insufficient to treat orbital cellulitis. Our case demonstrates that urgent (<24 h) surgical drainage is necessary to safeguard vision. Conclusion: Orbital cellulitis is a rare complication of a dental infection, but should not be missed. Adequate diagnostics with radiography are essential in determining the extent of the cellulitis. Both antimicrobial therapy and urgent surgical drainage are often needed to prevent major sequelae. Extraction of the causal tooth is necessary.
PML in an immunocompetent patient: diagnostic challenges and multidisciplinary approach Progressive multifocal leukoencephalopathy (PML) is a rare demyelinating disease of the central nervous system caused by an opportunistic infection with the JC virus (JCV – John Cunningham virus – Human polyomavirus 2). This virus affects oligodendrocytes, the cells responsible for producing and maintaining myelin in the brain. PML typically affects immunocompromised patients, such as those with HIV/AIDS, lymphoproliferative malignancies, or patients undergoing immunosuppressive therapies following organ transplantation or with autoimmune diseases. The clinical presentation of PML is highly variable and can manifest with symptoms such as speech disorders, visual problems, motor weakness, and cognitive decline. Diagnosing PML is complex and requires a combination of imaging, such as MRI, and laboratory tests, such as PCR for JC virus DNA on cerebrospinal fluid (CSF). Typical MRI findings include multifocal, asymmetrical white matter lesions without contrast enhancement. Histopathological examination can aid in doubtful cases, revealing characteristic changes in oligodendrocytes and astrocytes, as well as the presence of JC virus. The diagnosis is particularly challenging in immunocompetent patients, in whom PML is extremely rare. This case describes a 91-year-old man with rapidly progressive cognitive decline and focal neurological deficits, initially suspected of having an ischemic cerebrovascular accident or a tumoral process, but ultimately diagnosed with PML. This case highlights the diagnostic challenges and underscores the importance of a multidisciplinary approach, especially given the presentation in an apparently immunocompetent patient.
Monitoring anticholinergic effects in pharmacotherapy: an evaluation of information sources Objective: This study focused on information sources accessible to healthcare providers for assessing the anticholinergic burden. It aims to raise awareness about anticholinergic effects and their potential impact on the health of elderly patients. Methodology: The methodology involved a literature review, a detailed analysis of leaflets, a comparison of anticholinergic risk scales, and an evaluation of the most widely used interaction software in Belgian community pharmacies. Results and discussion: This evaluation confirms both the usefulness and the variability and limitations of the available information sources. Leaflets are not standardized, making it difficult to find relevant information. Anticholinergic risk scales are heterogeneous, have diverse inclusion criteria, and lack extensive clinical validation. Additionally, interaction software has significant limitations and often fails to recognize the cumulative effects of anticholinergic medications. Conclusion: Pharmaceutical care for patients can be enhanced by using various information sources on anticholinergic burden, provided that healthcare professionals have a thorough understanding of each source’s strengths and weaknesses.
Integrated care: evolution or illusion? Integrated care is gaining importance, but how should hospitals respond—or should they at all? Rising healthcare complexity, shorter hospital stays, and the expanding role of primary care are forcing hospitals to redefine their position within the healthcare landscape. They can no longer function as isolated entities but must evolve into active players within a broader care network. This requires close collaboration across disciplines and care levels, with a strong focus on case management as a connecting link. Without fundamental reforms, integrated care remains a theoretical ideal. Structural integration of case management, supported by sustainable financing and efficient data exchange, is essential to foster collaboration and reduce fragmentation. The question is not whether integrated care is necessary, but how we can break down the barriers that still hinder this transition.
The willingness of Belgian women to donate enucleated eggs to prevent mitochondrial disorders and infertility This study wanted to find out whether Belgian women would be willing to donate enucleated eggs. To this end, an online survey was conducted in 2022 among a representative sample of 1000 women in Belgium between the ages of 18 and 50. There was no statistically significant difference between the willingness to donate enucleated eggs and whole eggs (anonymous or identifiable). However, anonymity did affect willingness to donate, with significantly fewer women willing to donate identifiably. Respondents were divided on their parental status if they were to donate enucleated eggs, with less than half (44%) not considering themselves a genetic mother. Women who were willing to donate anonymously enucleated eggs were significantly less likely to see themselves as a genetic mother of the child compared to the others. Fewer than 1 in 5 women found the technique unacceptable because the resulting child would carry genetic material from three people. Women in the general population did not show a greater willingness to donate enucleated eggs than whole eggs. The fact that respondents were sharply divided on whether or not they would consider themselves a genetic mother of the resulting child may explain this result. Other factors, such as the possible higher health risk for the child, may also have contributed to a lower willingness.
Severe hyperglycemia with enfortumab vedotin: a case report and literature review Introduction: Guidelines recommend enfortumab vedotin as therapy for patients with locally advanced or metastatic urothelial cell carcinoma (UCC) combined with pembrolizumab in first line or as monotherapy in third line. Enfortumab vedotin is an antibody drug conjugate (ADC) directed against nectin-4, a transmembrane protein highly expressed in malignant urothelial cells. Case description: A 62-year-old man, known with a locally advanced UCC and obesity (BMI 36.2 kg/m2), was hospitalised with complaints of vomiting and diarrhea. We report severe hyperglycemia after two administrations of enfortumab vedotin, requiring up to 600 units of intravenous insulin per day. The course was complicated with acute renal failure and development of circulatory shock, with suspicion of septic shock. The patient died on day 4 after initiation of palliative sedation. Discussion: A literature review revealed 16 case reports of enfortumab vedotin – associated hyperglycemia. The underlying mechanism is severe insulin resistance, as evidenced by the massive insulin requirement and the measurement of increased C-peptide. Vedotin (monomethyl auristatin E, MMAE) is suspected to be the causal agent as the complication was also observed with other ADC with MMAE as payload. The mortality rate is high, but the complication is reversible if the patient can clear the medication. Conclusion: Hyperglycemia as a side effect of enfortumab vedotin occurs frequently, with the possibility of rapid deterioration to refractory diabetic ketoacidosis based on severe insulin resistance. Additional studies are necessary to better understand the pathophysiology and to more safely support therapy with enfortumab vedotin.
Retinoids as a plausible cause of aberrant bone formation A 71-year-old man presents with progressive pain and stiffness, both in axial and peripheral skeleton over a period of 6 months. Although this patient had previously been diagnosed with psoriasis, he had never exhibited such musculoskeletal symptoms in the past. Imaging reveals bilateral ossifications in the forearms and the right femur. Based on clinical findings and imaging, fibrodysplasia ossificans progressiva (FOP) is initially considered, despite the atypical age of onset. Nevertheless, literature research reveals that the most probable cause of skeletal aberrations is the chronic use of retinoids, prescribed as treatment for psoriasis. Although the symptoms of progressive stiffness and pain disappear by withdrawal of medication, residual functional impairment remains due to irreversible ossification.
Never too busy again: how to manage time effectively and efficiently as a healthcare professional This article discusses the challenges of time management in medical practice, focusing on the balance between efficiency and effectiveness. It examines six common pitfalls in time management, including unclear priorities, procrastination, and multitasking. Through techniques such as the Eisenhower matrix model, the RACI model of delegation, and the principles of lean management, doctors can better manage their time and reduce stress. The article further provides practical solutions, such as setting clear boundaries, rejecting tasks that do not contribute to core responsibilities, and fostering calm and focus by consciously handling work processes. These methods aim to improve doctors' personal effectiveness, allowing them not only to work more efficiently but also to achieve a healthier work-life balance.
