臨床および医療症例レポート

Prophylaxis, a Greek term, means "to guard or avoid beforehand." The goal of antibiotic prophylaxis in paediatric urology is to prevent urinary tract infections (UTIs) in children who are at risk, such as those with hydroureteronephrosis and vesicoureteral reflux (VUR). Both benefits and risks of antibiotic prophylaxis for paediatric urologic diseases have been established. Antibiotic prophylaxis is at best unnecessary and at worst hazardous for all children with VUR, as well as those who have all degrees of hydronephrosis (HN) and hydroureteronephrosis. It is unknown whether prophylactic antibiotics will have a positive or negative effect on the body as it ages and develops. Over the last two decades, increased public and physician awareness of the truth of previous statements has resulted in a more selective approach to the use of prophylactic antibiotics. Although it was previously thought that most children with conditions such as VUR or hydronephrosis were at high risk of UTI and thus would benefit from continuous antibiotic prophylaxis (CAP), data from multiple studies has shown otherwise. The usage of prophylactic antibiotics has changed over the past 20 years as medical professionals and the general public have become more aware of the veracity of earlier claims. Contrary to what was previously believed, most children with diseases like VUR or hydronephrosis are not at high risk for UTIs and do not benefit from continuous antibiotic prophylaxis (CAP), according to evidence from numerous research.

The co-location of specialists in primary care has been suggested as a tactic to lower costs, inefficiencies, and fragmentation of treatment. In order to evaluate the effects of co-located speciality care models in primary care settings, a systematic review and meta-analysis were carried out. Methods: Ovid MEDLINE, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus were all searched during the month of February 2015. The bibliographies of the included studies were manually searched. The following outcomes in physically adjacent primary care specialties were included in randomised controlled trials (RCTs) and observational studies: patient satisfaction, provider satisfaction, health care access and use, clinical outcomes, and costs.

The success of immunotherapy in breast cancer care is limited to the triple negative subtype. There are no current recommendations for the use of checkpoint inhibitors in HER2 positive disease; although the tumor biology in HER2-positive breast cancer demonstrates that the immune system has a potentially substantial contribution to the therapeutic effects of trastuzumab. Our group is currently conducting an investigator initiated clinical trial of safety and clinical activity for atezolizumab (a PDL-1 inhibitor) added to standard of care paclitaxel, trastuzumab and pertuzumab for first line treatment of patients with metastatic HER2-positive breast cancer (NCT03125928, PI: LJ Goldstein, co-PI: E Obeid). Our case report demonstrates the successful use of immunotherapy (in this case, pembrolizumab) and trastuzumab in a patient with metastatic HER2-positive breast cancer with low PD-L1 positivity and a high tumor mutational burden seen on Caris testing. This case demonstrates clinical support for the use of this combination and illustrates the importance of continued research to better identify the role of immunotherapy in HER2-positive patients. We believe this report adds significant information to previously published data and alerts treating breast oncologists to such therapies, as the field awaits our and other clinical trials of immunotherapy in metastatic HER2-positive breast cancer.

Actinomycosis is a bacterial infection with chronic or subacute nature that is caused by anaerobic bacteria of Actinomyces species. Originally, it was considered a disease of fungal etiology. As of today, it is known that it is a bacterial disease caused by microorganisms that naturally live in the oral cavity, the final section of gastrointestinal tract, and in the female reproductive system. Actinomyces reveal their virulence only in the case of mucosal membrane disruption. Infection spreads through continuity in surrounding tissue forming extensive abscesses and fistulas producing yellow colored granules. The most common localizations for lesions caused by Actinomyces are the cervicofacial region, rib cage, abdominal cavity, and pelvis in women.

The subject of this case is actinomycosis in a 35 years old patient. Typical symptoms presented by patients with this disease are: fever, change in bowel habits, lack of appetite, abdominal pain, nausea and vomiting symptoms that are not very specific. What is more, in the preoperative diagnostic process, or even during surgery, actinomycosis is often confused with acute inflammatory or tumor lesions. In most cases, the diagnosis is made only after surgery after examination of histopathological sample.